slid e 2 introduction optimizing dose and image quality in...

1

Slide 1

Optimizing Dose andOptimizing Dose andImage Quali ty in Digita lImage Quality in Dig ital

Mammogra phyMammog raphy

Eric A.Eric A. BernsBerns, PhD, PhD

[email protected]@radiology.northwestern.edu

Northwestern University Medical SchoolNorthwestern University Medical SchoolLynn Sage Comprehensive Breast CenterLynn Sage Comprehensive Breast Center

Chicago, ILChicago, IL

Slide 2

AccreditedFFDM units

CertifiedFacilities withFFDM units

Total AccreditedMammo Units

Total CertifiedMammoFacilities

+785

+523

-84

-100

Difference

1,604

1,130

13,556

8,829

August 1, 2006

819

607

13,640

8,929

April 1, 2005

Certified Statistics – 15 Months

Introduc tionIntrodu ction

Slide 3

FFDM vs. Date

0%

2%

4%

6%

8%

10%

12%

Ju l-98 Dec-99 Apr-01 Sep-02 Jan-04 May-05 Oct-06

% Fac w Dig

% Unit s FFDM

GE 2000DGE 2000DApp: Jan 2000App: Jan 2000

FischerFischer SenoscanSenoscanApp: SeptApp: Sept ‘‘0101

LoradLorad CCDCCDApp: MarApp: Mar ‘‘0202

LoradLorad SeleniaSeleniaApp: OctApp: Oct ‘‘0202

SiemensSiemens NovationNovationApp: AugApp: Aug ‘‘0404

GE DSGE DSApp: Feb 2004App: Feb 2004

GE EssentialGE EssentialApp: AprApp: Apr ‘‘0606

FujiFuji FCRmFCRmApp: JulApp: Jul ‘‘0606

Slide 4

�� Cesium IodideCesium Iodide with Silicon Diode Array (GE)with Silicon Diode Array (GE)

�� SeleniumSelenium with Silicon Diode Array (with Silicon Diode Array (LoradLorad, Siemens,, Siemens,

Kodak, Agfa)Kodak, Agfa)

�� Slot Scanning CCDSlot Scanning CCD Array (Fischer)Array (Fischer)

�� Computed RadiologyComputed Radiology (Fuji, Kodak, Konica, Agfa)(Fuji, Kodak, Konica, Agfa)

Detector TypesDetector Types

Introduc tionIntrodu ction

2

Slide 5

EquipmentEquipment

GEGE SenographeSenographe 2000D2000D

Slide 6

GEGE SenographeSenographe DSDS

EquipmentEquipment

Slide 7

GEGE SenographeSenographe EssentialEssential

EquipmentEquipmentSlide 8

�� GEGE SenographeSenographe 2000D & DS & Essential2000D & DS & Essential

–– FOV: 19.2 x 23.0 cm & 24.0 x 31.0 cmFOV: 19.2 x 23.0 cm & 24.0 x 31.0 cm

–– Spatial resolution: 100 microns (5.0Spatial resolution: 100 microns (5.0 lplp/mm)/mm)

EquipmentEquipment

3

Slide 9

LoradLorad SeleniaSelenia


EquipmentEquipment

SiemensSiemens MammomatMammomat NovationNovationDRDR

Slide 11

�� LoradLorad SeleniaSelenia & Siemens& Siemens NovationNovation

–– FOV: 24 x 29 cmFOV: 24 x 29 cm



FischerFischer SenoscanSenoscan

EquipmentEquipment

4

Slide 13

��FischerFischer SenoscanSenoscan

–– FOV: 21 x 29 cm (std), 11 x 15 cm (high res)FOV: 21 x 29 cm (std), 11 x 15 cm (high res)

–– 54 & 27 microns54 & 27 microns –– 9.39.3 lplp/mm in 54/mm in 54 µµm modem mode

