Libby Brateman

Characterization of a fiber‐optic‐coupled radioluminescent detector for application in the mammography energy range

Fiber-optic-coupled radioluminescent (FOC) dosimeters are members of a new family of dosimeters that are finding increased clinical applications. This study provides the first characterization of a Cu doped quartz FOC dosimeter at diagnostic energies, specifically across the range of x-ray energies and intensities used in mammographies. We characterize the calibration factors, linearity, angular dependence, and reproducibility of the FOC dosimeters. The sensitive element of each dosimeter was coupled to a photon counting photomultiplier module via 1 m long optical fibers. A computer controlled interface permitted real-time monitoring of the dosimeter output and rapid data acquisition. The axial-angular responses for all dosimeter models show nearly uniform response without any marked decrease in sensitivity. However, the normal-to-axial angular response showed a marked decrease in sensitivity of about 0 degrees C and 180 degrees C. In most clinical applications, appropriate dosimeter positioning can minimize the contributions of the varying normal-to-axial response. The FOC dosimeters having the greatest sensitive length provided the greatest sensitivity, with greatest to lowest sensitivity observed for 4.0, 1.9, 1.6, and 1.1 mm length sensitive elements. The average sensitivity of the dosimeters varies linearly with sensitive volume (R2=95%) and as a function of tube potential and target/filter combinations, generally exhibiting an increased sensitivity for higher energies. The dosimeter sensitivity as a function of tube potential had an average increase of 4.72 +/- 2.04% for dosimeter models and three target-filter combinations tested (Mo/Mo, Mo/Rh, and Rh/Rh) over a range of 25-31 kVp. All dosimeter models exhibited a linear response (R2 > or = 0.997) to exposure for all target-filter combinations, tube potentials, and tube current-time product stations evaluated and demonstrated reproducibility within 2%. All of the dosimeters examined in this study provided a response adequate for the accurate measurement of doses in clinical mammography applications.

Radiation dosimetry in digital breast tomosynthesis: Report of AAPM Tomosynthesis Subcommittee Task Group 223

The radiation dose involved in any medical imaging modality that uses ionizing radiation needs to be well understood by the medical physics and clinical community. This is especially true of screening modalities. Digital breast tomosynthesis (DBT) has recently been introduced into the clinic and is being used for screening for breast cancer in the general population. Therefore, it is important that the medical physics community have the required information to be able to understand, estimate, and communicate the radiation dose levels involved in breast tomosynthesis imaging. For this purpose, the American Association of Physicists in Medicine Task Group 223 on Dosimetry in Tomosynthesis Imaging has prepared this report that discusses dosimetry in breast imaging in general, and describes a methodology and provides the data necessary to estimate mean breast glandular dose from a tomosynthesis acquisition. In an effort to maximize familiarity with the procedures and data provided in this Report, the methodology to perform the dose estimation in DBT is based as much as possible on that used in mammography dose estimation.

Characterization of a commercially-available, optically-stimulated luminescent dosimetry system for use in computed tomography.

Optically-stimulated luminescent (OSL) nanoDot dosimeters, commercially available from Landauer, Inc. (Glenwood, IL), were assessed for use in computed tomography (CT) for erasure and reusability, linearity and reproducibility of response, and angular and energy response in different scattering conditions. Following overnight exposure to fluorescent room light, the residual signal on the dosimeters was 2%. The response of the dosimeters to identical exposures was consistent, and reported doses were within 4% of each other. The dosimeters responded linearly with dose up to 1 Gy. The dosimeter response to the CT beams decreased with increased tube voltage, showing up to a −16% difference when compared to a 0.6-cm3 NIST-traceable calibrated ionization chamber for a 135 kVp CT beam. The largest range in percent difference in dosimeter response to scatter at central and peripheral positions inside CTDI phantoms was 14% at 80 kVp CT tube voltage, when compared to the ionization chamber. The dosimeters responded uniformly to x-ray tube angle over the ranges of increments of 0° to 75° and 105° to 180° when exposed in air, and from 0° to 360° when exposed inside a CTDI phantom. While energy and scatter correction factors should be applied to dosimeter readings for the purpose of determining absolute doses, these corrections are straightforward but depend on the accuracy of the ionization chamber used for cross-calibration. The linearity and angular responses, combined with the ability to reuse the dosimeters, make this OSL system an excellent choice for clinical CT dose measurements.

