Quality Controls in Digital Mammography protocol of the EFOMP Mammo Working group.

This article aims to present the protocol on Quality Controls in Digital Mammography published online in 2015 by the European Federation of Organisations for Medical Physics (EFOMP) which was developed by a Task Force under the Mammo Working Group. The main objective of this protocol was to define a minimum set of easily implemented quality control tests on digital mammography systems that can be used to assure the performance of a system within a set and acceptable range. Detailed step-by-step instructions have been provided, limiting as much as possible any misinterpretations or variations by the person performing. It is intended that these tests be implemented as part of the daily routine of medical physicists and system users throughout Europe in a harmonised way so allowing results to be compared. In this paper the main characteristics of the protocol are illustrated, including examples, together with a brief summary of the contents of each chapter. Finally, instructions for the download of the full protocol and of the related software tools are provided.

Objective criteria for acceptability and constancy tests of digital subtraction angiography.

PURPOSE: Demonstrate an objective procedure to quantify image quality in digital subtraction angiography (DSA) and suggest thresholds for acceptability and constancy tests. METHODS: Series of images were obtained in a DSA system simulating a small (paediatric) and a large patient using the dynamic phantom described in the IEC and DIN standards for acceptance tests of DSA equipment. Image quality was quantified using measurements of contrast-to-noise ratio (CNR). Overall scores combining the CNR of 10-100 mg/ml Iodine at a vascular diameter of 1-4 mm in a homogeneous background were defined. Phantom entrance surface air kerma (Ka,e) was measured with an ionisation chamber. RESULTS: The visibility of a low-contrast vessel in DSA images has been identified with a CNR value of 0.50 ± 0.03. Despite using 14 times more Ka,e (8.85 vs 0.63 mGy/image), the protocol for large patients showed a decrease in the overall score CNRsum of 67% (4.21 ± 0.06 vs 2.10 ± 0.05). The uncertainty in the results of the objective method was below 5%. CONCLUSION: Objective evaluation of DSA images using CNR is feasible with dedicated phantom measurements. An objective methodology has been suggested for acceptance tests compliant with the IEC/DIN standards. The defined overall scores can serve to fix a reproducible baseline for constancy tests, as well as to study the device stability within one acquisition series and compare different imaging protocols. This work provides aspects that have not been included in the recent European guidelines on Criteria for Acceptability of Medical Radiological Equipment.

Experimental estimates of peak skin dose and its relationship to the CT dose index using the CTDI head phantom.

A straightforward method is presented to estimate peak skin doses (PSDs) delivered by computed tomography (CT) scanners. The measured PSD values are related to the well-known volume CT dose index (CTDI(vol)), displayed on the console of CT scanners. PSD measurement estimates were obtained, in four CT units, by placing radiochromic film on the surface of a CTDI head phantom. Six different X-ray tube currents including the maximum allowed value were used to irradiate the phantom. PSD and CTDI(vol) were independently measured and later related to the CTDI(vol) value displayed on the console. A scanner-specific relationship was found between the measured PSD and the associated CTDI(vol) displayed on the console. The measured PSD values varied between 27 and 136 mGy among all scanners when the routine head scan parameters were used. The results of this work allow relating the widely used CTDI(vol) to an actual radiation dose delivered to the skin of a patient.

A phantom using titanium and Landolt rings for image quality evaluation in mammography.

A phantom for image quality evaluation of digital mammography systems is presented and compared to the most widely used phantoms in Europe and the US. The phantom contains objects for subjective detection of Landolt rings (four-alternative, forced-choice task) and for objective calculation of signal-difference-to-noise ratios (SDNR), both in a titanium background within a 12-step wedge. Evaluating phantom images corresponding to exposures between 15 and 160 mAs (average glandular dose between 0.2 and 2 mGy), the resulting scores were compared to the scores obtained following the European EPQC and American College of Radiology (ACR) protocols. Scores of the Landolt test equal to 19 and 8.5 and SDNR equal to 20 and 11 were found to be equivalent to the acceptable limiting values suggested by EPQC and ACR. In addition, the Landolt and SDNR tests were shown to take into account the anatomical variations in thickness and tissue density within the breast. The simplified evaluation method presented was shown to be a sensitive, efficient and reliable alternative for image quality evaluation of mammography systems.