–– Scan timeScan time: 5.2 seconds: 5.2 seconds


�� Computed RadiologyComputed Radiology

–– FujiFuji –– FDA approvedFDA approved

–– KodakKodak

–– KonicaKonica

–– AgfaAgfa

EquipmentEquipment

Slide 15

Fuj iFuj i FCRmFCRm

FCSm

Flash Plus IIP m


�� FujiFuji FCRmFCRm

–– FOV: 18 x 24 and 24 x 30 cmFOV: 18 x 24 and 24 x 30 cm


–– 60 to 80 imaging plates per hour60 to 80 imaging plates per hour

EquipmentEquipment

5

Slide 17

KodakKodak DirectViewDirectView CR Mammography SystemCR Mammography System


�� SectraSectra MicrodoseMicrodose–– SlotSlot--scanning photon counter detectorscanning photon counter detector

–– FOV: 24 x 26 cmFOV: 24 x 26 cm


EquipmentEquipment

Slide 19

PlanmedPlanmed NuanceNuance –– Amorphous SeleniumAmorphous Selenium –– 8585 µµmm


•• FDAFDA--ApprovedLaser ImagersApprovedLaser Imagers~ 40~ 40 µµm spotm spot

••Agfa LR5200LaserImager(Wet Chemistry)Agfa LR5200LaserImager (Wet Chemistry)

••Agfa DS4500MAgfa DS4500M

••Kodak8600 LaserImagerKodak8600Laser Imager

••Kodak8610 LaserImagerKodak8610Laser Imager

••Kodak8900Kodak8900

••FujiFuji DrypixDrypix 4000,5000,70004000,5000,7000

••FujiFuji DrypixDrypix FMFM--DP LDP L

••CodonicsCodonicsHorizonHorizon CiCi, GS,SF, GS, SF

••KonicaMinoltaKonicaMinolta DryProDryPro 793793

EquipmentEquipment

6

Slide 21

�� Until recently, workstations came with acquisitionUntil recently, workstations came with acquisition

unitsunits

�� Those days are overThose days are over

�� Spurred by FDA approval of third party RWS, highSpurred by FDA approval of third party RWS, high

resolution displays, and PACSresolution displays, and PACS

�� As a result, FFDM is becoming more a la carte toAs a result, FFDM is becoming more a la carte to

allow best of each (acquisition, RWS, PACS, etc.)allow best of each (acquisition, RWS, PACS, etc.)

WorkstationsWorkstationsSlide 22

�� What is a Multimodality Review Workstation?What is a Multimodality Review Workstation?

Worksta tionsWorkstations

Slide 23

Multim odality Workst ationsMulti modality Workst ations�� FDA Approved Multimodality WorkstationsFDA Approved Multimodality Workstations

–– AGFA IMPAX MA3000AGFA IMPAX MA3000

–– SectraSectra IDS5/mxIDS5/mx

–– KodakKodak DirectViewDirectView PACS SystemPACS System

–– McKessonMcKesson’’s PACSs PACS MammoMammo StationStation

–– iCadiCad Second Look 500MSecond Look 500M

–– CedaraCedara II--ReadMammoReadMammo

–– Fuji SynapseFuji Synapse

–– GE Seno Advantage & Seno Adv. 2GE Seno Advantage & Seno Adv. 2

–– FischerFischer SenoviewSenoview Plus (Plus (CedaraCedara))

–– HologicHologic SecureViewSecureView DXDX

–– SiemensSiemens MammoReportPlusMammoReportPlus

Slide 24

�� Current challengesCurrent challenges

–– Device to device connectivityDevice to device connectivity

–– DICOM incompatibilities between acquisition andDICOM incompatibilities between acquisition and

displaysdisplays

•• Can result in image degradationCan result in image degradation

–– PACS connectivityPACS connectivity

Worksta tionsWorkstations

7

Slide 25

DetectorSize(cm)DetectorSize (cm) vs.vs. Imagesize(pixels)Imagesize(pixels)

