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Slide 1
Optimizing Dose andOptimizing Dose andImage Quali ty in Digita lImage Quality in Dig ital
Mammogra phyMammog raphy
Eric A.Eric A. BernsBerns, PhD, PhD
eberns@radiology.northwestern.edueberns@radiology.northwestern.edu
Northwestern University Medical SchoolNorthwestern University Medical SchoolLynn Sage Comprehensive Breast CenterLynn Sage Comprehensive Breast Center
Chicago, ILChicago, IL
Slide 2
AccreditedFFDM units
CertifiedFacilities withFFDM units
Total AccreditedMammo Units
Total CertifiedMammoFacilities
+785
+523
-84
-100
Difference
1,604
1,130
13,556
8,829
August 1, 2006
819
607
13,640
8,929
April 1, 2005
Certified Statistics – 15 Months
Introduc tionIntrodu ction
Slide 3
FFDM vs. Date
0%
2%
4%
6%
8%
10%
12%
Ju l-98 Dec-99 Apr-01 Sep-02 Jan-04 May-05 Oct-06
% Fac w Dig
% Unit s FFDM
GE 2000DGE 2000DApp: Jan 2000App: Jan 2000
FischerFischer SenoscanSenoscanApp: SeptApp: Sept ‘‘0101
LoradLorad CCDCCDApp: MarApp: Mar ‘‘0202
LoradLorad SeleniaSeleniaApp: OctApp: Oct ‘‘0202
SiemensSiemens NovationNovationApp: AugApp: Aug ‘‘0404
GE DSGE DSApp: Feb 2004App: Feb 2004
GE EssentialGE EssentialApp: AprApp: Apr ‘‘0606
FujiFuji FCRmFCRmApp: JulApp: Jul ‘‘0606
Slide 4
�� Cesium IodideCesium Iodide with Silicon Diode Array (GE)with Silicon Diode Array (GE)
�� SeleniumSelenium with Silicon Diode Array (with Silicon Diode Array (LoradLorad, Siemens,, Siemens,
Kodak, Agfa)Kodak, Agfa)
�� Slot Scanning CCDSlot Scanning CCD Array (Fischer)Array (Fischer)
�� Computed RadiologyComputed Radiology (Fuji, Kodak, Konica, Agfa)(Fuji, Kodak, Konica, Agfa)
Detector TypesDetector Types
Introduc tionIntrodu ction
2
Slide 5
EquipmentEquipment
GEGE SenographeSenographe 2000D2000D
Slide 6
GEGE SenographeSenographe DSDS
EquipmentEquipment
Slide 7
GEGE SenographeSenographe EssentialEssential
EquipmentEquipmentSlide 8
�� GEGE SenographeSenographe 2000D & DS & Essential2000D & DS & Essential
–– FOV: 19.2 x 23.0 cm & 24.0 x 31.0 cmFOV: 19.2 x 23.0 cm & 24.0 x 31.0 cm
–– Spatial resolution: 100 microns (5.0Spatial resolution: 100 microns (5.0 lplp/mm)/mm)
EquipmentEquipment
3
Slide 9
LoradLorad SeleniaSelenia
EquipmentEquipmentSlide 10
EquipmentEquipment
SiemensSiemens MammomatMammomat NovationNovationDRDR
Slide 11
�� LoradLorad SeleniaSelenia & Siemens& Siemens NovationNovation
–– FOV: 24 x 29 cmFOV: 24 x 29 cm
–– Spatial resolution: 70 microns (7.14Spatial resolution: 70 microns (7.14 lplp/mm)/mm)
EquipmentEquipmentSlide 12
FischerFischer SenoscanSenoscan
EquipmentEquipment
4
Slide 13
��FischerFischer SenoscanSenoscan
–– FOV: 21 x 29 cm (std), 11 x 15 cm (high res)FOV: 21 x 29 cm (std), 11 x 15 cm (high res)
–– 54 & 27 microns54 & 27 microns –– 9.39.3 lplp/mm in 54/mm in 54 µµm modem mode
–– Scan timeScan time: 5.2 seconds: 5.2 seconds
EquipmentEquipmentSlide 14
�� Computed RadiologyComputed Radiology
–– FujiFuji –– FDA approvedFDA approved
–– KodakKodak
–– KonicaKonica
–– AgfaAgfa
EquipmentEquipment
Slide 15
Fuj iFuj i FCRmFCRm
FCSm
Flash Plus IIP m
EquipmentEquipmentSlide 16
�� FujiFuji FCRmFCRm
–– FOV: 18 x 24 and 24 x 30 cmFOV: 18 x 24 and 24 x 30 cm
–– Spatial resolution: 50 microns (10.0Spatial resolution: 50 microns (10.0 lplp/mm)/mm)
–– 60 to 80 imaging plates per hour60 to 80 imaging plates per hour
EquipmentEquipment
5
Slide 17
KodakKodak DirectViewDirectView CR Mammography SystemCR Mammography System
EquipmentEquipmentSlide 18
�� SectraSectra MicrodoseMicrodose–– SlotSlot--scanning photon counter detectorscanning photon counter detector
–– FOV: 24 x 26 cmFOV: 24 x 26 cm
–– Spatial resolution: 50 microns (10.0Spatial resolution: 50 microns (10.0 lplp/mm)/mm)
EquipmentEquipment
Slide 19
PlanmedPlanmed NuanceNuance –– Amorphous SeleniumAmorphous Selenium –– 8585 µµmm
EquipmentEquipmentSlide 20
•• FDAFDA--ApprovedLaser ImagersApprovedLaser Imagers~ 40~ 40 µµm spotm spot
••Agfa LR5200LaserImager(Wet Chemistry)Agfa LR5200LaserImager (Wet Chemistry)
••Agfa DS4500MAgfa DS4500M
••Kodak8600 LaserImagerKodak8600Laser Imager
••Kodak8610 LaserImagerKodak8610Laser Imager
••Kodak8900Kodak8900
••FujiFuji DrypixDrypix 4000,5000,70004000,5000,7000
••FujiFuji DrypixDrypix FMFM--DP LDP L
••CodonicsCodonicsHorizonHorizon CiCi, GS,SF, GS, SF
••KonicaMinoltaKonicaMinolta DryProDryPro 793793
EquipmentEquipment
6
Slide 21
�� Until recently, workstations came with acquisitionUntil recently, workstations came with acquisition
unitsunits
�� Those days are overThose days are over
�� Spurred by FDA approval of third party RWS, highSpurred by FDA approval of third party RWS, high
resolution displays, and PACSresolution displays, and PACS
�� As a result, FFDM is becoming more a la carte toAs a result, FFDM is becoming more a la carte to
allow best of each (acquisition, RWS, PACS, etc.)allow best of each (acquisition, RWS, PACS, etc.)
