AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Digital Mammography Update: Design Digital Mammography Update: Design and Characteristics of Current Systems and Characteristics of Current Systems
Kalpana M. Kanal, Ph.D., DABRKalpana M. Kanal, Ph.D., DABRAssistant ProfessorAssistant Professor
Department of RadiologyDepartment of RadiologyUniversity of WashingtonUniversity of Washington
Seattle, WashingtonSeattle, Washington
AAPM Annual Meeting 2009 AAPM Annual Meeting 2009 –– Anaheim, CAAnaheim, CA
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Educational ObjectivesEducational Objectives
Understand the physics of digital detector technologyUnderstand the physics of digital detector technologyRecognize that vendors use varying detector technology Recognize that vendors use varying detector technology in FFDM systemsin FFDM systemsAppreciate the advantages and disadvantages of digital Appreciate the advantages and disadvantages of digital mammography systems mammography systems Understand briefly the image quality metrics such as Understand briefly the image quality metrics such as DQE and MTFDQE and MTF
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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ResourcesResourcesDoug PfeifferDoug Pfeiffer, MS, DABR, MS, DABRDigital Mammography: An Digital Mammography: An overview overview –– Dr. MaheshDr. Mahesh(Radiographics (Radiographics 2004;24:17472004;24:1747--1760)1760)Fundamentals of Digital Fundamentals of Digital
Mammography Primer Mammography Primer –– Dr. Dr. SmithSmith (Hologic Inc)(Hologic Inc)Digital Mammography Digital Mammography ––Pisano and YaffePisano and Yaffe (Radiology (Radiology 2005; 234:3532005; 234:353--262)262)Bloomquist and Yaffe Bloomquist and Yaffe –– Med Med Phys 33 (3), 2006Phys 33 (3), 2006
IntroductionIntroduction
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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FullFull--Field Digital Mammography (FFDM)Field Digital Mammography (FFDM)
c.f. www.gehealthcare.com/rad/xr/education/dig_xray_intro.htmlc.f. www.gehealthcare.com/rad/xr/education/dig_xray_intro.html
- Screen-Film
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FullFull--Field Digital Mammography (FFDM)Field Digital Mammography (FFDM)
Wide dynamic range Wide dynamic range (1000:1) compared with (1000:1) compared with SFM (40:1)SFM (40:1)Dynamic image Dynamic image manipulationmanipulationAbility to postAbility to post--processprocessSoftSoft--copy read copy read accompanied by accompanied by computercomputer--aidedaided--diagnosis (CAD)diagnosis (CAD)3D imaging3D imaging
Radiographics 2004:24,1749
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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FullFull--Field Digital Mammography (FFDM)Field Digital Mammography (FFDM)
AdvantageAdvantageEach component of the mammographic process can Each component of the mammographic process can be optimized with digital mammographybe optimized with digital mammography
Radiographics 2004:24,1750
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SFM vs. FFDMSFM vs. FFDM
SFM: Half mAs, Automatic exposure control, Double mAs
FFDM: Same technique factors as SFM, W/L adjusted
Radiographics 2004:24,1750
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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SFM vs. FFDMSFM vs. FFDM
Radiographics 2004:24,1751
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FDA and Digital MammographyFDA and Digital Mammography
Butler Butler -- http://www.acr.org/accreditation/mammography/rsna07presentationhttp://www.acr.org/accreditation/mammography/rsna07presentation.aspx.aspx
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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MQSA ScorecardMQSA Scorecard
Certification statistics, as of July 1, 2009 Certification statistics, as of July 1, 2009 Total certified facilities / Total accredited unitsTotal certified facilities / Total accredited units
8,714 / 12,8758,714 / 12,875Certified facilities with FFDM units / Accredited FFDM Certified facilities with FFDM units / Accredited FFDM unitsunits
4,659 / 6,9644,659 / 6,96453%53% certified facilities with FFDM unitscertified facilities with FFDM units54%54% accredited FFDM units (38% last year)accredited FFDM units (38% last year)
http://www.fda.gov/cdrh/mammography/scorecardhttp://www.fda.gov/cdrh/mammography/scorecard--statistics.htmlstatistics.html
Technologies for FFDMTechnologies for FFDM
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Technologies for FFDMTechnologies for FFDMIndirect CaptureIndirect Capture
