Aili K. Bloomquist

Development of contrast digital mammography.

Development of breast tumors is often accompanied by angiogenesis--the formation of new blood vessels. It is possible to image the effects of this process by tracking the uptake and washout of contrast agents in the vicinity of a lesion. In this article, a method for carrying out contrast subtraction mammography on a full-field digital mammography unit is described. Spectral measurements and modeling were performed to optimize the choice of x-ray target, kilovoltage and x-ray beam filtration for contrast digital mammography (CDM) on an available digital mammography system. Phantom studies were carried out to determine the sensitivity of CDM to iodine. Detection of iodine area densities of 0.3 mg/cm2 is possible for a circular object with a radius of 1.3 mm, which allows detection of uptake levels in the breast typically seen with cancer and some benign breast conditions. It was found that with a molybdenum anode x-ray tube, copper filtration could be used to effectively shape the x-ray spectrum to maximize the proportion of x rays with energies above the k edge of iodine. Simple logarithmic subtraction was found to be adequate in suppressing background signals dependent on the x-ray beam intensity and background thickness of the breast. The total x-ray dose from the procedure ranges between 1 and 3 mGy, similar to that from a conventional single view film mammogram. A clinical pilot study is currently being carried out to evaluate this technique.

Quality control for digital mammography in the ACRIN DMIST trial: Part I

The Digital Mammography Imaging Screening Trial, conducted by the American College of Radiology Imaging Network, is a clinical trial designed to compare the accuracy of full-field digital mammography (FFDM) versus screen-film mammography in a screening population. Five FFDM systems from four manufacturers (Fischer, Fuji, General Electric, and Lorad) were employed in the study at 35 clinical sites. A core physics team devised and implemented tests to evaluate these systems. A detailed description of physics and quality control tests is presented, including estimates of: mean glandular dose, modulation transfer function (MTF), 2D noise power spectra, and signal-to-noise ratio (SNR). The mean glandular doses for the standard breast ranged from 0.79 to 2.98 mGy, with 1.62 mGy being the average across all units and machine types. For the five systems evaluated, the MTF dropped to 50% at markedly different percentages (22% to 87%) of the Nyquist limit, indicating that factors other than detector element (del) size have an important effect on spatial resolution. Noise power spectra and SNR were measured; however, we found that it was difficult to standardize and compare these between units. For each machine type, the performance as measured by the tests was very consistent, and no predictive benefit was seen for many of the tests during the 2-year period of the trial. It was found that, after verification of proper operation during acceptance testing, if systems failed they generally did so suddenly rather than through gradual deterioration of performance. Because of the relatively short duration of this study further, investigation of the long-term failure characteristics of these systems is advisable.

Resolution at oblique incidence angles of a flat panel imager for breast tomosynthesis

Oblique incidence of x rays on an imaging detector causes blurring that reduces spatial resolution. For simple projection imaging this effect is small and often ignored. However, for breast tomosynthesis, the incidence angle can be larger (>20 degrees), leading to increased blur for some of the projections. The modulation transfer function (MTF) is measured for a typical phosphor-coupled flat-panel detector versus angular incidence of the x-ray beam for two x-ray spectra: 26 kV Mo/Mo and 40 kV Rh/Al. At an incidence angle of 40 degrees the MTF at 5 mm(-1) falls by 35% and 40% for each spectrum, respectively (and 65%/80% at 8 mm(-1)). Increasing the detector absorber thickness to achieve improved quantum efficiency will cause the blurring effect due to beam obliquity to become greater. The impact of this blur is likely to cause misregistration and increased relative noise in tomosynthesis reconstructed images.