WorkstationsWorkstationsSlide 22
�� What is a Multimodality Review Workstation?What is a Multimodality Review Workstation?
Worksta tionsWorkstations
Slide 23
Multim odality Workst ationsMulti modality Workst ations�� FDA Approved Multimodality WorkstationsFDA Approved Multimodality Workstations
–– AGFA IMPAX MA3000AGFA IMPAX MA3000
–– SectraSectra IDS5/mxIDS5/mx
–– KodakKodak DirectViewDirectView PACS SystemPACS System
–– McKessonMcKesson’’s PACSs PACS MammoMammo StationStation
–– iCadiCad Second Look 500MSecond Look 500M
–– CedaraCedara II--ReadMammoReadMammo
–– Fuji SynapseFuji Synapse
–– GE Seno Advantage & Seno Adv. 2GE Seno Advantage & Seno Adv. 2
–– FischerFischer SenoviewSenoview Plus (Plus (CedaraCedara))
–– HologicHologic SecureViewSecureView DXDX
–– SiemensSiemens MammoReportPlusMammoReportPlus
Slide 24
�� Current challengesCurrent challenges
–– Device to device connectivityDevice to device connectivity
–– DICOM incompatibilities between acquisition andDICOM incompatibilities between acquisition and
displaysdisplays
•• Can result in image degradationCan result in image degradation
–– PACS connectivityPACS connectivity
Worksta tionsWorkstations
7
Slide 25
DetectorSize(cm)DetectorSize (cm) vs.vs. Imagesize(pixels)Imagesize(pixels)
23042304
41004100
56255625
3400340019201920 40964096
25602560
20482048
2323
2929
21211919 2424
GEGE2000D &2000D&DSDS
FischerFischer
LoradLorad& Siemens& Siemens
MonitorMonitor
FischerFischer
LoradLorad& Siemens& Siemens
GE EssentialGE Essential
3131 31003100
24002400
GE EssentialGE Essential
WorkstationsWorkstations
GEGE2000D&2000D&DSDS
Slide 26
�� GE (2000D, DS, Essential)GE (2000D, DS, Essential)
�� Mo &Mo & RhRh Targets, Mo &Targets, Mo & RhRh FiltersFilters
–– Mo/Mo, Mo/Mo/Mo, Mo/RhRh,, Rh/RhRh/Rh
�� 3 Modes3 Modes
–– ConCon –– Thin, less dense (2000D)Thin, less dense (2000D)
–– StdStd –– Intermediate (DS & Essential)Intermediate (DS & Essential)
–– DosDos –– Thick, dense breastsThick, dense breasts
AEC System Functio nAEC System Funct ion
Slide 27
�� LoradLorad –– Mo target, Mo &Mo target, Mo & RhRh FiltersFilters–– Mo/Mo, Mo/Mo/Mo, Mo/RhRh
�� ModesModes–– AutoAuto--FilterFilter –– AEC sensor, exposure adjustmentAEC sensor, exposure adjustment
–– AutoAuto--kVkV –– Filter, AEC sensor, exposure adjustmentFilter, AEC sensor, exposure adjustment
–– AutoAuto--TimeTime –– kV, filter, AEC sensor, exposure adjustmentkV, filter, AEC sensor, exposure adjustment
–– TECTEC –– (Tissue Exposure Control)(Tissue Exposure Control) -- Breast densityBreast density
•• (enhanced manual mode)(enhanced manual mode)
–– ManualManual
�� Recommended ModeRecommended Mode –– AutoAuto--FilterFilter
AEC System Funct ionAEC System Funct ionSlide 28
�� SiemensSiemens –– Mo & W Targets, Mo &Mo & W Targets, Mo & RhRh FiltersFilters
–– Mo/Mo, Mo/Mo/Mo, Mo/RhRh, W/, W/RhRh
�� ModesModes
–– OPDOSE Mode (recommended using W/OPDOSE Mode (recommended using W/RhRh))
•• Compress breast to given compressionCompress breast to given compression
•• T/F &T/F & kVpkVp prepre--selected by vendor lookup tablesselected by vendor lookup tables
–– ManualManual
AEC System Functio nAEC System Funct ion
8
Slide 29
�� AEC SummaryAEC Summary
–– Manufacturer only recommends, user decidesManufacturer only recommends, user decides
–– Ultimately up to the Radiologist and/or PhysicistUltimately up to the Radiologist and/or Physicist
to decide which mode to useto decide which mode to use
–– Make mode choice based on knowing effect onMake mode choice based on knowing effect on
dose and image qualitydose and image quality
AEC System Funct ionAEC System Funct ionSlide 30
How Does Digital Compare to ScreenHow Does Digital Compare to Screen--filmfilmMammography in Terms Of:Mammography in Terms Of:
•• Exposure Times?Exposure Times?
