A technique optimization protocol and the potential for dose reduction in digital mammography

Phantom-based analysis of variations in automatic exposure control across three mammography systems: implications for radiation dose and image quality in mammography, DBT, and CEM

BACKGROUND

Automatic exposure control (AEC) plays a crucial role in mammography by determining the exposure conditions needed to achieve specific image quality based on the absorption characteristics of compressed breasts. This study aimed to characterize the behavior of AEC for digital mammography (DM), digital breast tomosynthesis (DBT), and low-energy (LE) and high-energy (HE) acquisitions used in contrast-enhanced mammography (CEM) for three mammography systems from two manufacturers.

METHODS

Using phantoms simulating various breast thicknesses, 363 studies were acquired using all available AEC modes 165 DM, 132 DBT, and 66 LE-CEM and HE-CEM. AEC behaviors were compared across systems and modalities to assess the impact of different technical components and manufacturers' strategies on the resulting mean glandular doses (MGDs) and image quality metrics such as contrast-to-noise ratio (CNR).

RESULTS

For all systems and modalities, AEC increased MGD for increasing phantom thicknesses and decreased CNR. The median MGD values (interquartile ranges) were 1.135 mGy (0.772-1.668) for DM, 1.257 mGy (0.971-1.863) for DBT, 1.280 mGy (0.937-1.878) for LE-CEM, and 0.630 mGy (0.397-0.713) for HE-CEM. Medians CNRs were 14.2 (7.8-20.2) for DM, 4.91 (2.58-7.20) for a single projection in DBT, 11.9 (8.0-18.2) for LE-CEM, and 5.2 (3.6-9.2) for HE-CEM. AECs showed high repeatability, with variations lower than 5% for all modes in DM, DBT, and CEM.

CONCLUSIONS

The study revealed substantial differences in AEC behavior between systems, modalities, and AEC modes, influenced by technical components and manufacturers' strategies, with potential implications in radiation dose and image quality in clinical settings.

RELEVANCE STATEMENT

The study emphasized the central role of automatic exposure control in DM, DBT, and CEM acquisitions and the great variability in dose and image quality among manufacturers and between modalities. Caution is needed when generalizing conclusions about differences across mammography modalities.

KEY POINTS

• AEC plays a crucial role in DM, DBT, and CEM. • AEC determines the "optimal" exposure conditions needed to achieve specific image quality. • The study revealed substantial differences in AEC behavior, influenced by differences in technical components and strategies.

[Dose-reduction Efficiency by Breast Compression in Digital Mammography]

PURPOSE

Although breast compression has been an efficient practice to reduce the breast dose in mammography, there may be some differences between analog and digital systems. The purpose of this study was to evaluate the dose-reduction efficiency by breast compression in digital mammography under its own criterion that signal difference-to-noise ratio (SDNR) be kept at a certain value.

METHOD

By adopting SDNR as an image quality indicator and average glandular dose (AGD) as a dose indicator, we measured SDNR versus AGD relationship for each breast depth. Then by utilizing figure of merit (FOM), we calculated the breast depth that we had to reduce for halving the breast dose while keeping the SDNR.

RESULT

To halve the dose, 1.49 cm compression was necessary for 0% breast density, 1.25 cm for 50%, and 1.06 cm for 100%.

CONCLUSION

Through FOM analysis, we quantitatively revealed the dose-reduction efficiency by breast compression in digital mammography.

Low-dose whole-spine imaging using slot-scan digital radiography: a phantom study

BACKGROUND

Slot-scan digital radiography (SSDR) is equipped with detachable scatter grids and a variable copper filter. In this study, this function was used to obtain parameters for low-dose imaging for whole-spine imaging.

METHODS

With the scatter grid removed and the beam-hardening (BH) filters (0.0, 0.1, 0.2, or 0.3 mm) inserted, the tube voltage (80, 90, 100, 110, or 120 kV) and the exposure time were adjusted to 20 different parameters that produce equivalent image quality. Slot-scan radiographs of an acrylic phantom were acquired with the set parameters, and the optimal parameters (four types) for each filter were determined using the figure of merit. For the four types of parameters obtained in the previous section, SSDR was performed on whole-spine phantoms by varying the tube current, and the parameter with the lowest radiation dose was determined by visual evaluation.