Evaluating radiographic parameters for mobile chest computed radiography: Phantoms, image quality and effective dose

Conventional chest radiography is technically difficult because of wide variations in tissue attenuations in the chest and limitations of screen-film systems. Mobile chest radiography, performed bedside on hospital inpatients, presents additional difficulties due to geometric and equipment limitations inherent in mobile x-ray procedures and the severity of illness in the patients. Computed radiography (CR) offers a different approach for mobile chest radiography by utilizing a photostimulable phosphor. Photostimulable phosphors overcome some image quality limitations of mobile chest imaging, particularly because of the inherent latitude. Because they are more efficient in absorbing lower-energy x-rays than rare-earth intensifying screens, this study evaluated changes in kVp for improving mobile chest CR. Three commercially available systems were tested, with the goal of implementing the findings clinically. Exposure conditions (kVp and grid use) were assessed with two acrylic-and-aluminum chest phantoms which simulated x-ray attenuation for average-sized and large-sized adult chests. These phantoms contained regions representing the lungs, heart and subdiaphragm to allow proper CR processing. Signal-to-noise ratio (SNR) measurements using different techniques were obtained for acrylic and aluminum disks (1.9 cm diameter) superimposed in the lung and heart regions of the phantoms, where the disk thicknesses (contrast) were determined from disk visibility. Effective doses to the phantoms were also measured for these techniques. The results indicated that using an 8:1, 33 lines/cm antiscatter grid improved the SNR by 60-300 % compared with nongrid images, depending on phantom and region; however, the dose to the phantom also increased by 400-600%. Lowering x-ray tube potential from 80 to 60 kVp improved the SNR by 30-40%, with a corresponding increase in phantom dose of 40-50%. Increasing the potential from 80 to 100 kVp reduced both the SNR and the phantom dose by approximately 10%. The most promising changes in technique for trial in clinical implementation include using an antiscatter grid, especially for large patients, and potentially increasing kVp.

Comparison of Two Commercial CAD Systems for Digital Mammography

I n late 2006, an outpatient imaging center began its conversion to digital mammography (DM). Part of this transition was a plan to purchase software for computer-aided detection (CAD) to assist in analysis of the digital mammography images. The preparation to purchase one of two systems included a comparison of several specifications, including DICOM compatibility and the ability of the systems to fit well into the digital mammography program of the imaging center. A small study was designed to determine whether one of the two different commercially available systems being considered [R2 ImageChecker (version 8.3.17) and iCAD Second Look (version 7.2-H)] was superior to the other for assisting in interpretation of digital mammography images from screening mammograms obtained with the newly installed General Electric Senographe DS unit. Patient images included in this study were given retrospective approval from the Institutional Review Board with waiver of informed consent for publication of the study results.

Proposition: a pregnant resident physician should be excused from training rotations such as angiography and nuclear medicine because of the potential exposure of the fetus.

It has been reasonably well documented that a pregnant resident physician can assume radiology rotations, including higher-exposure rotations such as angiography and nuclear medicine, without exposing the fetus to radiation levels that exceed national and international guidelines. Hence, many medical physicists support the contention that rotations should not be altered because a resident is pregnant. On the other hand, many if not most physicists subscribe to the ALARA (as low as reasonably achievable) principle, especially in cases of fetal exposure where increased radiation susceptibility is combined with an inability to decide for one-self. In addition, altered rotations usually can be accommodated by swapping rotations with other residents, with the pregnant resident taking high exposure rotations after delivery of the child. Policies on this issue vary among institutions, possibly because medical physicists have not come to closure on the issue. This issue of Point/Counterpoint is directed toward that objective.

