Evaluation of detector dynamic range in the x-ray exposure domain in mammography: a comparison between film-screen and flat panel detector systems

Patient doses from screen-film and full-field digital mammography in a population-based screening programme

The aim of this study was to compare mean glandular dose (MGD) in all full-field digital mammography (FFDM) and screen film mammography (SFM) systems used in a national mammography screening program. MGD from 31 screening units (7 FFDM and 24 SFM), based on an average of 50 women at each screening unit, representing 12 X-ray models (6 FFDM and 6 SFM) from five different manufacturers were calculated. The MGD was significantly lower for FFDM compared with SFM (craniocaudal): 1.19 versus 1.27 mGy, respectively, mediolateral oblique: 1.33 versus 1.45 mGy, respectively), but not all of the FFDM units provided lower doses than the SFM units. Comparing FFDMs, the photon counting scanning-slit technology provides significantly lower MGDs than direct and indirect conversion digital technology. The choice of target/filter combination influences the MGD, and has to be optimised with regard to breast thickness.

Effects of exposure equalization on image signal-to-noise ratios in digital mammography: a simulation study with an anthropomorphic breast phantom

PURPOSE

The scan equalization digital mammography (SEDM) technique combines slot scanning and exposure equalization to improve low-contrast performance of digital mammography in dense tissue areas. In this study, full-field digital mammography (FFDM) images of an anthropomorphic breast phantom acquired with an anti-scatter grid at various exposure levels were superimposed to simulate SEDM images and investigate the improvement of low-contrast performance as quantified by primary signal-to-noise ratios (PSNRs).

METHODS

We imaged an anthropomorphic breast phantom (Gammex 169 "Rachel," Gammex RMI, Middleton, WI) at various exposure levels using a FFDM system (Senographe 2000D, GE Medical Systems, Milwaukee, WI). The exposure equalization factors were computed based on a standard FFDM image acquired in the automatic exposure control (AEC) mode. The equalized image was simulated and constructed by superimposing a selected set of FFDM images acquired at 2, 1, 1/2, 1/4, 1/8, 1/16, and 1/32 times of exposure levels to the standard AEC timed technique (125 mAs) using the equalization factors computed for each region. Finally, the equalized image was renormalized regionally with the exposure equalization factors to result in an appearance similar to that with standard digital mammography. Two sets of FFDM images were acquired to allow for two identically, but independently, formed equalized images to be subtracted from each other to estimate the noise levels. Similarly, two identically but independently acquired standard FFDM images were subtracted to estimate the noise levels. Corrections were applied to remove the excess system noise accumulated during image superimposition in forming the equalized image. PSNRs over the compressed area of breast phantom were computed and used to quantitatively study the effects of exposure equalization on low-contrast performance in digital mammography.

RESULTS

We found that the highest achievable PSNR improvement factor was 1.89 for the anthropomorphic breast phantom used in this study. The overall PSNRs were measured to be 79.6 for the FFDM imaging and 107.6 for the simulated SEDM imaging on average in the compressed area of breast phantom, resulting in an average improvement of PSNR by ∼35% with exposure equalization. We also found that the PSNRs appeared to be largely uniform with exposure equalization, and the standard deviations of PSNRs were estimated to be 10.3 and 7.9 for the FFDM imaging and the simulated SEDM imaging, respectively. The average glandular dose for SEDM was estimated to be 212.5 mrad, ∼34% lower than that of standard AEC-timed FFDM (323.8 mrad) as a result of exposure equalization for the entire breast phantom.

CONCLUSIONS

Exposure equalization was found to substantially improve image PSNRs in dense tissue regions and result in more uniform image PSNRs. This improvement may lead to better low-contrast performance in detecting and visualizing soft tissue masses and micro-calcifications in dense tissue areas for breast imaging tasks.

Comparison of full field digital (FFD) and computed radiography (CR) mammography systems in Greece

The purpose of this study is to evaluate and compare the performance of 52 full field digital (FFD) and computed radiography (CR) mammography systems checked by the Greek Atomic Energy Commission with respect to dose and image quality. Entrance surface air kerma (ESAK) was measured and average glandular dose (AGD) was calculated according to the European protocol on dosimetry in mammography. The exposures were performed using the clinical protocol of each laboratory. The image quality was assessed by the total score of resolved phantom structures incorporated in an American College of Radiology accreditation phantom. The mean ESAK values for FFD and CR systems were 4.59 ± 1.93 and 5.0 ± 1.78 mGy, respectively, whereas the AGD yielded a mean value of 1.06 ± 0.36 mGy for the FFD and 1.04 ± 0.35 mGy for the CR systems. Considering image quality, FFD systems indicated a mean total score of 13.04 ± 0.89, whereas CR systems a mean total score of 11.54 ± 1.06.

