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Objective:To compare radiation dose between digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM), and explore the correlation of average glandular dose(AGD) with breast density and compression thickness.Methods:The mammographic data of patients with breast diseases who underwent digital breast tomosynthesis (DBT) and the population who underwent full-field digital mammography (FFDM) screening in the First Affiliated Hospital of Kunming Medical University from October 2020 to May 2022 were retrospectively collected. The compression thickness, compression force and AGD were recorded. According to the 2013 ACR BI-RADS MAMMOGRAPHY, the breast gland density was classified into 4 types: a(glandular tissue<25%), b(glandular tissue 25%~50%), c(glandular tissue 50%~75%) and d(glandular tissue >75%), by two senior doctors engaged in breast imaging diagnosis. The relationships between different gland densities, different compression thicknesses and AGD under FFDM and DBT mode were analyzed.Results:In both FFDM and DBT modes, the AGD increased significantly with the increase of breast density( F=861.63, 617.83, 330.33, 451.45, 290.47, P<0.001), and AGD a<AGD b<AGD c<AGD d. For type c and d breasts undergoing FFDM, AGD was lowest when the compression thickness was 31~40 mm. Under the same compression thickness, The AGD DBT was significantly higher than the AGD FFDMin all types (Type a: t=-17.88, -42.19, -29.90, -28.14, -24.95, P<0.001; Type b: t=-49.18, -35.94, -27.25, -28.37, -24.10, P<0.001; Type c: t=-11.78, -32.90, -23.13, -20.51, -18.24, P<0.001; Type d: t=-7.94, -26.24, -17.24, -15.44, -13.81, P<0.001). The difference between two AGDs of Type d with compression thickness of 61~70 mm was the largest, which was 1.07 mGy (95% CI: 0.92~1.22). The AGD was positively correlated with breast density and compression thickness, and the relationship of FFDM was stronger than that of DBT. Conclusions:The AGD is positively correlated with breast density and compression thickness in mammography. Compared with FFDM, DBT can increase AGD, The AGD would increase in DBT than FFDM but be safe. DBT would be beneficial to patients with breast diseases in clinical practice.
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Objective To investigate the diagnostic value of full-field digital mammography (FFDM) combined with three-dimentional digital breast tomosynthesis (3D-DBT) in the lesions of dense breast mass. Methods A total of 121 patients with breast mass (135 lesions) in Shanxi Provincial People's Hospital from January 2018 to May 2018 were retrospectively analyzed. The differences of FFDM combined with 3D-DBT technique and FFDM alone in the diagnosis of dense breast mass lesions were compared and analyzed by using American Radiological Society's Breast Imaging Reporting and Data System (BI-RADS) grading diagnosis, and then the pathological results were compared. Results The sensitivity, accuracy rate and specificity of FFDM combined with 3D-DBT in the diagnosis of breast cancer among 135 lesions was 97.3％ (36/37), 80.0％ (108/135) and 73.5％ (72/98), respectively. The sensitivity, accuracy rate and specificity of FFDM in the diagnosis of breast cancer was 86.5％ (32/37), 70.4％ (95/135) and 64.3％ (63/98), respectively. Area under the receiver operating characteristic curve of FFDM combined with 3D-DBT was higher than that of FFDM alone (0.854 vs. 0.754). Compared with FFDM, mass diameter measured by 3D-DBT was close to the pathological results. The detection rates of mass, burr features and suspected malignant aggregation calcification by using FFDM combined with 3D-DBT were superior than those by using FFDM [100.0％ (72/72) vs. 81.9％ (59/72), 52.8％ (19/36) vs. 41.7％ (15/36), 75.0％ (27/36) vs. 66.7％ (24/36), respectively]. Conclusions For the focal mass of compact glands, compared with FFDM alone, the accuracy rate of the mass measurement, the detection rate of the suspected mass, the malignant mass burr, and themicro-calcification of aggregation treated by FFDM combined with 3D-DBT have been increased in a varying degree.