RESULTS

The parameters for each filter according to the FOM results were 90 kV, 400 mA, and 2.8 ms for 0.0 mm thickness; 100 kV, 400 mA, and 2.0 ms for 0.1 mm thickness; 100 kV, 400 mA, and 2.8 ms for 0.2 mm thickness; and 110 kV, 400 mA, and 2.2 ms for 0.3 mm thickness. Visual evaluation of the varying tube currents was performed using these four parameters when the BH filter thicknesses were 0.0, 0.1, 0.2, and 0.3 mm. The entrance surface dose was 59.44 µGy at 90 kV, 125 mA, and 2.8 ms; 57.39 µGy at 100 kV, 250 mA, and 2.0 ms; 46.89 µGy at 100 kV, 250 mA, and 2.8 ms; and 39.48 µGy at 110 kV, 250 mA, and 2.2 ms, indicating that the 0.3-mm BH filter was associated with the minimum dose.

CONCLUSION

Whole-spine SSDR could reduce the dose by 79% while maintaining the image quality.

Use of Diagnostic Imaging Modalities in Modern Screening, Diagnostics and Management of Breast Tumours 1st Central-Eastern European Professional Consensus Statement on Breast Cancer

Breast radiologists and nuclear medicine specialists updated their previous recommendation/guidance at the 4th Hungarian Breast Cancer Consensus Conference in Kecskemét. A recommendation is hereby made that breast tumours should be screened, diagnosed and treated according to these guidelines. These professional guidelines include the latest technical developments and research findings, including the role of imaging methods in therapy and follow-up. It includes details on domestic development proposals and also addresses related areas (forensic medicine, media, regulations, reimbursement). The entire material has been agreed with the related medical disciplines.

Construction of mammographic examination process ontology using bottom-up hierarchical task analysis

Describing complex mammography examination processes is important for improving the quality of mammograms. It is often difficult for experienced radiologic technologists to explain the process because their techniques depend on their experience and intuition. In our previous study, we analyzed the process using a new bottom-up hierarchical task analysis and identified key components of the process. Leveraging the results of the previous study, the purpose of this study was to construct a mammographic examination process ontology to formally describe the relationships between the process and image evaluation criteria to improve the quality of mammograms. First, we identified and created root classes: task, plan, and clinical image evaluation (CIE). Second, we described an "is-a" relation referring to the result of the previous study and the structure of the CIE. Third, the procedural steps in the ontology were described using the new properties: "isPerformedBefore," "isPerformedAfter," and "isPerformedAfterIfNecessary." Finally, the relationships between tasks and CIEs were described using the "isAffectedBy" property to represent the influence of the process on image quality. In total, there were 219 classes in the ontology. By introducing new properties related to the process flow, a sophisticated mammography examination process could be visualized. In relationships between tasks and CIEs, it became clear that the tasks affecting the evaluation criteria related to positioning were greater in number than those for image quality. We developed a mammographic examination process ontology that makes knowledge explicit for a comprehensive mammography process. Our research will support education and help promote knowledge sharing about mammography examination expertise.

Optimization of the exposure parameters in digital mammography using contrast-detail metrics

PURPOSE

Optimization studies in digital mammography aid to assure the image quality and radiological protection of the patient. The aim of this work is to test effectiveness and applicability of a method based on a Figure of Merit (FOM=(IQF_inv)²/AGD) to improve all the exposure parameters (Target/Filter combination, kVp and mAs) in order to improve the image acquisition technique that will provide the best compromise between image quality and the average glandular dose (AGD).

METHODS

A contrast-detail analysis, employing the test object CDMAM, was carried out for the digital mammography unit manufactured by Lorad Hologic - model Selenia. We simulated two breast thicknesses using phantoms and a Figure of Merit as optimization tool, which includes an indicator of image quality, the IQF_inv and the average glandular dose. Images of the ACR and TORMAM phantoms were obtained with both, automatic and optimized exposure parameters. In order to compare the image quality, the SNR (Signal to Noise Ratio) was measured in each image.

