Comparison of anode/filter combinations in digital mammography with respect to the average glandular dose

PURPOSE

To investigate the average glandular dose (AGD) applied for clinical digital mammograms acquired with the anode/filter combinations molybdenum/molybdenum (Mo/Mo), molybdenum/rhodium (Mo/Rh), and tungsten/rhodium (W/Rh).

MATERIALS AND METHODS

Using the method of Dance, the AGD was evaluated from the exposure data of 4867 digital mammograms at two sites equipped with a full-field digital mammography (FFDM) system based on an amorphous selenium detector. 1793 images were acquired and analyzed with Mo/Mo, 643 with Mo/Rh, and 2431 with W/Rh.

RESULTS

In the Mo/Mo cases the mean compressed breast thickness was 46 +/- 10 mm with an average AGD of 2.29 +/- 1.31 mGy. For the Mo/Rh cases with a mean compressed thickness of 64 +/- 9 mm, we obtained 2.76 +/- 1.31 mGy. The W/Rh cases with a mean compressed thickness of 52 +/- 13 mm resulted in 1.26 +/- 0.44 mGy. The image quality was assessed as normal and adequate for diagnostic purposes in all cases.

CONCLUSION

Applying a W/Rh beam quality permits the reduction of the patient dose by approximately 50 % when using an FFDM system based on amorphous selenium. The dose reduction becomes larger as the breast thickness increases. The results are in agreement with simulations and phantom studies known from the literature.

Experimental phantom lesion detectability study using a digital breast tomosynthesis prototype system

PURPOSE

To compare the sensitivity of conventional two-dimensional (2D) projection imaging with tomosynthesis with respect to the detectability of mammographic phantom lesions.

MATERIALS AND METHODS

Using a breast tomosynthesis prototype based on a commercial FFDM system (Siemens MAMMOMAT Novation), but modified for a wide angle tube motion and equipped with a fast read-out amorphous selenium detector, we acquired standard 2D images and tomosynthesis series of projection views. We used the Wisconsin mammographic random phantom, model RMI 152A. The anode filter combinations Mo/Mo and W/Rh at two different doses were used as typical radiographic techniques. Slice images through the phantom parallel to the detector were reconstructed with a distance of 1 mm employing a filtered back-projection algorithm. The image data sets were read by five radiologists and evaluated with respect to the detectability of the phantom details.

RESULTS

For all studied radiographic techniques, the detection rate in the tomosynthesis mode was 100 %, i. e. 75 true positive findings out of 75 possible hits. In contrast, the conventional projection mode yielded a detection rate between 80 and 93 % (corresponding to 60 and 70 detected details) depending on the dose and X-ray spectrum.

CONCLUSION

Tomosynthesis has the potential to increase the sensitivity of digital mammography. Overlapping structures from out-of-plane tissue can be removed in the tomosynthesis reconstruction process, thereby enhancing the diagnostic accuracy.

Why and how is soft copy reading possible in clinical practice?

The properties of the human visual system (HVS) relevant to the diagnostic process are described after a brief introduction on the general problems and advantages of using soft copy for primary radiology interpretations. At various spatial and temporal frequencies the contrast sensitivity defines the spatial resolution of the eye-brain system and the sensitivity to flicker. The adaptation to the displayed radiological scene and the ambient illumination determine the dynamic range for the operation of the HVS. Although image display devices are determined mainly by state-of-the-art technology, analysis of the HVS may suggest technical characteristics for electronic displays that will help to optimize the display to the operation of the HVS. These include display size, spatial resolution, contrast resolution, luminance range, and noise, from which further consequences for the technical components of a monitor follow. It is emphasized that routine monitor quality control must be available in clinical practice. These image quality measures must be simple enough to be applied as part of the daily routine. These test instructions might also serve as elements of technical acceptance and constancy tests.