Signal and noise transfer properties of CMOS based active pixel flat panel imager coupled to structured CsI:Tl

Complementary metal-oxide-semiconductors (CMOS) active pixel sensors can be optically coupled to CsI:Tl phosphors forming a indirect active pixel flat panel imager (APFPI) for high performance medical imaging. The aim of this work is to determine the x-ray imaging capabilities of CMOS-based APFPI and study the signal and noise transfer properties of CsI:Tl phosphors. Three different CsI:Tl phosphors from two different vendors have been used to produce three system configurations. The performance of each system configuration has been studied in terms of the modulation transfer function (MTF), noise power spectra, and detective quantum efficiency (DQE) in the mammographic energy range. A simple method to determine quantum limited systems in this energy range is also presented. In addition, with aid of monochromatic synchrotron radiation, the effect of iodine characteristic x-rays of the CsI:Tl on the MTF has been determined. A Monte Carlo simulation of the signal transfer properties of the imager is also presented in order to study the stages that degrade the spatial resolution of our current system. The effect of using substrate patterning during the growth of CsI:Tl columnar structure was also studied, along with the effect of CsI:Tl fixed pattern noise due to local variations in the scintillation light. CsI:Tl fixed pattern noise appears to limit the performance of our current system configurations. All the system configurations are quantum limited at 0.23 microC/kg with two of them having DQE (0) equal to 0.57. Active pixel flat panel imagers are shown to be digital x-ray imagers with almost constant DQE throughout a significant part of their dynamic range and in particular at very low exposures.

Physical characteristics of GE Senographe Essential and DS digital mammography detectors

The purpose of this study was to investigate physical characteristics of two full field digital mammography (FFDM) systems (GE Senographe Essential and DS). Both are indirect conversion (x ray to light) alpha-Si flat panels coupled with a CsI(Tl) scintillator. The examined systems have the same pixel size (100 microm) but a different field of view: a conventional size 23 x 19.2 cm2 and a large field 24 X 30.7 cm2, specifically designed to image large breasts. In the GE Senographe Essential model relevant improvements in flat panel design were implemented and new deposition tools for metal, alpha-Si, and CsI(Tl) were introduced by GE. These changes in detector design are expected to be beneficial for advanced applications such as breast tomosynthesis. The presampling modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE) were measured for a wide range of exposure (25-240 microGy) with a RQA-M2 technique (28 kVp with a Mo/Mo target/filter combination and 2 mm of additional aluminum filtration). At 1, 2, and at 4 lp/mm MTF is equal to 0.9, 0.76, and 0.46 for the conventional field detector and to 0.85, 0.59, and 0.24 for the large field detector. The latter detector exhibits an improved NNPS due to a lower electronic noise and a better DQE that reaches 60%. In addition a contrast-detail analysis was performed with CDMAM 3.4 phantom and CDCOM software: GE Senographe DS showed statistically significant poorer detection ability in comparison with the GE Senographe Essential. These results could have been expected, at least qualitatively, considering the relative DQE of the two systems.

Effective x-ray attenuation coefficient measurements from two full field digital mammography systems for data calibration applications

Background

Breast density is a significant breast cancer risk factor. Currently, there is no standard method for measuring this important factor. Work presented here represents an essential component of an ongoing project that seeks to determine the appropriate method for calibrating (standardizing) mammography image data to account for the x-ray image acquisition influences. Longer term goals of this project are to make accurate breast density measurements in support of risk studies.

Methods

Logarithmic response calibration curves and effective x-ray attenuation coefficients were measured from two full field digital mammography (FFDM) systems with breast tissue equivalent phantom imaging and compared. Normalization methods were studied to assess the possibility of reducing the amount of calibration data collection. The percent glandular calibration map functional form was investigated. Spatial variations in the calibration data were used to assess the uncertainty in the calibration application by applying error propagation analyses.

Results

Logarithmic response curves are well approximated as linear. Measured effective x-ray attenuation coefficients are characteristic quantities independent of the imaging system and are in agreement with those predicted numerically. Calibration data collection can be reduced by applying a simple normalization technique. The calibration map is well approximated as linear. Intrasystem calibration variation was on the order of four percent, which was approximately half of the intersystem variation.

Conclusion

FFDM systems provide a quantitative output, and the calibration quantities presented here may be used for data acquired on similar FFDM systems.