23042304

41004100

56255625

3400340019201920 40964096

25602560

20482048

2323

2929

21211919 2424

GEGE2000D &2000D&DSDS

FischerFischer

LoradLorad& Siemens& Siemens

MonitorMonitor

FischerFischer

LoradLorad& Siemens& Siemens

GE EssentialGE Essential

3131 31003100

24002400

GE EssentialGE Essential

WorkstationsWorkstations

GEGE2000D&2000D&DSDS

Slide 26

�� GE (2000D, DS, Essential)GE (2000D, DS, Essential)

�� Mo &Mo & RhRh Targets, Mo &Targets, Mo & RhRh FiltersFilters

–– Mo/Mo, Mo/Mo/Mo, Mo/RhRh,, Rh/RhRh/Rh

�� 3 Modes3 Modes

–– ConCon –– Thin, less dense (2000D)Thin, less dense (2000D)

–– StdStd –– Intermediate (DS & Essential)Intermediate (DS & Essential)

–– DosDos –– Thick, dense breastsThick, dense breasts

AEC System Functio nAEC System Funct ion

Slide 27

�� LoradLorad –– Mo target, Mo &Mo target, Mo & RhRh FiltersFilters–– Mo/Mo, Mo/Mo/Mo, Mo/RhRh

�� ModesModes–– AutoAuto--FilterFilter –– AEC sensor, exposure adjustmentAEC sensor, exposure adjustment

–– AutoAuto--kVkV –– Filter, AEC sensor, exposure adjustmentFilter, AEC sensor, exposure adjustment

–– AutoAuto--TimeTime –– kV, filter, AEC sensor, exposure adjustmentkV, filter, AEC sensor, exposure adjustment

–– TECTEC –– (Tissue Exposure Control)(Tissue Exposure Control) -- Breast densityBreast density

•• (enhanced manual mode)(enhanced manual mode)

–– ManualManual

�� Recommended ModeRecommended Mode –– AutoAuto--FilterFilter

AEC System Funct ionAEC System Funct ionSlide 28

�� SiemensSiemens –– Mo & W Targets, Mo &Mo & W Targets, Mo & RhRh FiltersFilters

–– Mo/Mo, Mo/Mo/Mo, Mo/RhRh, W/, W/RhRh

�� ModesModes

–– OPDOSE Mode (recommended using W/OPDOSE Mode (recommended using W/RhRh))

•• Compress breast to given compressionCompress breast to given compression

•• T/F &T/F & kVpkVp prepre--selected by vendor lookup tablesselected by vendor lookup tables

–– ManualManual

AEC System Functio nAEC System Funct ion

8

Slide 29

�� AEC SummaryAEC Summary

–– Manufacturer only recommends, user decidesManufacturer only recommends, user decides

–– Ultimately up to the Radiologist and/or PhysicistUltimately up to the Radiologist and/or Physicist

to decide which mode to useto decide which mode to use

–– Make mode choice based on knowing effect onMake mode choice based on knowing effect on

dose and image qualitydose and image quality

AEC System Funct ionAEC System Funct ionSlide 30

How Does Digital Compare to ScreenHow Does Digital Compare to Screen--filmfilmMammography in Terms Of:Mammography in Terms Of:

•• Exposure Times?Exposure Times?

•• Breast Dose?Breast Dose?

•• Detection of LowDetection of Low--contrast Lesions?contrast Lesions?