a scintillator such as a scintillator such as cesium iodide (CsI) cesium iodide (CsI) absorbs xabsorbs x--rays and rays and generates a light generates a light scintillationscintillationdetected by an array of detected by an array of photodiodes or chargephotodiodes or charge--coupled devices (CCDs)coupled devices (CCDs)Resolution degradation Resolution degradation
http://www.hologic.com/wh/pdf/R-LM-016_Radiology_Management.pdf
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Technologies for FFDMTechnologies for FFDMDirect CaptureDirect Capture
XX--ray photons are directly ray photons are directly captured by a captured by a photoconductor such as photoconductor such as amorphous selenium (aamorphous selenium (a--Se), which converts the Se), which converts the absorbed xabsorbed x--rays directly to rays directly to a digital signala digital signalSpatial resolution limited Spatial resolution limited to pixel sizeto pixel size
http://www.hologic.com/wh/pdf/R-LM-016_Radiology_Management.pdf
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Various Approaches in development of Various Approaches in development of FFDM systemsFFDM systems
IndirectIndirectA single flatA single flat--panel scintillator and an amorphous silicon panel scintillator and an amorphous silicon (a(a--Si) diode array Si) diode array –– GE GE Slot scanning with scintillators and CCD arrays Slot scanning with scintillators and CCD arrays –– Fischer Fischer Imaging, now HologicImaging, now HologicPhotostimulable phosphor plates Photostimulable phosphor plates -- FujiFuji
DirectDirectA flatA flat--panel amorphous selenium (apanel amorphous selenium (a--Se) array Se) array –– Hologic, Hologic, SiemensSiemensTiled scintillators with fiberoptic tapers and mosaic CCD Tiled scintillators with fiberoptic tapers and mosaic CCD arrays arrays –– Hologic StereotacticHologic Stereotactic
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Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect CaptureGEGE
GE GE SenographeSenographe 2000D Full Field 2000D Full Field Digital Mammography System on Digital Mammography System on 01/28/0001/28/00
GE GE SenographeSenographe DS Full FieldDS Full FieldDigital Mammography (FFDM) Digital Mammography (FFDM) System System -- 02/19/0402/19/04
GE Senographe Essential Full GE Senographe Essential Full Field Digital Mammography Field Digital Mammography (FFDM) System (FFDM) System -- 04/11/0604/11/06 (larger detector)
Fig. Ref: GE DS QC manualFig. Ref: GE DS QC manual
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect CaptureGEGE
In this system, the digital In this system, the digital detector array is constructed detector array is constructed from an afrom an a--Si thinSi thin--film transistor film transistor (TFT) matrix deposited on a (TFT) matrix deposited on a glass substrateglass substrateThe CsI scintillator is deposited The CsI scintillator is deposited on the aon the a--Si detectorSi detectorEach lightEach light--sensitive diode sensitive diode element is connected by TFTs element is connected by TFTs to a control and a data line so to a control and a data line so that charge produced in the that charge produced in the diode is read out in response to diode is read out in response to light emission from the scintillatorlight emission from the scintillator
Radiographics 2004:24,1753
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Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect CaptureGEGE
Radiographics 2004:24,1753
141414141414Bit DepthBit Depth
5 lp/cm5 lp/cm5 lp/cm5 lp/cm5 lp/cm5 lp/cmLimiting Limiting Spatial Spatial
ResolutionResolution
2394 x 3062 2394 x 3062 pixels (14 MB)pixels (14 MB)
1914 x 2294 1914 x 2294 pixels (9 MB)pixels (9 MB)
1914 x 2294 1914 x 2294 pixels (9 MB)pixels (9 MB)
Image sizeImage size
100 100 µµmm100 100 µµmm100 100 µµmmPixel sizePixel size
24.0 x 30.724.0 x 30.719.2 x 23.019.2 x 23.019.2 x 23.019.2 x 23.0Detector Detector sizesize
EssentialEssentialDSDS2000D2000D
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect CaptureGE GE –– Advantages and DisadvantagesAdvantages and Disadvantages
Close bonding between CsI and aClose bonding between CsI and a--Si ensures minimal Si ensures minimal light losslight lossStrong signal from the Si diode array yields higher Strong signal from the Si diode array yields higher detective quantum efficiencydetective quantum efficiencyDetector is linear over a wide range (10Detector is linear over a wide range (1055) of exposures) of exposures
Limiting factor is the large pixel size (100 Limiting factor is the large pixel size (100 μμm)m)Smaller pixel sizes improve spatial resolution but at the Smaller pixel sizes improve spatial resolution but at the cost of increased image noise and decreased SNR for cost of increased image noise and decreased SNR for the same breast dosethe same breast dosePossibility of ghosting in imagesPossibility of ghosting in images