Solid-state dosimeters: A new approach for mammography measurements

PURPOSE To compare responses of modern commercially available solid-state dosimeters (SStDs) used in mammography medical physics surveys for two major vendors of current digital mammography units. To compare differences in dose estimates among SStD responses with ionization chamber (IC) measurements for several target/filter (TF) combinations and report their characteristics. To review scientific bases for measurements of quantities required for mammography for traditional measurement procedures and SStDs. METHODS SStDs designed for use with modern digital mammography units were acquired for evaluation from four manufacturers. Each instrument was evaluated under similar conditions with the available mammography beams provided by two modern full-field digital mammography units in clinical use: a GE Healthcare Senographe Essential (Essential) and a Hologic Selenia Dimensions 5000 (Dimensions), with TFs of Mo/Mo, Mo/Rh; and Rh/Rh and W/Rh, W/Ag, and W/Al, respectively. Measurements were compared among the instruments for the TFs over their respective clinical ranges of peak tube potentials for kVp and half-value layer (HVL) measurements. Comparisons for air kerma (AK) and their associated relative calculated average glandular doses (AGDs), i.e., using fixed mAs, were evaluated over the limited range of 28-30 kVp. Measurements were compared with reference IC measurements for AK, reference HVLs and calculated AGD, for two compression paddle heights for AK, to evaluate scatter effects from compression paddles. SStDs may require different positioning from current mammography measurement protocols. RESULTS Measurements of kVp were accurate in general for the SStDs (within -1.2 and +1.1 kVp) for all instruments over a wide range of set kVps and TFs and most accurate for Mo/Mo and W/Rh. Discrepancies between measurements and reference values were greater for HVL and AK. Measured HVL values differed from reference values by -6.5% to +3.5% depending on the SStD and TF. AK measurements over limited (28-30) kVps ranged from -6% to +7% for SStDs, compared with IC reference values. Relative AGDs for each SStD using its associated measurements of kVp, HVL and AK underestimated AGD in nearly all cases, compared with reference IC values, with discrepancies of <-1% to ∼-10%. Some differences in AGD were related to differences in contributions of compression paddle scatter to AK measurements made by ICs. Applying measured factors for scatter effects in AK measurements for three SStDs reduced discrepancies between -6.2% and +1.3%, shifting AGDs from SStDs closer to IC AGDs. CONCLUSIONS This study revealed that SStD measurements yielded good agreement with set kVp, poor agreement with standard HVL determinations, and AK measurements that were substantially different from IC measurements. Discrepancies are partly related to the scattered radiation measured by ICs in determining AK. As a result, IC measurements required for AGD, using currently accepted methodology, typically result in higher AGDs than SStDs, because current methodologies do not account for differing instrument responses to scatter. HVLs reported by SStDs contribute to discrepancies in calculated AGD that depend on kVp and TF. Medical physicists are encouraged to compare their results for SStD instruments using a similar methodology for potential discrepancies with their traditional instruments.

Characterization of scatter in digital mammography from physical measurements

PURPOSE That scattered radiation negatively impacts the quality of medical radiographic imaging is well known. In mammography, even slight amounts of scatter reduce the high contrast required for subtle soft-tissue imaging. In current clinical mammography, image contrast is partially improved by use of an antiscatter grid. This form of scatter rejection comes with a sizeable dose penalty related to the concomitant elimination of valuable primary radiation. Digital mammography allows the use of image processing as a method of scatter correction that might avoid effects that negatively impact primary radiation, while potentially providing more contrast improvement than is currently possible with a grid. For this approach to be feasible, a detailed characterization of the scatter is needed. Previous research has modeled scatter as a constant background that serves as a DC bias across the imaging surface. The goal of this study was to provide a more substantive data set for characterizing the spatially-variant features of scatter radiation at the image detector of modern mammography units. METHODS This data set was acquired from a model of the radiation beam as a matrix of very narrow rays or pencil beams. As each pencil beam penetrates tissue, the pencil widens in a predictable manner due to the production of scatter. The resultant spreading of the pencil beam at the detector surface can be characterized by two parameters: mean radial extent (MRE) and scatter fraction (SF). The SF and MRE were calculated from measurements obtained using the beam stop method. Two digital mammography units were utilized, and the SF and MRE were found as functions of target, filter, tube potential, phantom thickness, and presence or absence of a grid. These values were then used to generate general equations allowing the SF and MRE to be calculated for any combination of the above parameters. RESULTS With a grid, the SF ranged from a minimum of about 0.05 to a maximum of about 0.16, and the MRE ranged from about 3 to 13 mm. Without a grid, the SF ranged from a minimum of 0.25 to a maximum of 0.52, and the MRE ranged from about 20 to 45 mm. The SF with a grid demonstrated a mild dependence on target/filter combination and kV, whereas the SF without a grid was independent of these factors. The MRE demonstrated a complex relationship as a function of kV, with notable difference among target/filter combinations. The primary source of change in both the SF and MRE was phantom thickness. CONCLUSIONS Because breast tissue varies spatially in physical density and elemental content, the effective thickness of breast tissue varies spatially across the imaging field, resulting in a spatially-variant scatter distribution in the imaging field. The data generated in this study can be used to characterize the scatter contribution on a point-by-point basis, for a variety of different techniques.