•• Breast Dose?Breast Dose?
•• Detection of LowDetection of Low--contrast Lesions?contrast Lesions?
3 AOP Modes:3 AOP Modes: ContrastContrast ++StandardStandard OODoseDose --
2000 FFDM2000FFDMVariability DataVariability Data
Slide 31
�� ContrastContrast--Detail image analysisDetail image analysis
–– Acquire images at recommended techniquesAcquire images at recommended techniques
•• 2, 4, 6, 8 cm2, 4, 6, 8 cm
•• Calculate DoseCalculate Dose
•• Score contrastScore contrast--detail image for image qualitydetail image for image quality
�� ACR PhantomACR Phantom
–– Calculate DoseCalculate Dose
–– ScoresScores
�� Compare to screenCompare to screen--film datafilm data
MethodsMethodsSlide 32
Contrast Detail PhantomsContrast Detail Phantoms
Metho dsMethods
9
Slide 33
MethodsMethodsSlide 34
Metho dsMethods
Decreasing Diameter
DecreasingContrast
0.25 mm 4.0 mm
4%
0.25%
Slide 35
ACR PhantomACR Phantom
MethodsMethodsSlide 36
ACR PhantomACR Phantom
10
Slide 37
0
100
200
300
400
500
600
700
0 1 2 3 4 5 6 7 8 9 10
Thickne ss (cm)
Ave
rage
Gla
ndul
arD
ose
(mra
d)
CMAP 2 cm
CMAP 4 cm
CMAP ACR Phantom
CMAP 6 cm
CMAP 8 cm
FFDM - Con/Auto
FFDM - Std/Auto
FFDM - Dos/Auto
Average Glandular Dose vs. ThicknessAverage Glandular Dose vs. Thickness38 Screen38 Screen--film Units, 18 FFDM Unitsfilm Units, 18 FFDM Units
33 mGymGy Limit forLimit forACR PhantomACR Phantom
Slide 38
Exposure Time vs. ThicknessExposure Time vs. Thickness38 Screen38 Screen--film Units, 18 FFDM Unitsfilm Units, 18 FFDM Units
0
1
2
3
4
5
6
0 1 2 3 4 5 6 7 8 9 10
Thickn ess (cm)
Exp
osu
reT
ime
(sec
on
ds)
CMAP 2 cm
CMAP 4 cm
CMAP ACR Phant om
CMAP 6 cm
CMAP 8 cm
FFDM - Con/Auto
FFDM - Std/A uto
FFDM - Dos /Auto 2 seconds
16% ofFSM > 2 s
74%ofFSM > 2 s
Slide 39
6
8
10
12
14
16
18
0 2 4 6 8 10
Thickn ess (cm)
CD
Sco
res
CMAP 2 cmCMAP 4 cmCMAP 6 cmCMAP 8 cmFFDM - Con/Aut oFFDM - Std/AutoFFDM - Dos/ Aut o
Contrast Detail Scores vs. ThicknessContrast Detail Scores vs. Thickness38 Screen38 Screen--film Units, 18 FFDM Unitsfilm Units, 18 FFDM Units
Slide 40
MedicalPhysics.March 2003.30 (3) pages334-340
Metho dsMethods
20022002GE 2000DGE 2000D OptoOpto DataData
11
Slide 41
�� Objective:Objective: To determine optimized techniqueTo determine optimized technique
factors for fullfactors for full--field digital mammographyfield digital mammography
system (GE 2000D) for lowsystem (GE 2000D) for low--contrast lesioncontrast lesion
detectiondetection
�� Optimization done under condition ofOptimization done under condition of matchedmatched
patient dosepatient dose to screento screen--film mammographyfilm mammography
�� Compare fullCompare full--field digital results to screenfield digital results to screen--filmfilm
resultsresults
MethodsMethodsSlide 42
CD Score vs.CD Score vs. kVpkVp2 cm Breasts2 cm Breast s
88
99
1010
1111
1212
1313
1414
1515
2020 2525 3030 3535 4040 4545 5050
kVpkVp
Mea
nC
DS
core
Mea
nC
DS
core
2 cm Mo/Mo2 cm Mo/Mo
2 cm Mo/2 cm Mo/RhRh
2 cm2 cm Rh/RhRh/Rh
ScreenScreen --FilmFilm
OptimizedTechniqueComparisonOptimizedTechniqueComparison
pp--value= 0.47value= 0.47
Mo/Mo TrendpMo/Mo Trendp--value= 0.0752value= 0.0752
Mo/Mo/RhRh TrendpTrendp--value= 0.1369value= 0.1369
Rh/RhRh/Rh TrendpTrendp--value = 0.0985value = 0.0985
ResultsResults
Slide 43
CD Scor e vs.CD Score vs. kVpkVp4 cm Breasts4 cm Breasts
88
99
1010
1111
1212
1313
1414
1515
2020 2525 3030 3535 4040 4545 5050
kVpkVp
Mea
nC
DS
core
Mea
nC
DS
core
4 cm Mo/Mo4 cm Mo/Mo
4 cm Mo/4 cm Mo/RhRh
4 cm4 cm Rh/RhRh/Rh
ScreenScreen --FilmFilm
OptimizedTechniqueComparisonOptimizedTechniqueComparison
pp--value = 0.013value= 0.013
Mo/Mo TrendpMo/Mo Trendp--value= 0.2221value= 0.2221
Mo/Mo/RhRh TrendpTrend p--value= 0.5691value= 0.5691
Rh/RhRh/RhTrendpTrend p--value= 0.0123value= 0.0123
Resul tsResul tsSlide 44
CD Score vs.CD Score vs. kVpkVp6 cm Breasts6 cm Breasts
88
99
1010
1111
1212
1313
1414
1515
2020 2525 3030 3535 4040 4545 5050
kVpkVp
Mea
nC
DS
core
Mea
nC
DS
core
6 cm Mo/Mo6 cm Mo/Mo
6 cm Mo/6 cm Mo/RhRh
6 cm6 cm Rh/RhRh/Rh
ScreenScreen --FilmFilm
Mo/Mo TrendpMo/Mo Trendp--value= 0.5710value= 0.5710
Mo/Mo/RhRh TrendpTrendp--value= 0.6496value= 0.6496