X-ray properties of an anthropomorphic breast phantom for MRI and x-ray imaging.

The purpose of this study is to characterize the x-ray properties of a dual-modality, anthropomorphic breast phantom whose MRI properties have been previously evaluated. The goal of this phantom is to provide a platform for optimization and standardization of two- and three-dimensional x-ray and MRI breast imaging modalities for the purpose of lesion detection and discrimination. The phantom is constructed using a mixture of lard and egg whites, resulting in a variable, tissue-mimicking structure with separate adipose- and glandular-mimicking components. The phantom can be produced with either a compressed or uncompressed shape. Mass attenuation coefficients of the phantom materials were estimated using elemental compositions from the USDA National Nutrient Database for Standard Reference and the atomic interaction models from the Monte Carlo code PENELOPE and compared with human values from the literature. The image structure was examined quantitatively by calculating and comparing spatial covariance matrices of the phantom and patient mammography images. Finally, a computerized version of the phantom was created by segmenting a computed tomography scan and used to simulate x-ray scatter of the phantom in a mammography geometry. Mass attenuation coefficients of the phantom materials were within 20% and 15% of the values for adipose and glandular tissues, respectively, which is within the estimation error of these values. Matching was improved at higher energies (>20 keV). Tissue structures in the phantom have a size similar to those in the patient data, but are slightly larger on average. Correlations in the patient data appear to be longer than those in the phantom data in the anterior-posterior direction; however, they are within the error bars of the measurement. Simulated scatter-to-primary ratio values of the phantom images were as high as 85% in some areas and were strongly affected by the heterogeneous nature of the phantom. Key physical x-ray properties of the phantom have been quantitatively evaluated and shown to be comparable to those of breast tissue. Since the MRI properties of the phantom have been previously evaluated, we believe it is a useful tool for quantitative evaluation of two- and three-dimensional x-ray and MRI breast imaging modalities for the purpose of lesion detection and characterization.

Comparison of interpolation functions to improve a rebinning-free CT-reconstruction algorithm.

The robust algorithm OPED for the reconstruction of images from Radon data has been recently developed. This reconstructs an image from parallel data within a special scanning geometry that does not need rebinning but only a simple re-ordering, so that the acquired fan data can be used directly for the reconstruction. However, if the number of rays per fan view is increased, there appear empty cells in the sinogram. These cells need to be filled by interpolation before the reconstruction can be carried out. The present paper analyzes linear interpolation, cubic splines and parametric (or "damped") splines for the interpolation task. The reconstruction accuracy in the resulting images was measured by the Normalized Mean Square Error (NMSE), the Hilbert Angle, and the Mean Relative Error. The spatial resolution was measured by the Modulation Transfer Function (MTF). Cubic splines were confirmed to be the most recommendable method. The reconstructed images resulting from cubic spline interpolation show a significantly lower NMSE than the ones from linear interpolation and have the largest MTF for all frequencies. Parametric splines proved to be advantageous only for small sinograms (below 50 fan views).

Transition from screen-film to digital radiography: evolution of patient radiation doses at projection radiography.

PURPOSE: To retrospectively evaluate patient radiation doses in projection radiography after the transition to computed radiography (CR) in the authors' hospital. MATERIALS AND METHODS: The hospital's ethical committee approved the study and waived informed consent. In 2001, a dose reduction initiative was implemented, which involved collecting radiographic parameters, calculating patient entrance doses, and monitoring changes with an online computer, and a training program for radiographers was conducted. A database with 204 660 patient dose values was used to compute changes in patient doses over time. Sample sizes ranged from 1800 to 23 000 examinations. Doses were compared with European and American reference values. Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis. RESULTS: Median values for patient entrance doses increased 40%-103% after implementation of CR. Initial increases were corrected during the 1st year, and additional dose decreases were achieved after the dose reduction initiative was launched. At present, doses range between 15% and 38% of the European diagnostic reference levels established for screen-film radiography and between 28% and 41% of the reference values recommended by the American Association of Physicists in Medicine, representing an effective 20%-50% reduction in the initial values for CR. CONCLUSION: Though patient doses can increase considerably during the transition from conventional screen-film radiography to CR, dose management programs, including specific training of radiographers and patient dose audits, allow for reductions of the previous values.