A comparison of the performance of digital mammography systems

An objective analysis of image quality parameters was performed for six digital mammography systems. The presampled modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE) for the systems were determined at different doses, for 28 kVp with a Mo/Mo or W/Al target/filter combination and 2 mm of additional aluminium filtration. The flat-panel units have higher MTF and DQE in the mid to high frequency range than standard CR systems. The highest DQE, over the whole dose range, is for the slit-scanning direct photon counting system. Dual-side read CR can overcome the inherent x-ray absorption and signal collection limitations of standard CR mammography, improving the low-frequency DQE by 40%, to the same level as full-field systems, but it does not improve the poor spatial resolution of phosphor.

Effective x-ray attenuation measurements with full field digital mammography

This work shows that effective x-ray attenuation coefficients may be estimated by applying Beer's Law to phantom image data acquired with the General Electric Senographe 2000D full field digital mammography system. Theoretical developments are provided indicating that an approximate form of the Beer's relation holds for polychromatic x-ray beams. The theoretical values were compared with experimentally determined measured values, which were estimated at various detector locations. The measured effective attenuation coefficients are in agreement with those estimated with theoretical developments and numerical integration. The work shows that the measured quantities show little spatial variation. The main ideas are demonstrated with polymethylmethacrylate and breast tissue equivalent phantom imaging experiments. The work suggests that the effective attenuation coefficients may be used as known values for radiometric standardization applications that compensate for the image acquisition influences. The work indicates that it is possible to make quantitative attenuation coefficient measurements from a system designed for clinical purposes.

Evaluation of dual-energy subtraction of digital mammography images under conditions found in a commercial unit

Radiological contrast-to-noise ratio (CNR) is evaluated in subtracted images of microcalcifications in breast tissue. CNR is calculated for dual-kVp subtraction combining beams available in a Senographe 2000D, assuming single breast compression. Spectra were obtained from Boone et al (1997 Med. Phys. 24 1863-73), and the study was limited to lowest 25 kV Mo/Mo and highest 40 kV Rh/Rh beams, for 2.58 x 10(-4) C kg(-1) (1R) total exposure. For a standard case combining 25 kVp Mo/Mo and 40 kVp Rh/Rh beams, predicted maximum CNR for 300 microm calcification in 5 cm thick, 50% glandular, breast is about 1.2, below Rose's criterion for visualization. Total mean glandular doses are about 2.5 cGy for a standard case. The effect that input factors might have on predictions has been evaluated. Choice between alternative spectra can affect CNR by 50%. Assumed calcification composition leads to differences of 67% in calculated CNR, and assumed breast tissue composition can alter CNR by 45%; these results are weakly dependent on calcification or breast thickness, or on the assumed fraction of glandular tissue. CNR values are related to detected spectra effective energy. Calculations predict that above 37 kVp Mo/Mo beams are more energetic than Rh/Rh at the same kVp, due to beam hardening.

A comparison of the performance of modern screen-film and digital mammography systems

This work compares the detector performance and image quality of the new Kodak Min-R EV mammography screen-film system with the Fuji CR Profect detector and with other current mammography screen-film systems from Agfa, Fuji and Kodak. Basic image quality parameters (MTF, NPS, NEQ and DQE) were evaluated for a 28 kV Mo/Mo (HVL = 0.646 mm Al) beam using different mAs exposure settings. Compared with other screen-film systems, the new Kodak Min-R EV detector has the highest contrast and a low intrinsic noise level, giving better NEQ and DQE results, especially at high optical density. Thus, the properties of the new mammography film approach those of a fine mammography detector, especially at low frequency range. Screen-film systems provide the best resolution. The presampling MTF of the digital detector has a value of 15% at the Nyquist frequency and, due to the spread size of the laser beam, the use of a smaller pixel size would not permit a significant improvement of the detector resolution. The dual collection reading technology increases significantly the low frequency DQE of the Fuji CR system that can at present compete with the most efficient mammography screen-film systems.

Are phantoms useful for predicting the potential of dose reduction in full-field digital mammography?