RESULTS

In the two phantoms, for both 4.5 and 7.5cm thicknesses, the AGDs obtained with the optimized parameters show a reduction. In addition, the images obtained with the optimized exposure parameters, had the same or a better image quality when compared to the images obtained using the automatic mode.

CONCLUSIONS

The proposed optimization methodology proved to be an effective tool to improve the digital mammography unit, due to the use of objective metrics for evaluation and validation of the results.

ALTERNATIVE FIGURES-OF-MERIT IN DIGITAL MAMMOGRAPHY

The aim of this study is to explore the use of a quality (Q) factor in digital mammography as a figure-of-merit. Q factors take a reference value into account and can be compared to a theoretical value. They are also intended to summarise the performance of any unit based on a number. The mean glandular dose (MGD)-normalised Q factors were also introduced based on the relationship of the Q factors with MGD. Interestingly, the automatic exposure control exposures did not render the maximum normalised Q factor values as expected, which could indicate the need for further optimisation. It was also noted that the Q factors and the CDMAM-related quality parameters can be confidently predicted for a given MGD which in turn may be compared to the measured values. This might be another way to consider or perform optimisation in digital mammography.

Effect of exposure factors on image quality in screening mammography

INTRODUCTION

The aim of this research was to study the effect of exposure factors on image quality for digital screening mammography units in Kuwait which use Tungsten (W) targets with Rhodium (Rh) and Silver (Ag) as filters.

METHODS

Mammography Accreditation Phantom Model 015 was imaged using a Hologic Selenia Digital mammography unit with W targets and Rh and Ag filters. Four images, each at 26, 28, 30, and 32 kVp, were obtained using each target-filter combination (W/Rh and W/Ag). The images were evaluated by five senior technologists for the number of specks, fibers and masses visible on each image. Statistical analysis was carried out using non-parametric tests at p = 0.05 level.

RESULTS

There were significant changes in the visibility of fibers and specks between different kVp values with W/Rh (p < 0.001). However, with W/Ag combination, significant differences were observed in the fibers only (p < 0.001). Among the kVp values used, 28 kV emerged as the optimal value. Comparison of images obtained with the two filter materials, led to significant differences in the visibility of fibers and specks (p < 0.008). At 32 kVp, there were significant differences in the visibility of specks only (p < 0.008).

CONCLUSION

A W/Rh target-filter combination provides better image quality than that provided by W/Ag. In particular, 30 and 32 kVp X-ray beams produce higher quality images than the lower kV values.

Optimization of Image Quality and Dose in Digital Mammography

Nowadays, the optimization in digital mammography is one of the most important challenges in diagnostic radiology. The new digital technology has introduced additional elements to be considered in this scenario. A major goal of mammography is related to the detection of structures on the order of micrometers (μm) and the need to distinguish the different types of tissues, with very close density values. The diagnosis in mammography faces the difficulty that the breast tissues and pathological findings have very close linear attenuation coefficients within the energy range used in mammography. The aim of this study was to develop a methodology for optimizing exposure parameters of digital mammography based on a new Figure of Merit: FOM ≡ (IQFinv)2/AGD, considering the image quality and dose. The study was conducted using the digital mammography Senographe DS/GE, and CDMAM and TORMAM phantoms. The characterization of clinical practice, carried out in the mammography system under study, was performed considering different breast thicknesses, the technical parameters of exposure, and processing options of images used by the equipment's automatic exposure system. The results showed a difference between the values of the optimized parameters and those ones chosen by the automatic system of the mammography unit, specifically for small breast. The optimized exposure parameters showed better results than those obtained by the automatic system of the mammography, for the image quality parameters and its impact on detection of breast structures when analyzed by radiologists.