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Objective The aim of this study was to investigate FFDM differential diagnosis between breast mastitis,benign hyperplasia and breast cancer. Methods Fifty-nine cases of non-puerperal breast mastitis,sixty-eight cases of benign hyperpla-sia and two hundred and forty cases with non-mass type breast cancer were analyzed retrospectively,which were verified by surgery and pathology by contrast with FFDM signs,pathological types,grouped and statistics processed. The observation indexes of lamellar shadow included shape,density and edge. The observation indexes of linear shadow included direction,form and diameter. Results The FFDM signs in three groups of breast diseases were statistically significant(P<0. 05):the form of linear shadow,accompanied by calcifications,the shape of lamellar shadow,the direction of linear shadow,the distribution of lesion,the sharp angle of shadow edge. χ2 segmentation show that there were significant differences between three groups(P<0. 0125):the shape of lamellar shadow,the direc-tion of linear shadow. Conclusion There have some values for the diagnosis of breast cancer by rigid form and radial distribution of linear shadow,rigid shape and segmental distribution of lamellar shadow,the polymorphic calcifications and the sharp angle sign.
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Objective To explore the diagnostic value of calcification by full field digital mammography in cases without breast palpable lumps or nodules in ductal carcinoma in situ(DC1S).Methods Based on breast imaging-reporting and data system (BI-RADS)proposed by the American College of Radiology (ACR),the cases without palpable lumps or nodules,but with calcification (over Category 4a)found by full field digital mammography admitted from Oct.2014 to Oct.2016 were analyzed.They underwent excisional biopsy after three-dimensional guide wire positioning or three-dimensional vacuum rotary cutting.After being filmed again to make sure the resection was complete,the isolated specimen were sent to pathological examination.The pathology and calcification were analyzed and summarized.Results Among 126 cases,71 (56.3％)were breast adenosis,41 (32.5％) were DCIS,6(4.8％) were infiltrating ductal carcinoma (IDC),and 8 (6.3％)were other types.The detection rate of DCIS in younger group was higher.The calcifications in DCIS were mostly linear-branching,segmental calcification,and those in IDC were mostly pleomorphic,clustering or regional calcification.Conclusion Full field digital mammography has great diagnostic value for DCIS in cases with calcification but without palpable breast lumps or nodules.
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Objective To test the spatial resolution and average glandular dose (AGD) of full field digital mammography system to obtain high-resolution and contrast breast X-ray images with the lowest dose.Methods The M12 breast X-ray performance test phantom was placed on the breast support center position,then line-pair card was put on the M12 phantom and fixed groove,and exposure was carried out with auto exposure control,28 kV tube voltage and common anode filtration combination so as to detect the spatial resolution.Half-value layer (HVL) was measured by Fluke TNT12000 ray detection tools,2 mm-thickness plate and aluminum sheets with different thicknesses,and then AGD was calculated accordingly.Results The spatial resolutions were all higher than 7 lp/mm and proved to meet the quality standard,which had the vertical spatial resolution being 8 lp/mm,the maximum value of the lateral spatial resolution being 10 lp/mm and the minimum value being 8 lp/mm.AGD was lower than 2 mGy and then proved qualified which was limited within 0.60 and 0.61 mGy.Conclusion The test of spatial resolution and AGD of full digital mammography system can assess the performance and radiation dose,reflect the performance of equipment,ensure image quality and lower radiation dose.
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Background and purpose:Breast cancer is the most common malignancy in women. The new technology of mammography is helpful in breast cancer diagnosis. This study aimed to compare the efficacy of digital breast tomosynthesis (DBT) with conventional imaging methods in the diagnosis of benign and malignant breast lesions.Methods:During the period from Mar. 2015 to Dec. 2015, 227 patients with suspected lesions (by palpation or sonography) underwent further imaging exam in our hospital. The sonography, full-field digital mammography (FFDM), DBT and breast MRI were performed on all the patients. A double-blind assessment was carried out according to BI-RADS (version 2013) by experienced radiologists. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of all methods, referring to the pathological data as the golden standard; the difference in the efficiency of DBT from the other methods was determined byZ-test.Results:Thirty patients were excluded for the unsatisfactory images, and 205 lesions (132 malignant and 73 benign lesions) were detected in the remaining 197 patients. Area under the curve (AUC) of sonography, FFDM, DBT, DBT+FFDM and MRI based on the BI-RADS were 0.8308, 0.8592, 0.9167, 0.9198, and 0.9354, respectively. The AUC of DBT was significantly higher than those of sonography (Z=7.36,P=0.0067) and FFDM (Z=4.89,P=0.0271), while there was no significantly difference between DBT and MRI (Z=0.02,P=0.9002) or FFDM+DBT (Z=0.69,P=0.4048).Conclusion:DBT could significantly improve the diagnostic performance for breast lesions compared with sonography and FFDM, providing a comparable efficiency to MRI. As a new mammography technology, DBT has good clinical application prospect.
