Optimal technique factors for magnification mammography.

RATIONALE AND OBJECTIVES: Use of small focal spots with low x-ray tube currents may result in very long exposure times and thus result in motion blur in magnification mammography. The authors investigated the reduction in exposure time with increasing x-ray tube kVp and the corresponding decrease in perceived visibility of low-contrast objects in phantom images. METHODS: Exposure times required to radiograph an RMI 156 phantom in a magnification geometry were measured as a function of x-ray tube kVp when operated under automatic exposure control. Magnification images of the RMI 156 phantom were obtained at x-ray tube voltages ranging from 28 to 34 kVp. Five radiology residents ranked the visibility of two borderline fibers and six borderline microcalcification specks using a 5-point scale ranging from excellent to barely visible. RESULTS: Between 28 and 34 kVp, the density of the RMI phantom images was nearly constant with a mean value of 1.32 +/- 0.04. Increasing the x-ray tube voltage from 28 kVp to 34 kVp reduced the exposure time from 1.27 seconds to 0.66 seconds. Image quality at 30 and 32 kVp was not significantly worse than that achieved at 28 kVp. Increasing the x-ray tube voltage to 34 kVp, however, resulted in a statistically significant (P < 0.001) deterioration in the relative visibility of fibers and microcalcification specks. CONCLUSIONS: Magnification mammography performed at 32 kVp will decrease exposure times significantly and result in a microcalcification and fiber visibility that is similar to that achieved at 28 kVp.

Effect of patient support pads on image quality and dose in fluoroscopy.

An investigation was performed of the changes in image quality and patient dose as a result of increasing filtration for fluoroscopy performed under automatic brightness control. Filtration was added either at the x-ray tube housing (i.e., scatter-free geometry) or adjacent to a tissue equivalent phantom simulating the patient (i.e., with-scatter geometry). Patient doses were expressed in terms of the total energy imparted to patients simulated by either a 10 cm (i.e., pediatric) or 20 cm (i.e., adult) acrylic phantoms. Changes in image quality were determined by measuring the relative visibility of circular disks in a Leeds Test Object 10 contrast-detail phantom. In the scatter-free geometry, the addition of 4 mm Al filtration reduced the energy imparted by 27% (10 cm phantom) and 20% (20 cm phantom). In the with-scatter geometry, the corresponding reductions in energy imparted were 17% and 9% for the 10 and 20 cm phantoms, respectively. The visibility of low contrast disks generally decreased as the thickness of the added aluminum increased but the location of the added Al (i.e., with-scatter or scatter-free geometry) had no significant effect on the resultant image quality. These results demonstrate that the use of patient support pads with a thickness of approximately 4 mm Al will generally have an adverse impact on fluoroscopic image quality and result in modest reductions (approximately 10%) of adult patient doses.