3 AOP Modes:3 AOP Modes: ContrastContrast ++StandardStandard OODoseDose --

2000 FFDM2000FFDMVariability DataVariability Data

Slide 31

�� ContrastContrast--Detail image analysisDetail image analysis

–– Acquire images at recommended techniquesAcquire images at recommended techniques

•• 2, 4, 6, 8 cm2, 4, 6, 8 cm

•• Calculate DoseCalculate Dose

•• Score contrastScore contrast--detail image for image qualitydetail image for image quality

�� ACR PhantomACR Phantom

–– Calculate DoseCalculate Dose

–– ScoresScores

�� Compare to screenCompare to screen--film datafilm data

MethodsMethodsSlide 32

Contrast Detail PhantomsContrast Detail Phantoms

Metho dsMethods

9

Slide 33


Metho dsMethods

Decreasing Diameter

DecreasingContrast

0.25 mm 4.0 mm

4%

0.25%

Slide 35

ACR PhantomACR Phantom


ACR PhantomACR Phantom

10

Slide 37

0

100

200

300

400

500

600

700

0 1 2 3 4 5 6 7 8 9 10

Thickne ss (cm)

Ave

rage

Gla

ndul

arD

ose

(mra

d)

CMAP 2 cm

CMAP 4 cm

CMAP ACR Phantom

CMAP 6 cm

CMAP 8 cm

FFDM - Con/Auto

FFDM - Std/Auto

FFDM - Dos/Auto

Average Glandular Dose vs. ThicknessAverage Glandular Dose vs. Thickness38 Screen38 Screen--film Units, 18 FFDM Unitsfilm Units, 18 FFDM Units

33 mGymGy Limit forLimit forACR PhantomACR Phantom

Slide 38

Exposure Time vs. ThicknessExposure Time vs. Thickness38 Screen38 Screen--film Units, 18 FFDM Unitsfilm Units, 18 FFDM Units

0

1

2

3

4

5

6

0 1 2 3 4 5 6 7 8 9 10

Thickn ess (cm)

Exp

osu

reT

ime

(sec

on

ds)

CMAP 2 cm

CMAP 4 cm

CMAP ACR Phant om

CMAP 6 cm

CMAP 8 cm

FFDM - Con/Auto

FFDM - Std/A uto

FFDM - Dos /Auto 2 seconds

16% ofFSM > 2 s

74%ofFSM > 2 s

Slide 39

6

8

10

12

14

16

18

0 2 4 6 8 10

Thickn ess (cm)

CD

Sco

res

CMAP 2 cmCMAP 4 cmCMAP 6 cmCMAP 8 cmFFDM - Con/Aut oFFDM - Std/AutoFFDM - Dos/ Aut o

Contrast Detail Scores vs. ThicknessContrast Detail Scores vs. Thickness38 Screen38 Screen--film Units, 18 FFDM Unitsfilm Units, 18 FFDM Units

Slide 40

MedicalPhysics.March 2003.30 (3) pages334-340

Metho dsMethods

20022002GE 2000DGE 2000D OptoOpto DataData

11

Slide 41

�� Objective:Objective: To determine optimized techniqueTo determine optimized technique

factors for fullfactors for full--field digital mammographyfield digital mammography

system (GE 2000D) for lowsystem (GE 2000D) for low--contrast lesioncontrast lesion

detectiondetection

�� Optimization done under condition ofOptimization done under condition of matchedmatched

patient dosepatient dose to screento screen--film mammographyfilm mammography

�� Compare fullCompare full--field digital results to screenfield digital results to screen--filmfilm