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Objective To test the spatial resolution and average glandular dose (AGD) of full field digital mammography system to obtain high-resolution and contrast breast X-ray images with the lowest dose.Methods The M12 breast X-ray performance test phantom was placed on the breast support center position,then line-pair card was put on the M12 phantom and fixed groove,and exposure was carried out with auto exposure control,28 kV tube voltage and common anode filtration combination so as to detect the spatial resolution.Half-value layer (HVL) was measured by Fluke TNT12000 ray detection tools,2 mm-thickness plate and aluminum sheets with different thicknesses,and then AGD was calculated accordingly.Results The spatial resolutions were all higher than 7 lp/mm and proved to meet the quality standard,which had the vertical spatial resolution being 8 lp/mm,the maximum value of the lateral spatial resolution being 10 lp/mm and the minimum value being 8 lp/mm.AGD was lower than 2 mGy and then proved qualified which was limited within 0.60 and 0.61 mGy.Conclusion The test of spatial resolution and AGD of full digital mammography system can assess the performance and radiation dose,reflect the performance of equipment,ensure image quality and lower radiation dose.
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Objective To compare the accuracy of full field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in predicting size of ductal carcinoma in situ (DCIS).Methods Totally 30 women pateints with DCIS confirmed by histology were analyzed retrospectively.Two radiologists measured the size of the lesions on FFDM,DBT images respectively,and compared with pathological results.Two kinds of inspection methods correlation with pathology were compared with Pearson correlation analysis.Results Size of DCIS measured by doctor 1 and doctor 2 between FFDM and histology had correlation (r=0.857,0.818,both P＜0.01),and those between DBT and histology also had correlation (r=0.924,0.885,both P＜0.01).Intraclass correlation coefficient (ICC) of two doctors was 0.947 on FFDM,and 0.908 on DBT.Conclusion DBT provides a better estimation of the size of DCIS.Two physicians had high consistency for lesion size evaluation.For DCIS with microcalcifications,both FFDM and DBT provide smaller estimations compared with pathology,thus a bigger surgical resection of lesion is needed.
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Objective To evaluate the clinical value of full-field digital mammography three-dimensional (3D) positioning system for localization and excision of nonpalpable breast lesions.Methods 106 patients with nonpalpable breast lesions and underwent preoperative localization were analyzed retrospectively.They underwent wire-localization operation guided by mammography 3D positioning system (GE Senogrphe DS).The depth of wire insertion was calculated manually and automatically.Combined with the manual measurement, systematic measurement, skin elasticity and breast parenchyma structure, the positioning wire was placed.Then, the clinical resection was performed according to the wire localization.Results The localization accuracy of mammography 3D positioning system was 100%.11 patients appearedsyncope.With the rest, psychological comfort and fluid infusion, patients recovered quickly.Conclusion Full-field digital mammography 3D positioning system can improve the accuracy of clinical resection of nonpalpable breast lesion.