Rh/RhRh/Rh TrendpTrendp--value= 0.2735value = 0.2735
OptimizedTechniqueOptimizedTechniqueComparisonComparison
pp--value< 0.0001value< 0.0001
ResultsResults
12
Slide 45
CD Score vs.CD Score vs. kVpkVp8 cm Breasts8 cm Breasts
88
99
1010
1111
1212
1313
1414
1515
2020 2525 3030 3535 4040 4545 5050
kVpkVp
Mea
nC
DS
core
Mea
nC
DS
core
8 cm Mo/Mo8 cm Mo/Mo
8 cm Mo/8 cm Mo/RhRh
8 cm8 cm Rh/RhRh/Rh
ScreenScreen --FilmFilm
Mo/Mo TrendpMo/Mo Trendp--value< 0.0428value< 0.0428
Mo/Mo/RhRh TrendpTrendp--value< 0.9453value< 0.9453
Rh/RhRh/Rh TrendpTrendp--value< 0.0121value< 0.0121
OptimizedTechnique ComparisonOptimizedTechnique Comparison
pp--value < 0.0001value< 0.0001
Resul tsResul tsSlide 46
�� LowLow--contrast lesion optimization for FFDM (GE 2000D)contrast lesion optimization for FFDM (GE 2000D)
–– Thin breasts (< 2 cm): Mo/Mo with lowThin breasts (< 2 cm): Mo/Mo with low kVpkVp
–– Intermediate breasts (~4 cm): Insensitive to targetIntermediate breasts (~4 cm): Insensitive to target--filter andfilter and kVpkVp
selectionselection
–– Thick breasts (>5 cm):Thick breasts (>5 cm): Rh/RhRh/Rh with higherwith higher kVpkVp
Conclus ionsConclu sions
Slide 47
Compressed Breast Thickness vs. Dose - All Fischer Sites
0
1
2
3
4
5
6
0 1 2 3 4 5 6 7 8 9 10
Compressed Breast Thickness (cm)
Dos
e(m
Gy)
Film-screen
Digital
Fischer FFDM doses were 32% lower than SFM doses
ACRIN DataSlide 48
Compressed Breast Thicknes s vs. Dose - All GE Sites (5)
0
1
2
3
4
5
6
0 2 4 6 8 10
Compressed Breast Thickness (cm)
Dos
e(m
Gy)
Film Screen
Digital
Mean dose is 32% lowerwith FFDM than SFM
13
Slide 49
Compressed Breast Thickness vs. Dose - All Fuji Sites
0
1
2
3
4
5
6
0 2 4 6 8 10
Compressed Breast Thickness (cm)
Do
se(m
Gy)
Film-screen
Digital
Fuji FFDM doses were 5% lower than SFM doses
Slide 50
Compressed Breast Thickness vs. Dose - All Lorad Sites
0
1
2
3
4
5
6
0 2 4 6 8 10
Compressed Breast Thickness (cm)
Dos
e(m
Gy)
Film-screenDigital
Lorad FFDM doses were 2% higher than SFM doses
Slide 51
Mea
nG
land
ular
Dos
e(
Mea
nG
land
ular
Dos
e( m
Gy
mG
y ))
Mean Dose Comparison by Digital ManufacturerMean Dose Comparison by Digital Manufacturer
2.6
1.8
2.32.2
2.4
1.7
2.3 2.32.4
1.9
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Fischer Fuji GE Lorad All Sites
Screen-Film Digital Overall: Digital DosesOverall: Digital Doses22% Lower Than SFM22% Lower Than SFM
Slide 52
Compariso n of Image Qualityand Averag e Glandu lar Doseon Four FDA-approved Full -Field Digital Mammog raph y
Systems
ARRS 2006
14
Slide 53
PurposePurpose
�� To Measure and CompareTo Measure and Compare
–– Image QualityImage Quality
–– Average Glandular DoseAverage Glandular Dose
•• On 4 FDAOn 4 FDA--approved FFDM systemsapproved FFDM systems
•• Across full range of breast thicknessesAcross full range of breast thicknesses
•• Using each manufacturersUsing each manufacturers’’ recommended techniquesrecommended techniques
Slide 54
�� 4 FDA4 FDA--approved FFDM systemsapproved FFDM systems
–– GE 2000DGE 2000D
–– GEGE SenographeSenographe DSDS
–– LoradLorad SeleniaSelenia
–– SiemensSiemens NovationNovation
Metho dsMethods
Slide 55
�� To acquire imagesTo acquire images
–– Position the phantom like a clinical acquisitionPosition the phantom like a clinical acquisition
–– Apply 10Apply 10 dNdN compression forcecompression force
–– Acquire image using manufacturerAcquire image using manufacturer’’s recommendeds recommended
techniquetechnique
–– Record technique factorsRecord technique factors
–– MeasureMeasure HVLHVL’’ss and entrance exposuresand entrance exposures
–– Calculate AGDCalculate AGD
–– Measure and calculate ContrastMeasure and calculate Contrast--Detail scoresDetail scores
MethodsMethodsSlide 56
Average Gland ular Dose Comparison
0
0.5
1
1.5
2
2.5
3
3.5
4
0 2 4 6 8 10Breast Thickne ss (cm)
Do
se(m
Gy)
DS
2000D
Lorad
SiemSiemens
Lorad
GE 2000D
GE DS
ResultsResults
Rangeupto 2.9
15
Slide 57
Contr ast-Detail Scores
8
9
10
11
12
13
14
15
1617
18
0 2 4 6 8 10Breast Thickness (cm)
Co
ntr
ast-
Det
ailS
core
Siem ens
Lorad
GE 2000DGE DS
ResultsResults
Siem ens
LoradGE 2000D
GE DS