Radiographics 2004:24,1753
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PSP PSP
Base supportBase support
plate exposure:plate exposure:create latent imagecreate latent image
xx--ray exposureray exposure
Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect CaptureComputed Radiography Computed Radiography –– Fuji (7/10/2006)Fuji (7/10/2006)
(Barium fluorobromide)(Barium fluorobromide)
Technology introduced in 1981Technology introduced in 1981
Pfeiffer
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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plate erasure:plate erasure:remove residual signalremove residual signal
light erasurelight erasure
plate readout:plate readout:extract latent imageextract latent image
laser beam scanlaser beam scan
Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect CaptureComputed Radiography Computed Radiography –– FujiFuji
Technology introduced in 1981Technology introduced in 1981
Pfeiffer
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Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect CaptureComputed Radiography Computed Radiography –– FujiFuji
Fuji FCRm, Dual-side reader
10 lp/mm10 lp/mmSpatial Spatial ResolutionResolution
14 bits14 bitsDynamic Dynamic RangeRange
3328 x 4096 3328 x 4096 pixels (24 MB)pixels (24 MB)Image sizeImage size
50 50 µµmmPixel sizePixel size
18 x 2418 x 2424 x 3024 x 30
Detector Detector sizesize
http://www.fujimed.com/
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Fuji Fuji -- Dual Side ReadoutDual Side Readout
laser beamlaser beam
mirrormirror
Protective Protective layerlayer
photodetectorphotodetector
photodetectorphotodetector
opticalopticalguideguide
TransparentTransparentsupport support
PhosphorPhosphorlayerlayer
emissionemission
opticalopticalguideguide
Image courtesy: Doug Pfeiffer
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Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect CaptureFuji Fuji –– Advantages and DisadvantagesAdvantages and Disadvantages
Advantage of the CR mammo system is that filmAdvantage of the CR mammo system is that film--screen screen cassettes can be replaced by CR cassettes without replacing cassettes can be replaced by CR cassettes without replacing the entire systemthe entire systemBoth small and large cassettes can be accommodated by the Both small and large cassettes can be accommodated by the readerreaderDual side reader, 50 Dual side reader, 50 μμm pixel sizem pixel size
Disadvantage Disadvantage -- Effective pixel size influenced by phosphor Effective pixel size influenced by phosphor thickness, light diffusion within phosphor, laser light scatter thickness, light diffusion within phosphor, laser light scatter & & diameter of laser beamdiameter of laser beamTechnologist time on processing of imagesTechnologist time on processing of imagesNoise associated with the low collection efficiency of emitted Noise associated with the low collection efficiency of emitted lightlight
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect Capture
A narrow slotA narrow slot--detector and detector and a narrow fan beam of xa narrow fan beam of x--rays are scanned rays are scanned synchronously across the synchronously across the full field of view to cover full field of view to cover the entire breastthe entire breastSystem consists of System consists of phosphor (thalliumphosphor (thallium--activated CsI) with a activated CsI) with a fiberoptic coupling to a fiberoptic coupling to a CCDCCD
SenoScanSenoScan; Fischer Imaging ; Fischer Imaging –– 9/25/019/25/01
Radiographics 2004:24,1752
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Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect Capture
Seibert, AAPM Meeting Handout
SenoScanSenoScan; Fischer Imaging (now ; Fischer Imaging (now HologicHologic))
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Technologies for FFDM Technologies for FFDM –– Indirect CaptureIndirect Capture
Compact detector that is less expensive compared to Compact detector that is less expensive compared to othersothersExcellent scatter rejection due to small volume of breast Excellent scatter rejection due to small volume of breast exposed at any timeexposed at any timeNo grid needed therefore less doseNo grid needed therefore less doseLonger compression since scan times are longer Longer compression since scan times are longer (approx. 6 sec)(approx. 6 sec)Powerful tubes, elaborate signal readout and image Powerful tubes, elaborate signal readout and image reconstruction requiredreconstruction required
(SenoScan; Fischer Imaging (now Hologic))(SenoScan; Fischer Imaging (now Hologic))Advantages and DisadvantagesAdvantages and Disadvantages
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Comparison Comparison –– Indirect CaptureIndirect Capture