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Objective@#To assess the value of digital breast tomosynthesis (DBT) in the diagnosis of breast lesions.@*Methods@#Two hundred and fifty-three breast lesions in 250 patients were selected in this study. All lesions were confirmed pathologically. Preoperative diagnosis was performed independently with full-field digital mammography (FFDM), DBT and DBT plus FFDM, respectively. The diagnostic value of DBT for breast lesions was evaluated based on the pathological diagnosis as the gold standard. The diagnostic performance of DBT and FFDM for breast lesions was compared between the groups with different ages, mammary gland densities and hormone levels. The sensitivity of DBT and FFDM was compared between the groups with different pathological types and different sizes of breast cancer. The correlation between the longest diameter of breast cancers and pathological measurements shown on DBT and FFDM was analyzed.@*Results@#The areas under ROC curves were 0.890, 0.833 and 0.890 for DBT, FFDM and DBT plus FFDM, respectively. The areas under ROC curves for DBT or DBT plus FFDM were significantly greater than that for FFDM (P<0.05). In the group with breast density>50%, group with age ≤50 and non-menopause group, all the areas under ROC curves for DBT or DBT plus FFDM were all significantly larger than that for FFDM (P<0.05). No significant differences were observed in the group with breast density ≤50%, group with age>50 and menopause group (P>0.05). The sensitivity for both DBT and FFDM in the diagnosis of carcinoma in situ was 90.9% (10/11). The sensitivity for DBT and FFDM in the diagnosis of non-carcinoma in situ was 92.3% (120/130) and 83.8% (109/130), respectively. The sensitivity in the groups with the longest diameter of foci >0 mm but ≤10 mm, >10 mm but ≤20 mm, >20 mm but ≤30 mm, and >30 mm but ≤40 mm were 51.7% (4/7), 93.8% (61/65), 96.7% (30/31) and 100% (11/11), respectively, for DBT, and were 51.7% (4/7), 78.5% (51/65), 93.5% (29/31), and 100% (11/11), respectively, for FFDM. The correlation coefficients between the longest diameter of breast cancers and pathological measurements shown on DBT and FFDM were 0.905 and 0.849, respectively (P<0.001).@*Conclusions@#Compared with FFDM, DBT shows a higher diagnostic efficiency in patients with breast density >50%, age ≤50 years and non-menopause, non-carcinoma in situ, and the longest diameter of lesions >10 mm but ≤ 20 mm. The longest diameter of breast lesions is more accurately shown on DBT.
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Objective To test the key indexes of full-field digital mammography to keep it in good condition.Methods The testing was carried out based on clinical experiences and GBZ 186—2007 Mammography Quality Control Testing Specification.Results The testing items and indexes were proposed to facilitate the staff to check and operate the machine.Conclusion Clinical safety of full-field digital mammography and image quality are both enhanced greatly.
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Objective To compare imaging quality and radiation dose on full-field digital mammography (FFDM) system and dual-sided reading CR mammography (DSCRM) system.Methods The TRM of ALVIM statistics phantom was exposed by FFDM system and (DSCRM) with the same radiation dose.The exposure parameters and the entrance surface dose (ESD) were recorded.Then,the phantom was exposed by DSCRM system with different mAs and same kV,and the ESD was recorded.The images obtained above were read by three radiologists on the monitor of diagnosis work station with the same window width and window level.The evaluation of the images were given using a five-level confidence scale.ROC curves were drawn and probability Pdet were calculated.Results The ROC analysis of microcalcifications and masses showed A(z) values of 0.730-0.925 and 0.670-0.945 for FFDM,and 0.632-0.815 and 0.575-0.785 for DSCRM when the radiation dose is 1.36 mGy.The radiation dose with DR system could be reduced compared with dual-sided reading CR system at the same probabilities Pdet,the ESD reduced from 1.63 mGy to 1.36 mGy by 19.8％,the AGD reduced from 0.65 mGy to 0.56 mGy by 16.0％.Conclusions The observable details with FFDM system were proved to be superior to DSCRM system at the same radiation dose.With the similar image quality,the radiation dose of FFDM system was less than the DSCRM system.
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Objective To study the difference of image quality and radiation dose between different exposure modes with full-field digital mammography (FFDM).Methods The Fluke18-220mammographic phantom was exposed by FFDM system with different exposure modes at automatic exposure control ( AEC ) ,including contrast mode,standard mode and dose mode,and the exposure factors and radiation dose were recorded.The images on monitor with the best window width and window level were read by four independent radiologists.The images of specks groups,nylon fibers and masses was assessed by the four experienced readers at the criterion of American College of Radiology.Results The detection of specks groups,nylon fibers and masses were statistically different at the contrast mode and standard mode (F =41.321,P ＜ 0.05),further at the contrast mode and dose mode.The detection of specks groups、nylon fibers and masses were not statistically different( P ＞ 0.05 ) at standard mode and dose mode,but the radiation doses were different.The ESD at standard mode and dose mode was 4.5 and 3.15 mGy,respectively.The AGD of standard mode and dose mode was 1.18 mGy and 0.78 mGy,respectively.Conclusions The standard mode and dose mode of FFDM might be fit for most patients,especially at the dose mode.Contrast mode of FFDM should be strictly controled in use.