resultsresults


CD Score vs.CD Score vs. kVpkVp2 cm Breasts2 cm Breast s

88

99

1010

1111

1212

1313

1414

1515

2020 2525 3030 3535 4040 4545 5050

kVpkVp

Mea

nC

DS

core

Mea

nC

DS

core

2 cm Mo/Mo2 cm Mo/Mo

2 cm Mo/2 cm Mo/RhRh

2 cm2 cm Rh/RhRh/Rh

ScreenScreen --FilmFilm

OptimizedTechniqueComparisonOptimizedTechniqueComparison

pp--value= 0.47value= 0.47

Mo/Mo TrendpMo/Mo Trendp--value= 0.0752value= 0.0752

Mo/Mo/RhRh TrendpTrendp--value= 0.1369value= 0.1369

Rh/RhRh/Rh TrendpTrendp--value = 0.0985value = 0.0985

ResultsResults

Slide 43

CD Scor e vs.CD Score vs. kVpkVp4 cm Breasts4 cm Breasts

88

99

1010

1111

1212

1313

1414

1515

2020 2525 3030 3535 4040 4545 5050

kVpkVp

Mea

nC

DS

core

Mea

nC

DS

core



4 cm4 cm Rh/RhRh/Rh


OptimizedTechniqueComparisonOptimizedTechniqueComparison

pp--value = 0.013value= 0.013


Mo/Mo/RhRh TrendpTrend p--value= 0.5691value= 0.5691

Rh/RhRh/RhTrendpTrend p--value= 0.0123value= 0.0123

Resul tsResul tsSlide 44

CD Score vs.CD Score vs. kVpkVp6 cm Breasts6 cm Breasts

88

99

1010

1111

1212

1313

1414

1515

2020 2525 3030 3535 4040 4545 5050

kVpkVp

Mea

nC

DS

core

Mea

nC

DS

core



6 cm6 cm Rh/RhRh/Rh



Mo/Mo/RhRh TrendpTrendp--value= 0.6496value= 0.6496

Rh/RhRh/Rh TrendpTrendp--value= 0.2735value = 0.2735

OptimizedTechniqueOptimizedTechniqueComparisonComparison

pp--value< 0.0001value< 0.0001

ResultsResults

12

Slide 45

CD Score vs.CD Score vs. kVpkVp8 cm Breasts8 cm Breasts

88

99

1010

1111

1212

1313

1414

1515

2020 2525 3030 3535 4040 4545 5050

kVpkVp

Mea

nC

DS

core

Mea

nC

DS

core



8 cm8 cm Rh/RhRh/Rh


Mo/Mo TrendpMo/Mo Trendp--value< 0.0428value< 0.0428

Mo/Mo/RhRh TrendpTrendp--value< 0.9453value< 0.9453

Rh/RhRh/Rh TrendpTrendp--value< 0.0121value< 0.0121

OptimizedTechnique ComparisonOptimizedTechnique Comparison

pp--value < 0.0001value< 0.0001

Resul tsResul tsSlide 46

�� LowLow--contrast lesion optimization for FFDM (GE 2000D)contrast lesion optimization for FFDM (GE 2000D)

–– Thin breasts (< 2 cm): Mo/Mo with lowThin breasts (< 2 cm): Mo/Mo with low kVpkVp

–– Intermediate breasts (~4 cm): Insensitive to targetIntermediate breasts (~4 cm): Insensitive to target--filter andfilter and kVpkVp

selectionselection

–– Thick breasts (>5 cm):Thick breasts (>5 cm): Rh/RhRh/Rh with higherwith higher kVpkVp

Conclus ionsConclu sions

Slide 47

Compressed Breast Thickness vs. Dose - All Fischer Sites

0

1

2

3

4

5

6

0 1 2 3 4 5 6 7 8 9 10

Compressed Breast Thickness (cm)

Dos

e(m

Gy)

Film-screen

Digital

Fischer FFDM doses were 32% lower than SFM doses

ACRIN DataSlide 48

Compressed Breast Thicknes s vs. Dose - All GE Sites (5)

0

1

2

3

4

5

6

0 2 4 6 8 10


Dos

e(m

Gy)

Film Screen

Digital

Mean dose is 32% lowerwith FFDM than SFM

13

Slide 49

Compressed Breast Thickness vs. Dose - All Fuji Sites

0

1

2

3

4

5

6

0 2 4 6 8 10


Do

se(m

Gy)

Film-screen

Digital

Fuji FFDM doses were 5% lower than SFM doses

Slide 50

Compressed Breast Thickness vs. Dose - All Lorad Sites

0

1

2

3

4

5

6

0 2 4 6 8 10


Dos

e(m

Gy)