Slide 58
ResultsResults
Average Glandular Dose Comparison
0
0.5
1
1.5
2
2.5
3
3.5
4
0 2 4 6 8 10Breast Thick ness (cm)
Dos
e(m
Gy)
DS
2000D
Lorad
Siem
Contrast- Detail Score s
8
910
11
12
13
1415
16
17
18
0 2 4 6 8 10Breast Thickness (cm)
Co
ntr
ast-
Det
ailS
core
Slide 59
ACR Phantom Avera ge Glandu lar Dose
0
0.5
1
1.5
2
2.5
3
AG
D(m
Gy)
ResultsResults
Siemens Lor adGE 2000DGE DS
Slide 60
Conclusion sConclus ions
�� Results indicate thatResults indicate that
–– Average glandular doses varies by up to a factorAverage glandular doses varies by up to a factor
of 2.9of 2.9
–– There are significant differences in image qualityThere are significant differences in image quality
–– Technique factors and automatic exposure modeTechnique factors and automatic exposure modeselection can play an important role in clinicalselection can play an important role in clinicalimage quality and patient doseimage quality and patient dose
16
Slide 61
DigitalDigitalProposedProposedPhantomPhantom
Slide 62
Slide 63 Slide 64
0.750.750.750.7544
0.650.65
0.540.540.540.5455
0.300.30
0.400.400.400.4066
0.820.82
0.890.890.890.8933
1.121.1222
1.561.5611
Fiber Diamete rFiber Diamete r(mm)(mm)
Propos edPropos edACRACRACRACRPhantomPhant omObject #Object #
Phantom Compar isonPhantom Compari son
17
Slide 65
0.240.240.240.240.750.750.750.7544
0.200.200.650.65
0.160.160.160.160.540.540.540.5455
0.100.100.300.30
0.130.130.400.400.400.4066
0.280.280.820.82
0.320.320.320.320.890.890.890.8933
0.400.401.121.1222
0.540.541.561.5611
Speck DiameterSpeck Diameter(mm)(mm)Fiber Diameter (mm)Fiber Diameter (mm)
ProposedProposedACRACRPropos edPropos edACRACRACRACRPhantomPhantomObject #Object #
Phantom Compa riso nPhantom Compari son
Slide 66
0.500.500.500.500.240.240.240.240.750.750.750.7544
0.380.380.200.200.650.65
0.250.250.250.250.160.160.160.160.540.540.540.5455
0.150.150.100.100.300.30
0.200.200.130.130.400.400.400.4066
0.680.680.280.280.820.82
0.750.750.750.750.320.320.320.320.890.890.890.8933
1.001.000.400.401.121.1222
2.002.000.540.541.561.5611
Mass Thick nessMass Thickness(mm)(mm)
Speck DiameterSpeck Diamete r(mm)(mm)Fiber Diameter (mm)Fiber Diameter (mm)
ProposedProposedACRACRProposedProposedACRACRPropos edPropos edACRACRACRACRPhantomPhant omObject #Object #
Phantom Compar isonPhantom Compari son
Slide 67
18
4, 3, 3 3, 1, 1
Slide 72
�� Objective:Objective: To determine optimized technique factors forTo determine optimized technique factors for
clinically available fullclinically available full--field digital mammography systemsfield digital mammography systems
�� On 6 FFDM Units (Siemens counts as 2)On 6 FFDM Units (Siemens counts as 2)
�� UsingUsing
–– ContrastContrast--Detail PhantomsDetail Phantoms
–– ACR PhantomACR Phantom
–– Proposed ACR Digital PhantomProposed ACR Digital Phantom
Optimization 2006Optim ization 2006
19
Slide 73
�� Measure dose at all recommended techniquesMeasure dose at all recommended techniques
and compare to ACRIN dosesand compare to ACRIN doses
�� Compare dose and image quality within eachCompare dose and image quality within each
system using each modesystem using each mode
�� Compare dose and image quality for eachCompare dose and image quality for each
system using their recommended modesystem using their recommended mode
Optimization 2006Optimization 2006Slide 74
�� Evaluate performance of the ACR phantom andEvaluate performance of the ACR phantom and
compare to our proposed ACR digital phantomcompare to our proposed ACR digital phantom
�� Evaluate image quality as a function of dose forEvaluate image quality as a function of dose for
different modesdifferent modes
�� Ultimately find the optimum techniques to provideUltimately find the optimum techniques to provide
the highest image quality with the lowest dosethe highest image quality with the lowest dose
Optimization 2006Optim ization 2006
Slide 75
HVL vs. kVp
0.25
0.35
0.45
0.55
0.65
20 30 40 50
kVp
HV
L(m
mA
l)
GE 2000D Mo/MoGE 2000D Mo/RhGE 2000D Rh/RhGE DS Mo/MoGE DS Mo/RhGE DS Rh/RhGE Essential Mo/MoGE Essential Mo/RhGE Essential Rh/RhLorad Mo/MoLorad Mo/RhSiemens Mo/MoSiemens Mo/RhSiemens W/Rh