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Digital mammography has been progressively introduced in screening centers and the concern is to achieve an image of diagnostic value which would be able to detect early changes in the breast tissue. The aim of this study was to evaluate the image quality of mammograms using quantitative and qualitative methods of two FFDM systems with variations in breast thickness and anode/filter combination. This study was done from January to April 2008 with two FFDM systems; Siemens Mammomat NovationDR at Diagnostic Imaging Department, Hospital Kuala Lumpur and Hologic Lorad Selenia at Breast Clinic, National Cancer Society. A CIRS012A tissue equivalent breast phantom (4, 5 and 6 cm) thickness was used to obtain images in the craniocaudal plane with 26-32 kVp and a combination of molybdenum/molybdenum (Mo/Mo) and molybdenum/rhodium (Mo/Rh) anode/filter. For the qualitative evaluation, two independent radiologist with a minimum of five years experience was used to score the images. Wilcoxon Sign Rank Test showed that there are no significant differences (p > 0.05) in image quality between both the FFDM systems. Kappa analysis had a poor agreement between the scores given by the two radiologists. The quantitative analysis using Mann-Whitney test showed that there are significant differences (p < 0.05) between the SNR values of both FFDM systems. Although the qualitative evaluation was similar, the study showed that Lorad Selenia had a significantly superior SNR value, hence would be a better tool to detect early changes in the breast tissue. This study also demonstrated that a lower kVp is more suitable with molybdenum filter and as the breast thickness is increased rhodium filter with higher kVp displayed better quality images.
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Objective To investigate the utility of full-field digital mammography (FFDM) and localization and biopsy in diagnosis of nonpalpable breast cancer. Methods 42 cases with suspect breast cancer by routine film reading but negative clinical palpation were performed localization and biopsy under X-ray orientation and diagnosed with breast cancer by pathology. The characters of those cases were studied.Results Among 42 cases, 5 cases showed micronodules, 8 cases demonstrated local dense infiltration, 11cases had architecture distortion, 18 cases demonstrated micro-calcifications. The type of pathology comprised of intraductal carcinoma (23 cases), tabular carcinoma in situ (2 cases), early infiltration of ductal carcinoma (12 cases), infiltrating ductal carcinoma (3 cases), papilloma carcinoma (2 cases). Conclusion FFDM can clearly show direct and indirect X-ray signs of breast cancer, combined with localization and biopsy the nonpalpable breast cancer can be easily diagnosed.
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Análisis de la introducción de una nueva tecnología en Chile llamada "mamografía full digital o campo completo" para la detección precoz del cáncer de mama no palpable. Esta tecnología se ha desarrollado en Europa, Estados Unidos y en algunos países de Sud América. Se describen las ventajas de la mamografía full digital en la detección de microcalcificaciones comparada con la mamografía convencional. La mamografía digital en campo total permite que se visualice toda la glándula mamaria, desde la piel hasta la pared torácica (1, 2, 3). Entre julio del 2001 y julio del 2002 se estudiaron con mamografía full digital 3.176 pacientes. Se utilizó un mamógrafo digital de campo completo, General Electric Senographe 2000 D. Solo 48 casos disponían de una mamografía convencional reciente. En 10 de las 48 pacientes la mamografía digital detectó microcalcificaciones sospechosas, no visualizadas en mamografía convencional. Estos hallazgos modificaron en algunos casos la conducta de tratamiento en éstas pacientes (3-4).
Introduction of a new technology called "full field digital mammography" (FFDM) for the detection of non palpables breast cancers. The GE Senographe 2000 D is the world`s first all digital mammography system and is installed in Europe, USA and some countries of LatinAmerica. Description of the advantages of full field digital mammography in comparison to conventional Film-Screen Mammography. (FSM) in the study and detection of microcalcifications. Full field digital mammography gives better visibility of the breast, particularly near the skin line , the chest wall and in women with dense breast tissue. Between july 2001 and july 2002, 3.176 patients were studied with full digital mammography with a GE Senographe 2000 D. Only 48 cases had a recently conventional mammography and in 10 of the 48 cases the full digital mammography detected suspicious microcalcifications not seen in conventional mammography. This results changed the patient treatment in some cases.