Spectrum optimization for computed radiography mammography systems

PURPOSE

Technical quality assurance is a key issue in breast screening protocols. While full-field digital mammography systems produce excellent image quality at low dose, it appears difficult with computed radiography (CR) systems to fulfill the requirements for image quality, and to keep the dose below the limits. However, powder plate CR systems are still widely used, e.g., they represent ∼30% of the devices in the Austrian breast cancer screening program. For these systems the selection of an optimal spectrum is a key issue.

METHODS

We investigated different anode/filter (A/F) combinations over the clinical range of tube voltages. The figure-of-merit (FOM) to be optimized was squared signal-difference-to-noise ratio divided by glandular dose. Measurements were performed on a Siemens Mammomat 3000 with a Fuji Profect reader (SiFu) and on a GE Senograph DMR with a Carestream reader (GECa).

RESULTS

For 50mm PMMA the maximum FOM was found with a Mo/Rh spectrum between 27kVp and 29kVp, while with 60mm Mo/Rh at 28kVp (GECa) and W/Rh 25kVp (SiFu) were superior. For 70mm PMMA the Rh/Rh spectrum had a peak at about 31kVp (GECa). FOM increases from 10% to >100% are demonstrated.

CONCLUSION

Optimization as proposed in this paper can either lead to dose reduction with comparable image quality or image quality improvement if necessary. For systems with limited A/F combinations the choice of tube voltage is of considerable importance. In this work, optimization of AEC parameters such as anode-filter combination and tube potential was demonstrated for mammographic CR systems.

Evaluation of mean glandular dose and modulation transfer function for different tube potentials and target-filter combinations in computed radiography mammography

BACKGROUND

Different target-filter combinations in computed radiography have different impacts on the dose and image quality in digital radiography. This study aims to evaluate the mean glandular dose (MGD) and modulation transfer function (MTF) of various target-filter combinations by investigating the signal intensities of X-ray beams.

METHODS

General Electric (GE) Senographe DMR Plus mammography unit was used for MGD and MTF evaluation. The measured MGD was compared with the dose reference level (DRL), whereas the MTF was evaluated using ImageJ 1.46o software. A modified Mammography Accreditation Phantom RMI 156 was exposed using different target-filter combinations of molybdenum-molybdenum (Mo-Mo), molybdenum-rhodium (Mo-Rh) and rhodium-rhodium (Rh-Rh) at two different tube voltages, 26 kV and 32 kV with 50 mAs.

RESULTS

In the MGD evaluations, all target-filters gave an MGD value of < 1.5 mGy. The one-way ANOVA test showed a highly significant interaction between the MGD and the kilovoltage and target-filter material used (26 kV: F (2,12) = 49,234, P = 0.001;32 kV: F (2,12) = 89,972, P = 0.001). A Tukey post-hoc test revealed that the MGD for 26 kV and 32 kV was highly affected by the target-filter combinations. The test of homogeneity of variances indicates that the MGD varies significantly for 26 kV and 32 kV images (0.045 and 0.030 (P < 0.05), respectively). However, the one-way ANOVA for the MTF shows that no significant difference exists between the target-filter combinations used with 26 kV and 32 kV images either in parallel or perpendicular to the chest wall side F (2,189) = 0.26, P > 0.05).

CONCLUSION

Higher tube voltage and atomic number target-filter yield higher MGD values. However, the MTF is independent of the X-ray energy and the type of target-filter combinations used.

Dose reduction in automatic optimization parameter of full field digital mammography: breast phantom study

Purpose

We evaluated the impact of three automatic optimization of parameters (AOP) modes of digital mammography on the dose and image quality.

Methods

Computerized Imaging Reference Systems phantoms were used. A total of 12 phantoms with different thickness and glandularity were imaged. We analyzed the average glandular dose (AGD) and entrance surface exposure (ESE) of 12 phantoms imaged by digital mammography in three modes of AOP; namely standard mode (STD), contrast mode (CNT), and dose mode (DOSE). Moreover, exposure factors including kVp, mAs, and target/filter combination were evaluated. To evaluate the quality of the obtained digital image, two radiologists independently counted the objects of the phantoms.