Slide 76
HVL vs. kVp
0.25
0.35
0.45
0.55
0.65
20 25 30 35 40 45 50
kVp
HV
L(m
mA
l)
GE 2000D Mo/MoGE DS Mo/MoGE Essential Mo/MoLo rad Mo/MoSiemens Mo/Mo
20
Slide 77
HVL vs. kVp
0.25
0.35
0.45
0.55
0.65
20 25 30 35 40 45 50
kVp
HV
L(m
mA
l)
GE 2000D Mo/RhGE DS Mo/RhGE Essent ial Mo/RhLorad Mo/RhSiemens Mo/Rh
Slide 78
HVL vs. kVp
0.25
0.35
0.45
0.55
0.65
20 25 30 35 40 45 50
kVp
HV
L(m
mA
l)
GE 2000D Rh/RhGE DS Rh/RhGE Essential Rh/RhSiemens W/Rh
Slide 79
Entrance Skin Exposure vs. kVp
0
5
10
15
20
25
30
35
40
45
20 30 40 50
kVp
ES
E(m
R/m
As)
GE 2000D Mo/MoGE 2000D Mo/RhGE 2000D Rh/RhGE DS Mo/MoGE DS Mo/RhGE DS Rh/RhGE Essent ial Mo/MoGE Essent ial Mo/RhGE Essent ial Rh/RhLorad Mo/MoLorad Mo/RhSiemens Mo/MoSiemens Mo/RhSiemens W/Rh
Slide 80
Entrance Skin Expo sure vs. kVp
0
5
10
15
20
25
30
35
40
45
20 25 30 35 40 45 50
kVp
ES
E(m
R/m
As)
GE 2000D Mo/MoGE DS Mo/MoGE Essential Mo/MoLorad Mo/MoSiemens Mo/Mo
21
Slide 81
Entrance Skin Exposur e vs. kVp
0
5
10
15
20
25
30
35
40
45
20 25 30 35 40 45 50
kVp
ES
E(m
R/m
As)
GE 2000D Mo/RhGE DS Mo/RhGE Essential Mo/RhLorad Mo/Rh
Siemens Mo/Rh
Slide 82
Entrance Skin Expo sure vs. kVp
0
5
10
15
20
25
30
35
40
45
20 25 30 35 40 45 50
kVp
ES
E(m
R/m
As)
GE 2000D Rh/RhGE DS Rh/RhGE Essentia l Rh/RhSieme ns W/Rh
Slide 83
DoseDose
Slide 84
Average Glandular Dose vs. Breas t Thickness
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
0 2 4 6 8 10
Breast Thic knes s (cm)
AG
D(m
Gy)
GE 2000D - Con/Auto
GE 2000D - Std/Auto
GE 2000D - Dos/Aut o
GE DS - Con/Auto
GE DS - Std/Aut o
GE DS - Dos/Auto
GE Essentia l - Con/Auto
GE Essentia l - Std/Auto
GE Essentia l - Dos/Auto
Lorad - Auto-Filter
Siemen s - OpComp - Mo/Mo
Siemen s - OpComp - W/Rh
ACRIN - Film Dose
ACRIN - Digital Dose
22
Slide 85
Average Glandul ar Dose vs. Breast Thickne ss
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
0 2 4 6 8 10Breast Thickness (cm)
AG
D(m
Gy)
GE 2000D - Con/A uto
GE 2000D - Std/Au to
GE 2000D - Dos/Auto
Slide 86
Average Glandul ar Dose vs. Breast Thickne ss
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
0 2 4 6 8 10
Breast Thickness (cm)
AG
D(m
Gy)
GE DS - Con/Aut o
GE DS - Std/Auto
GE DS - Dos/Aut o
Slide 87
Average Glandul ar Dose vs. Breast Thickne ss
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
0 2 4 6 8 10
Breast Thickness (cm)
AG
D(m
Gy)
GE Essential - Con/Au to
GE Essential - Std/Auto
GE Essential - Dos/Aut o
Slide 88
Average Glandular Dose vs. Breas t Thickness
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
0 2 4 6 8 10
Breast Thick ness (cm)
AG
D(m
Gy)
GE 2000D - Con/Auto
GE DS - Std/Auto
GE Essential - Std/Auto
23
Slide 89
Average Glandular Dose vs. Breast Thic kness
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
0 2 4 6 8 10
Breast Thickness (cm)
AG
D(m
Gy)
Lorad - Auto-Filt er
Siemens - OpComp - Mo/Mo
Siemens - OpComp - W/Rh
Slide 90
Average Glandular Dose vs. Breas t Thickness
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
0 2 4 6 8 10
Breast Thic kness (cm)
AG
D(m
Gy)
GE 2000D - Con/Auto
GE DS - Std/Auto
GE Essen tial - Std/Au to
Lorad - Auto-Filt er
Siemens - OpComp - W/Rh
ACRIN - Film
Acrin-Dig ital
Slide 91
CD ScoresCD Scores
Slide 92
Contr ast -Detail Score vs . Breast Thickness
8
9
10
11
12
13
14
15
16
17
0 2 4 6 8 10
Breast Thickness (cm)
Co
ntr
ast-
Det
ailS
core
GE 2000D - Con/Auto
GE 2000D - Std/Auto
GE 2000D - Dos/Auto
GE DS - Con/Auto
GE DS - Std/Auto
GE DS - Dos/Auto
GE Essential - Con/Auto
GE Essential - Std/Auto
GE Essential - Dos/Auto
Lorad - Auto-Filter
Siemens - OpComp - Mo/Mo
Siemens - OpComp - W/Rh
24
Slide 93
Contrast-Det ail Score vs. Breast Thickne ss
8
9
10
11
12
13
14
15
16
17
0 2 4 6 8 10
Breast Thickness (cm)
Co
ntr
ast-
Det
ailS
core
GE 2000D - Con/AutoGE 2000D - Std/AutoGE 2000D - Dos/Auto
Slide 94
Contrast- Detail Score vs. Breast Thickne ss
8
9
10
11
12
13
14
15
16
17
0 2 4 6 8 10
Breast Thickness (cm)
Co
ntr
ast-
Det
ailS
core
GE DS - Con/AutoGE DS - Std/AutoGE DS - Dos/Auto
Slide 95
Contrast-Det ail Score vs. Breast Thickne ss
8
9
10
11
12
13
14
15
16
17
0 2 4 6 8 10
Breast Thickness (cm)
Co
ntr
ast-
Det
ailS
core