3328 x 4096 3328 x 4096 pixels (24 MB)pixels (24 MB)
Fuji Fuji FCRFCRmm
PSP platePSP plate
10 lp/mm10 lp/mm
50 50 µµmm
18 x 2418 x 2424 x 3024 x 30
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Technologies for FFDM Technologies for FFDM –– Direct CaptureDirect Capture
aa--Se, a good photoconductor is deposited directly onto Se, a good photoconductor is deposited directly onto the athe a--Si TFT substrate enabling direct captureSi TFT substrate enabling direct captureThe aThe a--Se detector directly converts xSe detector directly converts x--rays to electronrays to electron--hole pairs hole pairs The aThe a--Si TFT converts the electronSi TFT converts the electron--hole pairs to hole pairs to electronic signalelectronic signal
aa--Se Array (Selenia, Se Array (Selenia, HologicHologic) ) –– 10/2/0110/2/01
http://www.hologic.com/wh/digisel.htm
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Technologies for FFDM Technologies for FFDM –– Direct CaptureDirect CaptureFlatFlat--Panel aPanel a--Se Array (Selenia, Hologic)Se Array (Selenia, Hologic)
http://www.hologic.com/wh/digisel.htm
> 7 lp/cm> 7 lp/cmSpatial Spatial ResolutionResolution
14 bits14 bitsDynamic Dynamic RangeRange
3328 x 4096 3328 x 4096 pixels (24 MB)pixels (24 MB)Image sizeImage size
70 70 µµmmPixel sizePixel size24.0 x 29.024.0 x 29.0Detector sizeDetector size
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Technologies for FFDM Technologies for FFDM –– Direct CaptureDirect Capture
Advantage is that the detector response function Advantage is that the detector response function maintains its sharpness even with increasing thicknessmaintains its sharpness even with increasing thicknessHigh MTF and DQE can be achievedHigh MTF and DQE can be achieved
Potential weaknesses are the need for high biasing Potential weaknesses are the need for high biasing voltage, drifting of the dark signal and cost of detectorvoltage, drifting of the dark signal and cost of detectorInherent sharpness of detector may also increase the Inherent sharpness of detector may also increase the severity of aliasing artifacts associated with severity of aliasing artifacts associated with undersampling on any digital detectorundersampling on any digital detector
FlatFlat--Panel aPanel a--Se Array (Selenia, Hologic)Se Array (Selenia, Hologic)Advantages and DisadvantagesAdvantages and Disadvantages
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Technologies for FFDM Technologies for FFDM –– Direct CaptureDirect Captureaa--Se Array (Mammomat Novation, Siemens Se Array (Mammomat Novation, Siemens –– 8/20/04)8/20/04)
http://www.medical.siemens.com
> 7 lp/mm> 7 lp/mmSpatial Spatial ResolutionResolution
70 70 µµmm
24.0 x 29.024.0 x 29.0
14 bits14 bitsDynamic Dynamic RangeRange
3328 x 4096 3328 x 4096 pixels (24 MB)pixels (24 MB)Image sizeImage size
Pixel sizePixel size
Detector sizeDetector size
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Comparison Comparison –– Direct CaptureDirect Capture
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Technologies for FFDMTechnologies for FFDM
http://www.hologic.com/oem/pdf/DROverviewR-007_Nov2000.pdf
Fuji/Kodak/Fuji/Kodak/
Agfa/PhilipsAgfa/Philips
Fischer Fischer (Hologic)(Hologic)
GEGE HologicHologic
SiemensSiemens
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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MTF, DQE, DOSEMTF, DQE, DOSE
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MTFMTFMTF is a measure of signal transfer over a range of MTF is a measure of signal transfer over a range of frequencies and quantifies spatial resolutionfrequencies and quantifies spatial resolution
Yaffe - Radiology 2005:234,353
Type 1 Type 1 –– CsI (TFT)CsI (TFT)
Type 2 Type 2 –– CsI (CCD)CsI (CCD)
Type 3 Type 3 –– CRCR
Type 4 Type 4 –– aa--SeSe
http://www.hologic.com/wh/pdf/R-LM-016_Radiology_Management.pdf
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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MTFMTFBloomquist et al Bloomquist et al -- DMIST trialDMIST trial
Bloomquist – Medical Physics 2006:33 (3), 719
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DQEDQEDetective Quantum Efficiency (DQE) measures SNR Detective Quantum Efficiency (DQE) measures SNR transfer through the system as a function of spatial transfer through the system as a function of spatial frequency and is a good measure of dose efficiencyfrequency and is a good measure of dose efficiency
http://www.hologic.com/wh/pdf/R-LM-016_Radiology_Management.pdf
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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FFDM FFDM –– Radiation DoseRadiation Dose
Bloomquist et al Bloomquist et al -- DMIST trialDMIST trial
Bloomquist – Medical Physics 2006:33 (3), 719