Results

According to the AOP modes, the score of masses and specks was sorted as CNT>STD=DOSE. There was no difference in the score of fiber among the three modes. The score of image preference was sorted as CNT>STD>DOSE. The AGD, ESE, and mAs were sorted as CNT>STD>DOSE. The kVp was sorted as CNT=STD>DOSE. The score of all test objects in the phantom image was on a downtrend with increasing breast thickness. The score of masses was different among the three groups; 20-21%>30%>50% glandularity. The score of specks was sorted as 20-21%=30%>50% glandularity. The score of fibers was sorted as 30%>20-21%=50% glandularity. The score of image preference was not different among the three glandularity groups. The AGD, ESE, kVp, and mAs were correlated with breast thickness, but not correlated with glandularity.

Conclusion

The DOSE mode offers significant improvement (19.1-50%) in dose over the other two modes over a range of breast thickness and breast glandularity with acceptable image quality. Owning knowledge of the three AOP modes may reduce unnecessary radiation exposure by utilizing the proper mode according to its purpose.

Correlation of free-response and receiver-operating-characteristic area-under-the-curve estimates: results from independently conducted FROC∕ROC studies in mammography

PURPOSE

From independently conducted free-response receiver operating characteristic (FROC) and receiver operating characteristic (ROC) experiments, to study fixed-reader associations between three estimators: the area under the alternative FROC (AFROC) curve computed from FROC data, the area under the ROC curve computed from FROC highest rating data, and the area under the ROC curve computed from confidence-of-disease ratings.

METHODS

Two hundred mammograms, 100 of which were abnormal, were processed by two image-processing algorithms and interpreted by four radiologists under the FROC paradigm. From the FROC data, inferred-ROC data were derived, using the highest rating assumption. Eighteen months afterwards, the images were interpreted by the same radiologists under the conventional ROC paradigm; conventional-ROC data (in contrast to inferred-ROC data) were obtained. FROC and ROC (inferred, conventional) data were analyzed using the nonparametric area-under-the-curve (AUC), (AFROC and ROC curve, respectively). Pearson correlation was used to quantify the degree of association between the modality-specific AUC indices and standard errors were computed using the bootstrap-after-bootstrap method. The magnitude of the correlations was assessed by comparison with computed Obuchowski-Rockette fixed reader correlations.

RESULTS

Average Pearson correlations (with 95% confidence intervals in square brackets) were: Corr(FROC, inferred ROC) = 0.76[0.64, 0.84] > Corr(inferred ROC, conventional ROC) = 0.40[0.18, 0.58] > Corr (FROC, conventional ROC) = 0.32[0.16, 0.46].

CONCLUSIONS

Correlation between FROC and inferred-ROC data AUC estimates was high. Correlation between inferred- and conventional-ROC AUC was similar to the correlation between two modalities for a single reader using one estimation method, suggesting that the highest rating assumption might be questionable.

The use of a figure-of-merit (FOM) for optimisation in digital mammography: a literature review

The use of image quality parameters in digital mammography such as contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and detective quantum efficiency (DQE) has been widespread, with the intention of detector evaluation and/or quantitative evaluation of the system performance. These parameters are useful in ensuring adequate system performance when tests are done against international standards or guidelines. Parameters like CNR are relative quantities that lie within a range that is manufacturer and system dependent. The use of a figure-of-merit (FOM) is a relatively new concept as a tool in digital mammography permitting quantitative assessment in terms of image quality and patient dose. This review summarises the available evidence for the use and applicability of an FOM in digital mammography.

X-ray spectral measurements for tungsten-anode from 20 to 49 kVp on a digital breast tomosynthesis system

PURPOSE

This paper presents new spectral measurements of a tungsten-target digital breast tomosynthesis (DBT) system, including spectra of 43-49 kVp.

