Screen-Film and Digital Mammography Bob Pizzutiello, MS, FAAPM, FACMP Upstate Medical Physics for...
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Transcript of Screen-Film and Digital Mammography Bob Pizzutiello, MS, FAAPM, FACMP Upstate Medical Physics for...
Screen-Film and Digital Mammography
Bob Pizzutiello, MS, FAAPM, FACMP
Upstate Medical Physics
for our patients…The Image Still Matters!
Handouts at http://www.upstatemp.com/
Physician
Technologist
Medical Physicist
The Team Approach
Which image would you prefer?
Outline
• Contrast• Blur• Noise• Artifacts• Dose
Image Characteristics
SFM - FFDM To optimize Image Quality
and Radiation Dose
CNR - SNR
Technical Tips
SFM = Screen-film MammographyFFDM = Full Field Digital Mammography
•Screen-film Mammography• Film is used for image
• Acquisition• Display• Storage
•Digital Mammography• Separate devices used for
• Acquisition• Display• Storage
Image Characteristics
• Contrast• Blur• Noise• Artifacts• Dose
Contrast
A - Black Background
B - Dense Glandular Tissue
C - Fatty tissue
Higher Contrast Lower Contrast
Radiographic Contrast• Difference in OD between areas of interest on
the mammogram• Determined by Subject Contrast and
Film Contrast
Log E
Op
tical Den
sity
• X-ray exposure incident on the screen is converted into shades of gray (film)
• Areas that receive the Maximum radiation exposure turn film black
• Areas that receive the Minimum radiation exposure makes film clear (appears white)
Black background
Dense
Fatty
Optical D
ensity
Log E
Subject Contrast
Ratio of number of x-ray photons in the aerial image corresponding to different regions of the breast
Log E
Optical D
ensity
Film Contrast
Log E
Optical D
ensity
• Translates different amounts of screen light to different film Optical Density
• Slope of D-Log E curve
Film Contrast and Compression
• Images of thicker breasts have lower contrast
• Hence, compression improves contrast• Compression also moves objects closer to the
image receptor (less blur)• Compression reduces dose, since less
radiation is required to image a thinner breast
• Compression also improves imaging by improving separation of overlapping structures
70mm40mm
10 mm lesionA C
B DFilm
Film Contrast and LatitudeThe Tradeoff
• Latitude: the range of film exposures for a readable image – Not too light– Not too dark
Log E
Op
tical Den
sity
Range of acceptable exposure
Range of acceptable
optical density
Film Contrast and LatitudeThe Tradeoff
• High Film Contrast inherently means Low Latitude
• SF imaging is limited by these characteristics of the film
Contrast in FFDM• Display contrast can be adjusted as high as
desirable. • Small Window Width (WW) = large display
contrast
• Image display can be adjusted multiple times to view different areas of the breast (e.g., fatty and dense regions) by adjusting the Window Level (WL)
• Since there is essentially no limit on display contrast, subject contrast is less important, so beam energy can be higher• Shorter exposure times• Lower AGD
SFM Contrast Summary
• Subject Contrast creates differences in x-ray absorption
• Film Contrast amplifies those differences• Need adequate Radiographic Contrast to
visualize abnormalities• High Contrast means low latitude• Darker (regions of) mammograms have
better contrast - and conversely• Compression improves contrast• Challenge: balance film characteristics to
produce a diagnostic quality image
Image Blur
Image Blur
• Contact imaging
• Motion– Exposure
time– Compression
• Focal Spot– Size– Object
LocationA
B
Same for SFM and FFDM
A
B
AB
Objects that are closer to the image receptor have less blur and are not magnified
Magnification
• Motion• Exposure time• Compression• Increase kVp• Focal Spot• Size• Object
Location
Compressed breast
X-ray tube
Film
a b
c
e d
X-ray target
Compression paddle
MagnificationStand
Film
Blur region
Noise
Noise• Any undesired variation in image
background• Most commonly caused by insufficient
number of x-ray photons used to create the image
• Noise limits visibility of low-contrast objects
• We could produce images with much lower radiation dose, but they would have more noise
• Same for SFM and FFDM, but since contrast is not an issue for FFDM, want more signal to detector
Low and High Noise Images
Low and High Noise Images
Artifacts
Plus density (black) artifacts– Additional exposure of film granules– Light leaks– Static – Pressure from rollers
Minus density (white) artifacts– Objects that absorb x-rays or
light– Dust (very common)– Eye glasses– Nose– Fingerprints– Screen scratches or stains
• Measure optical density in several locations with a spot densitometer to determine quantitatively if a mammogram is underexposed.
• If the readings in the densest glandular area of the film are consistently less than 1.0, the mammogram is underexposed.
• Increase the density control (not kVp) to make the image darker.
Technical Tip #1
Fatty Tissue Region
Dense Tissue Region
Mammogram exposure level
Optical Density
Film Contrast
Optical Density
Film Contrast
Under-exposed 1.10 3.5 0.8 2.8
Appropriately exposed
2.00 4.5 1.05 3.5
ExampleNote that actual values may vary with the film used
How do we maintain consistent image quality ?
Technical Tip #2
• Goal: consistent background density• When Phantom Image BD and DD vary
(and mAs remains constant), • Obtain phantom images at the next higher
or lower density control setting needed to achieve the desired BD.