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Storage and EconomicsStorage and Economics
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Storage of Digital ImagesStorage of Digital Images
Radiographics 2004:24,1755
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Display of Digital ImagesDisplay of Digital Images
Radiographics 2004:24,1757
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Advantages and DisadvantagesAdvantages and Disadvantages
AdvantagesAdvantagesOptimize postOptimize post--processing of imagesprocessing of imagesPermit computerPermit computer--aided detection to improve the aided detection to improve the detection of lesionsdetection of lesionsStorage of images easierStorage of images easier
DisadvantagesDisadvantagesImage display and system costImage display and system costLimiting spatial resolution is inferior to film, 5Limiting spatial resolution is inferior to film, 5--13 13 lp/mm vs. 20 lp/mmlp/mm vs. 20 lp/mm
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Economics of FFDMEconomics of FFDM
SFM systems cost well under $100,000SFM systems cost well under $100,000FFDM systems cost in the range of $300,000 FFDM systems cost in the range of $300,000 -- $450,000$450,000
Reimbursement rates approved by Medicare are Reimbursement rates approved by Medicare are decreasing every yeardecreasing every year
Plain FilmPlain Film ScreeningScreening 2008 2008 -- $83.03, 2009 $83.03, 2009 -- $81.51$81.51DigitalDigital ScreeningScreening 2008 2008 -- $133.69, 2009 $133.69, 2009 -- $129.84 $129.84
DiagnosticDiagnostic 2008 2008 -- $151.21, 2009 $151.21, 2009 -- $152.56$152.56CADCAD 2008 2008 -- $14.86, 2009 $14.86, 2009 -- $12.26$12.26
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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BenefitsBenefits
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Expected Benefits of FFDMExpected Benefits of FFDM
The costs of FFDM systems should be compared along The costs of FFDM systems should be compared along with the inherent benefits of the digital technology prior with the inherent benefits of the digital technology prior to the purchase:to the purchase:
Reduced recall ratesReduced recall ratesIncreased patient throughputIncreased patient throughputIncreased early detection of breast cancerIncreased early detection of breast cancerDecreased falseDecreased false--negative biopsy resultsnegative biopsy resultsDecreasing film and processing costsDecreasing film and processing costsIncreasing the caseload of each mammography roomIncreasing the caseload of each mammography room
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Clinical Trials and Phantom StudiesClinical Trials and Phantom StudiesLarge screening study screened 49,500 womenLarge screening study screened 49,500 womenDigital Mammographic Imaging Screening TrialDigital Mammographic Imaging Screening Trial (DMIST), (DMIST), funded by NCI and conducted by ACRIN funded by NCI and conducted by ACRIN (http://www.acrin.org/6652_protocol.html)(http://www.acrin.org/6652_protocol.html)
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Future DevelopmentsFuture Developments
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Future DevelopmentsFuture Developments
Dual energy Dual energy CAD integrationCAD integrationTelemammographyTelemammographyTomosynthesisTomosynthesisContrast enhanced digital mammographyContrast enhanced digital mammography
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Future DevelopmentsFuture DevelopmentsTomosynthesisTomosynthesis
Radiology 2005:234:353:362
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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Future DevelopmentsFuture DevelopmentsContrast Enhanced Digital MammographyContrast Enhanced Digital Mammography
Radiology 2005:234:353:362
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TAKE HOME POINTSTAKE HOME POINTS
Different technologies exist for digital systems Different technologies exist for digital systems –– indirect and indirect and directdirectCommercially available FFDM systems vary in technologyCommercially available FFDM systems vary in technologyMany advantages exist for FFDM in comparison to FSMMany advantages exist for FFDM in comparison to FSMMTF and DQE are typically used to characterize FFDM MTF and DQE are typically used to characterize FFDM systemssystemsDose is lower with FFDM compared to FSMDose is lower with FFDM compared to FSMAdvanced applications of FFDM include tomosynthesis, Advanced applications of FFDM include tomosynthesis, contrast enhanced mammography etccontrast enhanced mammography etc
AAPM 2009 Breast Imaging Course -Digital Mammography Update
July 27, 2009
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THANK YOUTHANK YOU