Optimization of exposure parameters in full field digital mammography

Optimization of exposure parameters (target, filter, and kVp) in digital mammography necessitates maximization of the image signal-to-noise ratio (SNR), while simultaneously minimizing patient dose. The goal of this study is to compare, for each of the major commercially available full field digital mammography (FFDM) systems, the impact of the selection of technique factors on image SNR and radiation dose for a range of breast thickness and tissue types. This phantom study is an update of a previous investigation and includes measurements on recent versions of two of the FFDM systems discussed in that article, as well as on three FFDM systems not available at that time. The five commercial FFDM systems tested, the Senographe 2000D from GE Healthcare, the Mammomat Novation DR from Siemens, the Selenia from Hologic, the Fischer Senoscan, and Fujis 5000MA used with a Lorad M-IV mammography unit, are located at five different university test sites. Performance was assessed using all available x-ray target and filter combinations and nine different phantom types (three compressed thicknesses and three tissue composition types). Each phantom type was also imaged using the automatic exposure control (AEC) of each system to identify the exposure parameters used under automated image acquisition. The figure of merit (FOM) used to compare technique factors is the ratio of the square of the image SNR to the mean glandular dose. The results show that, for a given target/filter combination, in general FOM is a slowly changing function of kVp, with stronger dependence on the choice of target/filter combination. In all cases the FOM was a decreasing function of kVp at the top of the available range of kVp settings, indicating that higher tube voltages would produce no further performance improvement. For a given phantom type, the exposure parameter set resulting in the highest FOM value was system specific, depending on both the set of available target/filter combinations, and on the receptor type. In most cases, the AECs of the FFDM systems successfully identified exposure parameters resulting in FOM values near the maximum ones, however, there were several examples where AEC performance could be improved.

Quality control for digital mammography: Part II recommendations from the ACRIN DMIST trial

The Digital Mammography Imaging Screening Trial (DMIST), conducted under the auspices of the American College of Radiology Imaging Network (ACRIN), is a clinical trial designed to compare the accuracy of digital versus screen-film mammography in a screening population [E. Pisano et al., ACRIN 6652-Digital vs. Screen-Film Mammography, ACRIN (2001)]. Part I of this work described the Quality Control program developed to ensure consistency and optimal operation of the digital equipment. For many of the tests, there were no failures during the 24 months imaging was performed in DMIST. When systems failed, they generally did so suddenly rather than through gradual deterioration of performance. In this part, the utility and effectiveness of those tests are considered. This suggests that after verification of proper operation, routine extensive testing would be of minimal value. A recommended set of tests is presented including additional and improved tests, which we believe meet the intent and spirit of the Mammography Quality Standards Act regulations to ensure that full-field digital mammography systems are functioning correctly, and consistently producing mammograms of excellent image quality.

Quality control for digital mammography: Part II recommendations from the ACRIN DMIST trial: QC for digital mammography: Part II recommendations

The Digital Mammography Imaging Screening Trial (DMIST), conducted under the auspices of the American College of Radiology Imaging Network (ACRIN), is a clinical trial designed to compare the accuracy of digital versus screen-film mammography in a screening population [E. Pisano et al., ACRIN 6652-Digital vs. Screen-Film Mammography, ACRIN (2001)]. Part I of this work described the Quality Control program developed to ensure consistency and optimal operation of the digital equipment. For many of the tests, there were no failures during the 24 months imaging was performed in DMIST. When systems failed, they generally did so suddenly rather than through gradual deterioration of performance. In this part, the utility and effectiveness of those tests are considered. This suggests that after verification of proper operation, routine extensive testing would be of minimal value. A recommended set of tests is presented including additional and improved tests, which we believe meet the intent and spirit of the Mammography Quality Standards Act regulations to ensure that full-field digital mammography systems are functioning correctly, and consistently producing mammograms of excellent image quality.

Beam optimization for digital mammography – II

Optimization of acquisition technique factors (target, filter, and kVp) in digital mammography is required for maximization of the image SNR, while minimizing patient dose. The goal of this study is to compare, for each of the major commercially available FFDM systems, the effect of various technique factors on image SNR and radiation dose for a range of breast thickness and tissue types. This phantom study follows the approach of an earlier investigation [1], and includes measurements on recent versions of two of the FFDM systems discussed in that paper, as well as on three FFDM systems not available at that time. The five commercial FFDM systems tested are located at five different university test sites and include all FFDM systems that are currently FDA approved. Performance was assessed using 9 different phantom types (three compressed thicknesses, and three tissue composition types) using all available x-ray target and filter combinations. The figure of merit (FOM) used to compare technique factors is the ratio of the square of the image SNR to the mean glandular dose (MGD). This FOM has been used previously by others in mammographic beam optimization studies [2],[3]. For selected examples, data are presented describing the change in SNR, MGD, and FOM with changing kVp, as well as with changing target and/or filter type. For all nine breast types the target/filter/kVp combination resulting in the highest FOM value is presented. Our results suggest that in general, technique combinations resulting in higher energy beams resulted in higher FOM values, for nearly all breast types.