• Post the control booth (or alter the default AEC settings) to use this density control until further notice.
• Sign and date the note.
How can we help the radiologists to see abnormalities
in a mammogram ?
Technical Tip #3
• To assure optimal perception of well exposed SF mammograms, use viewboxes with sufficient brightness (luminance) to permit the observer to operate in day vision, even when viewing darker mammograms.
• ACR recommends that mammography viewboxes produce at least 3,000 cd/m2.
• Many facilities now use viewboxes that produce > 5,000 cd/m2 to optimally visualize darker mammograms.
Technical Tip #4
• For both SF and Digital mammography, • To minimize glare, maintain subdued
lighting in the reading room and mask each mammogram using fully exposed mammography film, sliding masking panels or “hand held tunnel viewers”.
• Technologists should use similar viewboxes (and eventually monitors) to assess overall image quality.
What should I do when the
exposure time seems long ?
Technical Tip #5• If exposure times exceed about 2
seconds, increase the kVp but do not change the density control (aka the “2-second rule” ),
• Listen to the exposure beep. When in doubt...
• Divide the post-exposure mAs by the mA to obtain the exposure time.
• To do this, you must know the mA (for large and small focal spots) of each unit in your department or practice.
Contact Mammography is 26 kVp, 225 mAs too long?
Unit 1 Unit 2 Unit 3
100 mA 80 mA 150 mA
225 mAs
2.25 sec
225 mAs
2.8 sec
225 mAs
1.5 sec
Copyright ©Radiological Society of North America, 1999
Hogge, J. P. et al. Radiographics 1999;19:503-522
• Screen-Film Mammo
• ACR Phantom Scores
• Optical Density & Contrast
• FFDM
• ACR Phantom Scores
• Pass/fail requirements differ by vendor
• Signal-to-Noise Ratio (SNR)
• Contrast-to-Noise Ratio (CNR)
Image Quality
ACR Phantom Imaging
GE & Fuji Lorad & Siemens
Fibers 4 5
Specks 3 4
Masses 3 4
Image Quality
Courtesy Eric Berns, PhD
Selenia 7.4 Test Procedure• It is important for performing this test that the
kVp and Filter selection is done at a thickness of 4.5 cm.
• Using the alternate test procedure guarantees the correct AEC behavior for the test because:• Selenia Auto-kV and Auto-Filter modes, kV and filter
selections are strictly controlled by compression thickness.
• The mAs value is determined by a short pre-exposure in all AEC modes.
• Following the steps in the alternate test procedure is clinically equivalent to acquiring the phantom image at 4.5 cm compression thickness using Auto-Filter or Auto-kV.
Image Quality
Fuji FCRm
GE 2000D,
DS, Essential
Hologic
SeleniaSiemens Novation
Manual Techniques X
Clinical Technique X Sort of… Sort of…
CNR X X X X
Courtesy Eric Berns, PhD
• Signal-to-Noise Ratio (SNR)
• Variation in background for uniform exposure
• Signal = average pixel value
• Noise = standard deviation
• SNR =
• SNR must be > 40
“What exactly is CNR and SNR”?
Average Signal Value – DC offsetStandard Deviation
Noise and SD ?
SD = 2.3
SD = 3.4
SD = 5.1
• Contrast-to-Noise Ratio (CNR)
• Similar to Density Difference (Film)
• Contrast = Difference in pixel values (bkg-disc)
• Noise = standard deviation
• CNR =
CNR
Mean(bkg) – Mean (disc)Standard Deviation (bkg)
•ACR Phantom Imaging
•Manual technique
(Mo/Mo, 26 kVp, 125 mAs)
•Score the processed image
• Acquisition workstation
• Each monitor of the RWS
• Laser imager
GE 2000D
Courtesy Eric Berns, PhD
•Contrast-to-Noise Test
(CNR)
•To examine consistency of
CNR ratio measured over time
•Use the raw image
•+ 20% of baseline
Background ROIBackground ROI Mass ROIMass ROI
CNR = (MeanCNR = (Meanbackgroundbackground - Mean - Meanmassmass)/SD)/SDbackgroundbackground
GE 2000D
Courtesy Eric Berns, PhD
CNR & MTF (DS, Essential)
Courtesy John Sandrik
Courtesy John Sandrik
Courtesy John Sandrik
•Contrast-to-Noise Test (CNR)
•To examine consistency of CNR measured over time
•Use 4 cm acrylic & 0.2 mm Al
•Manual technique (Mo/Mo, 26 kVp, 125 mAs)
•Calculate CNR using software
•+ 20% of baseline
Fuji FCRm
Courtesy Eric Berns, PhD
Rememebr this from Kodak?
Service Bulletin was updated • Recommendations for– Starter – now 3 oz per gallon,
across the board– New replenishment rates– Be sure your service people follow
these
• Kodak MinR Guide– Processor QC before-after service– Checklist available– http://www.kodak.com/global/
plugins/acrobat/en/health/pdf/prod/Mammo/M3-103.pdf
Summary
• Contrast• Blur• Noise• Artifacts• Dose
Image Characteristics
To optimize Image Quality
and Radiation Dose
CNR - SNR
Technical Tips
Thank you to the RMA!For many years of
service to the mammography
community.
Now for some well-deserved rest…
http://www.upstatemp.comclick Education & Training
Look for a link “RMA May 1, 2010”
http://www.upstatemp.com/