A phantom study was performed in full-field digital mammography to investigate the opportunity and the magnitude of a possible dose reduction that would leave the image quality above the accepted thresholds associated with some classical phantoms. This preliminary work is intended to lay the groundwork for a future clinical study on the impact of dose reduction on clinical results. Three different mammography phantoms (ACR RMI 156, CIRS 11A and CDMAM 3.4) were imaged by a full-field digital mammography unit (GE Senographe 2000D) at different dose levels. Images were rated by three observers with softcopy reading and scoring methods specific to each phantom. Different types of data analysis were applied to the ACR (American College of Radiology) and the other two phantoms, respectively. With reference to the minimum acceptance score in screen/film accreditation programmes, the ACR phantom showed that about 45% dose reduction could be applied, while keeping the phantom scores above that threshold. A relative comparison was done for CIRS and CDMAM, for which no threshold is defined. CIRS scoring remained close to the reference level down to 40% dose reduction, the inter- and intra-observer variability being the main source of uncertainty. Contrast-detail curves provided by CDMAM overlapped down to 50% dose reduction, at least for object contrast values ranging between 30% and 3%. This multi-phantom study shows the potential of further reducing the dose in full-field digital mammography beyond the current values. A common dose reduction factor around 50% seems acceptable for all phantoms. However, caution is required before extrapolating the results for clinical use, given the limitations of these widely used phantoms, mainly related to their limited dynamic range and uniform background.

On the noise variance of a digital mammography system

A recent paper by Cooper et al. [Med. Phys. 30, 2614-2621 (2003)] contains some apparently anomalous results concerning the relationship between pixel variance and x-ray exposure for a digital mammography system. They found an unexpected peak in a display domain pixel variance plot as a function of 1/mAs (their Fig. 5) with a decrease in the range corresponding to high display data values, corresponding to low x-ray exposures. As they pointed out, if the detector response is linear in exposure and the transformation from raw to display data scales is logarithmic, then pixel variance should be a monotonically increasing function in the figure. They concluded that the total system transfer curve, between input exposure and display image data values, is not logarithmic over the full exposure range. They separated data analysis into two regions and plotted the logarithm of display image pixel variance as a function of the logarithm of the mAs used to produce the phantom images. They found a slope of minus one for high mAs values and concluded that the transfer function is logarithmic in this region. They found a slope of 0.6 for the low mAs region and concluded that the transfer curve was neither linear nor logarithmic for low exposure values. It is known that the digital mammography system investigated by Cooper et al. has a linear relationship between exposure and raw data values [Vedantham et al., Med. Phys. 27, 558-567 (2000)]. The purpose of this paper is to show that the variance effect found by Cooper et al. (their Fig. 5) arises because the transformation from the raw data scale (14 bits) to the display scale (12 bits), for the digital mammography system they investigated, is not logarithmic for raw data values less than about 300 (display data values greater than about 3300). At low raw data values the transformation is linear and prevents over-ranging of the display data scale. Parametric models for the two transformations will be presented. Results of pixel variance measurements made on raw data images will be presented. The experimental data are in good agreement with those of Cooper et al. It will be shown that the slope of 0.6 found by Cooper et al. for the log-log plot at low exposure is not due to transfer function nonlinearity, it occurs because of an additive variance term-possibly due to electronic noise. It will also be shown, using population statistics from clinical images, that raw data values below 300 are rare in tissue areas. Those tissue areas with very low raw data values are within about a millimeter of the chest wall or in very dense muscle at comers of images.

Digital mammography

Despite its technical advantages, early clinical trials comparing digital mammography with film mammography for screening have been somewhat disappointing. Digital mammography,however, is in its infancy and can be expected to improve more rapidly than film mammography. Some areas of improvement being observed now include the development of new detector technologies; more powerful and better-designed interpretation workstations; and novel advanced applications, such as tomosynthesis and contrast-enhanced mammography, which are not possible with standard film mammography.

Impact of resolution and noise characteristics of digital radiographic detectors on the detectability of lung nodules

One of the unanswered questions in digital radiography is the connection between physical image quality metrics and clinical detection performance. In this paper, we examine the impact of two physical metrics, resolution and noise, on the detectability of nodules in a pulmonary background for specific digital radiographic detectors. A detection experiment was performed on a simulated image set using anatomical backgrounds from a high-quality lung radiograph and three different simulated nodule sizes (2-3.5 mm). The resolution and noise of the resulting images were modified using existing routines to simulate a selenium-based and a cesium iodide-based flat-panel detector at comparable exposures. A location-known-exactly (LKE) observer performance experiment was performed in which four experienced chest radiologists and three physicists specializing in chest radiology scored the images. The data from the observer experiment were analyzed by receiver operating characteristic (ROC) methodology. The detectability, as measured by the parameter Az, was higher for the selenium detector than the cesium iodide detector for all nodule sizes by an average of 8.5%. For one nodule size (2.75 mm), the difference between detectors was statistically significant (p < 0.01). The findings indicate that for the particular task studied, the superior resolution performance of the selenium-based detector provided better detectability of subtle lung nodules even though the images had greater noise than images obtained with the cesium iodide detector.