A harmonized quality control program for digital mammography

Digital mammography is rapidly becoming a mature imaging modality. To maintain high quality in mammography, a routine quality control program is necessary to detect drifting or degradation of system performance over time. The American College of Radiology is developing a quality control program which will apply to all types of full-field digital mammography equipment, and provide effective and more efficient validation of performance. In the DMIST trial, there were no failures for many of the QC tests during the 24 months imaging was performed. When systems failed, they generally did so suddenly, rather than through gradual deterioration of performance. A recommended set of tests is presented, which can be used to ensure that full-field digital mammography (FFDM) systems are functioning correctly, and consistently producing mammograms of excellent image quality.

One-dimensional scatter grid for the SenoScan slot-scanning digital mammography system

The SenoScan full-field digital mammography scanner uses a scanning slot detector that is 10 mm wide and 220 mm long. The X-ray beam is collimated to just outside the area of the detector. One important advantage of slot scanning is its inherent scatter rejection. As previously reported, the SenoScan slot scatter rejection is better than that obtained using a 3.5:1 mammography grid, and somewhat worse than that with a 5:1 grid. Additional scatter reduction can potentially improve the contrast in images of thick breasts. We evaluate a custom-designed grid for the slot scanning system. The grid is one-dimensional, offering scatter rejection along the longitudinal axis of the detector. We evaluate the reduction in scatter fraction, grid absorption and changes in the signal-difference-to-noise ratio (SDNR). Based on phantom studies, our results show effective scatter reduction by the grid with minimal reduction of SDNR. Grid absorption and scatter elimination do not necessarily lead to an increase in patient dose, especially if there is a improvement in the number of digital values in the image that are within the useful dynamic range of the detector. A benefit of removing the scatter contribution is an improvement in system dynamic range, because electronic detector gain adjustments can compensate for the drop in the digital pixel values.

TU‐B‐M100J‐01: Optimizing Mammography Image Quality and Dose: X‐Ray Spectrum and Exposure Parameter Selection

Optimization of exposure parameters (target, filter, and kVp) in digital mammography necessitates maximization of the image signal‐to‐noise ratio (SNR), while simultaneously minimizing patient dose. The goal of this talk is to compare, for each of the major commercially available full field mammography (FFDM) systems, the impact of the selection of technique factors on imageSNR and radiation dose for a range of breast thickness and tissue types. The comparison will be based on the results of a multi‐center phantom study. The five commercial FFDM systems tested, the Senographe 2000D from GE Healthcare, the Mammomat Novation from Siemens, and the Selenia from Hologic, the Fischer Senoscan, and Fujis 5000MA used with a Lorad M‐IV mammography unit, are located at five different university test sites. Performance was assessed using all available x‐ray target and filter combinations and nine different phantom types (three compressed thicknesses, and three tissue composition types). Each phantom type was also imaged using the automatic exposure control (AEC) of each system to identify the exposure parameters used under automated image acquisition. The figure of merit (FOM) used to compare technique factors is the ratio of the square of the imageSNR to the mean glandular dose (MGD). The results show that, for a given target/filter combination, in general FOM is a slowly changing function of kVp, with stronger dependence on the choice of target/filter combination. In all cases the FOM was a decreasing function of kVp at the top of the available range of kVp settings, indicating that higher tube voltages would produce no further performance improvement. For a given phantom type, the exposure parameter set resulting in the highest FOM value was system‐specific, depending on both the set of available target/filter combinations, and on the receptor type. Noise performance differed noticeably among the FFDM systems and played an important role in determining relative FOM values. In most cases, the AECs of the FFDM systems successfully identified exposure parameters resulting in FOM values near the maximum ones, however there were several examples where AEC performance could be improved. Educational Objectives: 1. become familiar with the effect of changing kVp, target material, and filtration on the mean glandular dose for a variety of breast. 2. become familiar with the effect of changing kVp, target material, and filtration on image signal and noise for specific commercial FFDM systems. 3. learn how the exposure technique factors selected for a variety of breast types by the AECs of current FFDM systems compare with the technique factors resulting in optimal FOM values.