GE Essential - Con /Auto
GE Essential - Std/Auto
GE Essential - Dos/Auto
Slide 96
Contr ast -Detail Score vs . Breast Thickness
8
9
10
11
12
13
14
15
16
17
0 2 4 6 8 10
Breast Thicknes s (cm)
Co
ntr
ast-
Det
ailS
core
Lora d - Auto-F ilter
Siemens - OpComp - Mo/Mo
Siemens - OpComp - W/Rh
25
Slide 97
Contr ast-Detail Score vs. Breast Thickn ess
8
9
10
11
12
13
14
15
16
17
0 2 4 6 8 10
Breast Thickness (cm)
Co
ntr
ast-
Det
ailS
core
GE 2000D - Con/Auto
GE DS - Std/Auto
GE Essential - Std/Auto
Lorad - Aut o-Filter
Siemens - OpCom p - W/Rh
Slide 98
ACRACRPhantomPhantom
Slide 99
AGD for the ACR Phantom
0.00
0.50
1.00
1.50
2.00
2.50
3.00
AG
D(m
Gy)
Con Std Dos
2000D
Con Std Dos Con Std Dos
DS Essent ial
AutoFilter
Lorad Siemen s
Mo/Mo W/Rh
Slide 100
Fibers for the ACR Phantom
0
1
2
3
4
5
6
7
Fib
ers
Con Std Dos
2000D
Con Std Dos Con Std Dos
DS Essential
AutoFilter
Lorad Siemens
Mo/Mo W/Rh
26
Slide 101
Speck Groups for the ACR Phant om
0
1
2
3
4
5
6
Sp
eck
Gro
up
s
Con Std Dos
2000D
Con Std Dos Con Std Dos
DS Essen tial
AutoFilter
Lorad Siemen s
Mo/Mo W/Rh
Slide 102
Masses for the ACR Phantom
0
1
2
3
4
5
6
Mas
ses
Con Std Dos
2000D
Con Std Dos Con Std Dos
DS Essent ial
AutoFilter
Lorad Siemens
Mo/Mo W/Rh
Slide 103
ProposedACRProposedACRDigital PhantomDigital Phantom
Slide 104
AGD for "Propose d" ACR Digita l Phantom
0.00
0.50
1.00
1.50
2.00
2.50
3.00
AG
D(m
Gy)
Con Std Dos
2000D
Con Std Dos Con Std Dos
DS Essential
AutoFilter
Lorad Siemens
Mo/Mo W/Rh
27
Slide 105
Fibers for "P ro posed" ACR Digit al Phan tom
0
1
2
3
4
5
6
7
8
Fib
ers
Con Std Dos
2000D
Con Std Dos Con Std Dos
DS Essential
AutoFilter
Lorad Siemens
Mo/Mo W/Rh
Slide 106
Speck Groups for "Pro pos ed" ACR Digit al Phantom
0
1
2
3
4
5
6
7
8
Sp
eck
Gro
up
s
Con Std Dos
2000D
Con Std Dos Con Std Dos
DS Essential
AutoFilter
Lorad Siemens
Mo/Mo W/Rh
Slide 107
Masses for "P roposed" ACR Digital Phantom
0
1
2
3
4
5
6
7
8
Mas
ses
Con Std Dos
2000D
Con Std Dos Con Std Dos
DS Essential
AutoFilter
Lorad Siemens
Mo/Mo W/Rh
Slide 108
Vary DoseVary Dosefrom Rec.from Rec.
Techs.Techs.
28
Slide 109
Contrast- Detail Scor es vs. % Vendo r AGDFor 6 cm Breast Thickn ess
9.0
10.0
11.0
12.0
13.0
14.0
15.0
16.0
0% 50% 100% 150% 200% 250%
% Vendor AGD
Co
ntr
ast-
Det
ailS
core
s
GE 2000D - Con/Auto
GE 2000D - Std/Auto
GE DS - Con/Auto
GE DS - Std/Auto
GE Essential -Con/AutoGE Essential -Std/AutoLorad
Siem ens - Mo/Mo
Siem ens - W/Rh
Slide 110
Contrast-Detail Score s vs. % Vendor AGDFor 6 cm Breast Thickness
9.0
10.0
11.0
12.0
13.0
14.0
15.0
16.0
0% 50% 100% 150% 200% 250%
% Vendo r AGD
Co
ntr
ast-
Det
ailS
core
s
GE 2000D - Con/Auto
GE 2000D - Std/Auto
Rh/Rh– 29 kVp
Rh/Rh– 31 kVp
Slide 111
Contrast- Detail Scor es vs. % Vendo r AGDFor 6 cm Breast Thickn ess
9
10
11
12
13
14
15
16
0% 50% 100% 150% 200% 250%
% Vendor AGD
Co
ntr
ast-
Det
ailS
core
s GE DS - Con/AutoGE DS - Std/Auto
Rh/Rh– 29 kVp
Rh/Rh– 29 kVp
Slide 112
Contrast-Det ail Scores vs. % Vendo r AGDFor 6 cm Breast Thickness
9.0
10.0
11.0
12.0
13.0
14.0
15.0
16.0
0% 50% 100% 150% 200% 250%
% Vendo r AGD
Co
ntr
ast-
Det
ailS
core
s GE Essent ial - Con/Auto
GE Essent ial - Std/AutoRh/Rh– 29 kVp
Rh/Rh– 29 kVp
29
Slide 113
Contrast- Detail Scores vs. % Vendor AGDFor 6 cm Breast Thick ness
9.0
10.0
11.0
12.0
13.0
14.0
15.0
16.0
0% 50% 100% 150% 200% 250%
% Vendor AGD
Co
ntr
ast-
Det
ailS
core
s
Lora d
Siemens - Mo/Mo
Siemens - W/Rh
Mo/Mo – 29 kVp
28 kVp
28 kVp
Slide 114
VaryVary kVpkVp
Slide 115
Contrast- Detail Scores vs. kVpAt Matched Average Glandular Doses to Film and Digital
8.0
9.0
10.0
11.0
12.0
13.0
14.0
15.0
16.0
17.0
23 25 27 29 31 33 35 37 39 41 43 45 47 49
kVp
Co
ntr
ast-
Det
ailS
core
s
GE 2000D - Mo/Mo - Film
GE 2000D - Mo/Rh - Film
GE 2000D - Rh/Rh - Fi lm
GE 2000D - Mo/Mo - Digital
GE 2000D - Mo/Rh - Digi tal
GE 2000D - Rh/Rh - Digital
GE DS - Mo/Mo - Film
GE DS - Mo/Rh - Film
GE DS - Rh/Rh - Film
GE DS - Mo/Mo - Dig ital
GE DS - Mo/Rh - Digital
GE DS - Rh/Rh - Digit al
GE Esse ntial - Mo/Mo - Fil m
GE Esse ntial - Mo/Rh - Film
GE Esse ntial - Rh/Rh - Film
GE Esse ntial - Mo/Mo - Digi tal
GE Esse ntial - Mo/Rh - Digit al