Film-screenDigital

Lorad FFDM doses were 2% higher than SFM doses

Slide 51

Mea

nG

land

ular

Dos

e(

Mea

nG

land

ular

Dos

e( m

Gy

mG

y ))

Mean Dose Comparison by Digital ManufacturerMean Dose Comparison by Digital Manufacturer

2.6

1.8

2.32.2

2.4

1.7

2.3 2.32.4

1.9

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Fischer Fuji GE Lorad All Sites

Screen-Film Digital Overall: Digital DosesOverall: Digital Doses22% Lower Than SFM22% Lower Than SFM

Slide 52

Compariso n of Image Qualityand Averag e Glandu lar Doseon Four FDA-approved Full -Field Digital Mammog raph y

Systems

ARRS 2006

14

Slide 53

PurposePurpose

�� To Measure and CompareTo Measure and Compare

–– Image QualityImage Quality

–– Average Glandular DoseAverage Glandular Dose

•• On 4 FDAOn 4 FDA--approved FFDM systemsapproved FFDM systems

•• Across full range of breast thicknessesAcross full range of breast thicknesses

•• Using each manufacturersUsing each manufacturers’’ recommended techniquesrecommended techniques

Slide 54

�� 4 FDA4 FDA--approved FFDM systemsapproved FFDM systems

–– GE 2000DGE 2000D

–– GEGE SenographeSenographe DSDS

–– LoradLorad SeleniaSelenia

–– SiemensSiemens NovationNovation

Metho dsMethods

Slide 55

�� To acquire imagesTo acquire images

–– Position the phantom like a clinical acquisitionPosition the phantom like a clinical acquisition

–– Apply 10Apply 10 dNdN compression forcecompression force

–– Acquire image using manufacturerAcquire image using manufacturer’’s recommendeds recommended

techniquetechnique

–– Record technique factorsRecord technique factors

–– MeasureMeasure HVLHVL’’ss and entrance exposuresand entrance exposures

–– Calculate AGDCalculate AGD

–– Measure and calculate ContrastMeasure and calculate Contrast--Detail scoresDetail scores


Average Gland ular Dose Comparison

0

0.5

1

1.5

2

2.5

3

3.5

4

0 2 4 6 8 10Breast Thickne ss (cm)

Do

se(m

Gy)

DS

2000D

Lorad

SiemSiemens

Lorad

GE 2000D

GE DS

ResultsResults

Rangeupto 2.9

15

Slide 57

Contr ast-Detail Scores

8

9

10

11

12

13

14

15

1617

18

0 2 4 6 8 10Breast Thickness (cm)

Co

ntr

ast-

Det

ailS

core

Siem ens

Lorad

GE 2000DGE DS

ResultsResults

Siem ens

LoradGE 2000D

GE DS

Slide 58

ResultsResults

Average Glandular Dose Comparison

0

0.5

1

1.5

2

2.5

3

3.5

4

0 2 4 6 8 10Breast Thick ness (cm)

Dos

e(m

Gy)

DS

2000D

Lorad

Siem

Contrast- Detail Score s

8

910

11

12

13

1415

16

17

18


Co

ntr

ast-

Det

ailS

core

Slide 59

ACR Phantom Avera ge Glandu lar Dose

0

0.5

1

1.5

2

2.5

3

AG

D(m

Gy)

ResultsResults

Siemens Lor adGE 2000DGE DS

Slide 60

Conclusion sConclus ions

�� Results indicate thatResults indicate that

–– Average glandular doses varies by up to a factorAverage glandular doses varies by up to a factor

of 2.9of 2.9

–– There are significant differences in image qualityThere are significant differences in image quality

–– Technique factors and automatic exposure modeTechnique factors and automatic exposure modeselection can play an important role in clinicalselection can play an important role in clinicalimage quality and patient doseimage quality and patient dose