METHODS

Raw x-ray spectra of 20-49 kVp were directly measured from the tube port of a Selenia Dimensions DBT system using a CdTe based spectrometer. Two configurations of collimation were employed: one with two tungsten pinholes of 25 μm and 200 μm diameters, and the other with a single pinhole of 25 μm diameter, for acquiring spectra from the focal spot and from the focal spot as well as its vicinity. Stripping correction was applied to the measured spectra to compensate distortions due to escape events. The measured spectra were compared with the existing mammographic spectra of the TASMIP model in terms of photon fluence per exposure, spectral components, and half-value layer (HVL). HVLs were calculated from the spectra with a numerical filtration of 0.7 mm aluminum and were compared against actual measurements on the DBT system using W/Al (target-filter) combination, without paddle in the beam.

RESULTS

The spectra from the double-pinhole configuration, in which the acceptance aperture pointed right at the focal spot, were harder than the single-pinhole spectra which include both primary and off-focus radiation. HVL calculated from the single-pinhole setup agreed with the measured HVL within 0.04 mm aluminum, while the HVL values from the double-pinhole setup were larger than the single-pinhole HVL by at most 0.1 mm aluminum. The spectra from single-pinhole setup agreed well with the TASMIP mammographic spectra, and are more relevant for clinical purpose.

CONCLUSIONS

The spectra data would be useful for future research on DBT system with tungsten targets.

Optimization of x-ray spectra in digital mammography through Monte Carlo simulations

In this work, a Monte Carlo code was used to investigate the performance of different x-ray spectra in digital mammography, through a figure of merit (FOM), defined as FOM = CNR²/(¯)D(g), with CNR being the contrast-to-noise ratio in image and [Formula: see text] being the average glandular dose. The FOM was studied for breasts with different thicknesses t (2 cm ≤ t ≤ 8 cm) and glandular contents (25%, 50% and 75% glandularity). The anode/filter combinations evaluated were those traditionally employed in mammography (Mo/Mo, Mo/Rh, Rh/Rh), and a W anode combined with Al or K-edge filters (Zr, Mo, Rh, Pd, Ag, Cd, Sn), for tube potentials between 22 and 34 kVp. Results show that the W anode combined with K-edge filters provides higher values of FOM for all breast thicknesses investigated. Nevertheless, the most suitable filter and tube potential depend on the breast thickness, and for t ≥ 6 cm, they also depend on breast glandularity. Particularly for thick and dense breasts, a W anode combined with K-edge filters can greatly improve the digital technique, with the values of FOM up to 200% greater than that obtained with the anode/filter combinations and tube potentials traditionally employed in mammography. For breasts with t < 4 cm, a general good performance was obtained with the W anode combined with 60 μm of the Mo filter at 24-25 kVp, while 60 μm of the Pd filter provided a general good performance at 24-26 kVp for t = 4 cm, and at 28-30 and 29-31 kVp for t = 6 and 8 cm, respectively.

[Optimization of exposure conditions for amorphous selenium direct conversion DR-based mammography system]

A new direct-conversion detector for DR mammography has improved the detectability of microcalcifications and masses. Each optimized exposure condition (target/filter combination and tube voltage) was defined through comparison of physical values and visual evaluation on breast specimens using the innovative DR mammography. The contrast-to-noise-ratios (CNRs) of PMMA phantoms of various thicknesses were obtained under a variety of exposure conditions whose average glandular doses (AGDs) were made consistent. Fifty breast specimens were irradiated under these combinations. Visual evaluation was conducted on the images, whose histograms were controlled for consistency. In the phantoms with thicknesses of 20 mm or more, tungsten/rhodium had the highest CNRs of the targets/filters such as molybdenum/molybdenum and molybdenum/rhodium. For visualizing microcalcifications and masses on breast specimens of thicknesses of 35 mm and below, molybdenum/molybdenum was the best. Nevertheless, to obtain better image quality, molybdenum/rhodium was superior for 35-55 mm thickness, and tungsten/rhodium was superior for 55 mm and above under the same AGD, enabling accurate and efficient diagnosis. The study showed that the exposure conditions differ for obtaining the highest CNR using phantoms and those under which breast specimen images allow the most accurate and efficient diagnosis. In addition, image evaluations of the breast specimens allowed optimization of exposure conditions that are closer to those of the actual diagnosis using mammography.