GE Esse ntial - Rh/Rh - Dig ital
Lorad - Mo/Mo - Film
Lorad - Mo/Rh - Film
Lorad - Mo/Mo - Digital
Lorad - Mo/Rh - Digital
Siemens - Mo/Mo - Film
Siemens - Mo/Mo - Dig ital
Siemens - W/Rh - Film
Siemens - W/Rh - Digital
Slide 116
SummarySummar y
Average Glandular Dose vs. Breast Thickness
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
0 2 4 6 8 10
Breast Thickness (cm)
AG
D(m
Gy)
GE 2000D - Con/Auto
GE DS - Std/Auto
GE Essential - Std/Auto
Lorad - Aut o-Fil ter
Siemens - OpComp - W/Rh
Contrast-Detail Score vs. Breast Thickness
8
9
10
11
12
13
14
15
16
17
0 2 4 6 8 10
Breast Thickness (cm)
Co
ntr
ast-
Det
ailS
core
GE 2000D - Con/Aut o
GE DS - Std/Auto
GE Essential - Std/Auto
Lorad - Auto-Fil ter
Siemens - OpComp - W/Rh
30
Slide 117
�� WhatWhat’’s responsible for different images responsible for different image
quality scores?quality scores?
–– Better calibration files on some digitalBetter calibration files on some digital
manufacturermanufacturer’’s systems fewer artifactss systems fewer artifacts
–– Different breast dosesDifferent breast doses
–– Different postDifferent post--processing algorithmsprocessing algorithms
ConclusionsConclusions
�� Better calibration files on some digitalBetter calibration files on some digitalmanufacturermanufacturer’’s systemss systems
vs.
Conclus ionsConclu sions
Slide 119
�� DoseDose
–– Digital in general has lower doses than filmDigital in general has lower doses than film
–– For the same phantom, dose varies widely by modeFor the same phantom, dose varies widely by mode
–– Breast thickness makes big contribution to doseBreast thickness makes big contribution to dose
–– Dose by thickness tracks pretty well across all vendorsDose by thickness tracks pretty well across all vendors
–– Dose is affected by selection of mode being usedDose is affected by selection of mode being used
ConclusionsConclusionsSlide 120
�� Image QualityImage Quality
–– Digital in general has higher image quality scoresDigital in general has higher image quality scores
–– For the same phantom, image quality varies widely byFor the same phantom, image quality varies widely by
modemode
–– Breast thickness has big effect on image qualityBreast thickness has big effect on image quality
–– Image quality by thickness tracks pretty well across allImage quality by thickness tracks pretty well across all
vendorsvendors
–– Image quality is affected by selection of mode being usedImage quality is affected by selection of mode being used
Conclus ionsConclu sions
31
Slide 121
�� Still to be doneStill to be done
–– Phantom images scored by several readersPhantom images scored by several readers
–– Analyzed for statistical differences and trendsAnalyzed for statistical differences and trends
�� What I didnWhat I didn’’t mentiont mention
–– Viewing conditionsViewing conditions
–– Vendor QCVendor QC
–– Monitor calibrationMonitor calibration
–– SNR DataSNR Data
ConclusionsConclusionsSlide 122
�� Take home messagesTake home messages
–– Dose makes more of a difference on image quality thanDose makes more of a difference on image quality than
kVpkVp
–– Digital has lower doses than FilmDigital has lower doses than Film
–– Some systems may set dose to low for theirSome systems may set dose to low for their
recommended moderecommended mode
–– Pay attention to what mode is used clinicallyPay attention to what mode is used clinically
Conclus ionsConclu sions
Slide 123
�� Take home messagesTake home messages
–– Digital mammography needs a more sensitive phantomDigital mammography needs a more sensitive phantom
–– There is a wide range of image quality scores and dosesThere is a wide range of image quality scores and doses
across FFDM systemsacross FFDM systems
–– Evaluate systems the way they are to be used clinicallyEvaluate systems the way they are to be used clinically
–– Manufacturer only recommends AEC mode, userManufacturer only recommends AEC mode, user
ultimately decides how the system is to be usedultimately decides how the system is to be used
ConclusionsConclusionsSlide 124
Thank YouThank You
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