16

Slide 61

DigitalDigitalProposedProposedPhantomPhantom

Slide 62

Slide 63 Slide 64

0.750.750.750.7544

0.650.65

0.540.540.540.5455

0.300.30

0.400.400.400.4066

0.820.82

0.890.890.890.8933

1.121.1222

1.561.5611

Fiber Diamete rFiber Diamete r(mm)(mm)

Propos edPropos edACRACRACRACRPhantomPhant omObject #Object #

Phantom Compar isonPhantom Compari son

17

Slide 65

0.240.240.240.240.750.750.750.7544

0.200.200.650.65

0.160.160.160.160.540.540.540.5455

0.100.100.300.30

0.130.130.400.400.400.4066

0.280.280.820.82

0.320.320.320.320.890.890.890.8933

0.400.401.121.1222

0.540.541.561.5611

Speck DiameterSpeck Diameter(mm)(mm)Fiber Diameter (mm)Fiber Diameter (mm)

ProposedProposedACRACRPropos edPropos edACRACRACRACRPhantomPhantomObject #Object #

Phantom Compa riso nPhantom Compari son

Slide 66

0.500.500.500.500.240.240.240.240.750.750.750.7544

0.380.380.200.200.650.65

0.250.250.250.250.160.160.160.160.540.540.540.5455

0.150.150.100.100.300.30

0.200.200.130.130.400.400.400.4066

0.680.680.280.280.820.82

0.750.750.750.750.320.320.320.320.890.890.890.8933

1.001.000.400.401.121.1222

2.002.000.540.541.561.5611

Mass Thick nessMass Thickness(mm)(mm)

Speck DiameterSpeck Diamete r(mm)(mm)Fiber Diameter (mm)Fiber Diameter (mm)

ProposedProposedACRACRProposedProposedACRACRPropos edPropos edACRACRACRACRPhantomPhant omObject #Object #

Phantom Compar isonPhantom Compari son

Slide 67

18

4, 3, 3 3, 1, 1

Slide 72

�� Objective:Objective: To determine optimized technique factors forTo determine optimized technique factors for

clinically available fullclinically available full--field digital mammography systemsfield digital mammography systems

�� On 6 FFDM Units (Siemens counts as 2)On 6 FFDM Units (Siemens counts as 2)

�� UsingUsing

–– ContrastContrast--Detail PhantomsDetail Phantoms

–– ACR PhantomACR Phantom

–– Proposed ACR Digital PhantomProposed ACR Digital Phantom

Optimization 2006Optim ization 2006

19

Slide 73

�� Measure dose at all recommended techniquesMeasure dose at all recommended techniques

and compare to ACRIN dosesand compare to ACRIN doses

�� Compare dose and image quality within eachCompare dose and image quality within each

system using each modesystem using each mode

�� Compare dose and image quality for eachCompare dose and image quality for each

system using their recommended modesystem using their recommended mode

Optimization 2006Optimization 2006Slide 74

�� Evaluate performance of the ACR phantom andEvaluate performance of the ACR phantom and

compare to our proposed ACR digital phantomcompare to our proposed ACR digital phantom

�� Evaluate image quality as a function of dose forEvaluate image quality as a function of dose for

different modesdifferent modes

�� Ultimately find the optimum techniques to provideUltimately find the optimum techniques to provide

the highest image quality with the lowest dosethe highest image quality with the lowest dose

Optimization 2006Optim ization 2006

Slide 75

HVL vs. kVp

0.25

0.35

0.45

0.55

0.65

20 30 40 50

kVp

HV

L(m

mA

l)

GE 2000D Mo/MoGE 2000D Mo/RhGE 2000D Rh/RhGE DS Mo/MoGE DS Mo/RhGE DS Rh/RhGE Essential Mo/MoGE Essential Mo/RhGE Essential Rh/RhLorad Mo/MoLorad Mo/RhSiemens Mo/MoSiemens Mo/RhSiemens W/Rh