Characterization of scatter in digital mammography from use of Monte Carlo simulations and comparison to physical measurements.

PURPOSE Monte Carlo simulations were performed with the goal of verifying previously published physical measurements characterizing scatter as a function of apparent thickness. A secondary goal was to provide a way of determining what effect tissue glandularity might have on the scatter characteristics of breast tissue. The overall reason for characterizing mammography scatter in this research is the application of these data to an image processing-based scatter-correction program. METHODS mcnpx was used to simulate scatter from an infinitesimal pencil beam using typical mammography geometries and techniques. The spreading of the pencil beam was characterized by two parameters: mean radial extent (MRE) and scatter fraction (SF). The SF and MRE were found as functions of target, filter, tube potential, phantom thickness, and the presence or absence of a grid. The SF was determined by separating scatter and primary by the angle of incidence on the detector, then finding the ratio of the measured scatter to the total number of detected events. The accuracy of the MRE was determined by placing ring-shaped tallies around the impulse and fitting those data to the point-spread function (PSF) equation using the value for MRE derived from the physical measurements. The goodness-of-fit was determined for each data set as a means of assessing the accuracy of the physical MRE data. The effect of breast glandularity on the SF, MRE, and apparent tissue thickness was also considered for a limited number of techniques. RESULTS The agreement between the physical measurements and the results of the Monte Carlo simulations was assessed. With a grid, the SFs ranged from 0.065 to 0.089, with absolute differences between the measured and simulated SFs averaging 0.02. Without a grid, the range was 0.28-0.51, with absolute differences averaging -0.01. The goodness-of-fit values comparing the Monte Carlo data to the PSF from the physical measurements ranged from 0.96 to 1.00 with a grid and 0.65 to 0.86 without a grid. Analysis of the data suggested that the nongrid data could be better described by a biexponential function than the single exponential used here. The simulations assessing the effect of breast composition on SF and MRE showed only a slight impact on these quantities. When compared to a mix of 50% glandular/50% adipose tissue, the impact of substituting adipose or glandular breast compositions on the apparent thickness of the tissue was about 5%. CONCLUSIONS The findings show agreement between the physical measurements published previously and the Monte Carlo simulations presented here; the resulting data can therefore be used more confidently for an application such as image processing-based scatter correction. The findings also suggest that breast composition does not have a major impact on the scatter characteristics of breast tissue. Application of the scatter data to the development of a scatter-correction software program can be simplified by ignoring the variations in density among breast tissues.

Meaningful Data or Just Measurements? Differences Between Ionization Chamber and Solid-State Detectors

One of the principal responsibilities of a clinical diagnostic medical physicist is to ensure good image quality at an appropriate dose. To determine dose, three quantities must be known for the x-ray beam: peak tube potential, half-value layer (HVL) and air kerma (AK), formerly known as exposure. Instrument and equipment setup (ie, geometric factors) are also important in finding the desired value. The gold standard for clinical exposure or AK measurements uses a calibrated air ionization chamber (IC), which is used with aluminum filters to determine HVL from additional measurements. A separate instrument is required to find the peak tube potential. Solidstate detectors (SStDs) are now available for use in diagnostic physics measurements in mammography, general radiography, and fluoroscopy. The advantage of these alternative instruments is that they can acquire measurements for multiple quantities simultaneously and record them directly into a computer database. The question is, how reliable are these measurements compared with the gold standard? Consider the following situation: You perform an image quality and dose assessment as part of your annual mammography medical physics survey. You have your trusted gold-standard instruments and a new