Slide 76

HVL vs. kVp

0.25

0.35

0.45

0.55

0.65

20 25 30 35 40 45 50

kVp

HV

L(m

mA

l)

GE 2000D Mo/MoGE DS Mo/MoGE Essential Mo/MoLo rad Mo/MoSiemens Mo/Mo

20

Slide 77

HVL vs. kVp

0.25

0.35

0.45

0.55

0.65

20 25 30 35 40 45 50

kVp

HV

L(m

mA

l)

GE 2000D Mo/RhGE DS Mo/RhGE Essent ial Mo/RhLorad Mo/RhSiemens Mo/Rh

Slide 78

HVL vs. kVp

0.25

0.35

0.45

0.55

0.65

20 25 30 35 40 45 50

kVp

HV

L(m

mA

l)

GE 2000D Rh/RhGE DS Rh/RhGE Essential Rh/RhSiemens W/Rh

Slide 79

Entrance Skin Exposure vs. kVp

0

5

10

15

20

25

30

35

40

45

20 30 40 50

kVp

ES

E(m

R/m

As)

GE 2000D Mo/MoGE 2000D Mo/RhGE 2000D Rh/RhGE DS Mo/MoGE DS Mo/RhGE DS Rh/RhGE Essent ial Mo/MoGE Essent ial Mo/RhGE Essent ial Rh/RhLorad Mo/MoLorad Mo/RhSiemens Mo/MoSiemens Mo/RhSiemens W/Rh

Slide 80

Entrance Skin Expo sure vs. kVp

0

5

10

15

20

25

30

35

40

45

20 25 30 35 40 45 50

kVp

ES

E(m

R/m

As)

GE 2000D Mo/MoGE DS Mo/MoGE Essential Mo/MoLorad Mo/MoSiemens Mo/Mo

21

Slide 81

Entrance Skin Exposur e vs. kVp

0

5

10

15

20

25

30

35

40

45

20 25 30 35 40 45 50

kVp

ES

E(m

R/m

As)

GE 2000D Mo/RhGE DS Mo/RhGE Essential Mo/RhLorad Mo/Rh

Siemens Mo/Rh

Slide 82

Entrance Skin Expo sure vs. kVp

0

5

10

15

20

25

30

35

40

45

20 25 30 35 40 45 50

kVp

ES

E(m

R/m

As)

GE 2000D Rh/RhGE DS Rh/RhGE Essentia l Rh/RhSieme ns W/Rh

Slide 83

DoseDose

Slide 84

Average Glandular Dose vs. Breas t Thickness

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10

Breast Thic knes s (cm)

AG

D(m

Gy)

GE 2000D - Con/Auto

GE 2000D - Std/Auto

GE 2000D - Dos/Aut o

GE DS - Con/Auto

GE DS - Std/Aut o

GE DS - Dos/Auto

GE Essentia l - Con/Auto

GE Essentia l - Std/Auto

GE Essentia l - Dos/Auto

Lorad - Auto-Filter

Siemen s - OpComp - Mo/Mo

Siemen s - OpComp - W/Rh

ACRIN - Film Dose

ACRIN - Digital Dose

22

Slide 85

Average Glandul ar Dose vs. Breast Thickne ss

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0


AG

D(m

Gy)

GE 2000D - Con/A uto

GE 2000D - Std/Au to

GE 2000D - Dos/Auto

Slide 86


0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10

Breast Thickness (cm)

AG

D(m

Gy)

GE DS - Con/Aut o

GE DS - Std/Auto

GE DS - Dos/Aut o

Slide 87


0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10


AG

D(m

Gy)

GE Essential - Con/Au to

GE Essential - Std/Auto

GE Essential - Dos/Aut o

Slide 88


0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10

Breast Thick ness (cm)

AG

D(m

Gy)

GE 2000D - Con/Auto

GE DS - Std/Auto


23

Slide 89

Average Glandular Dose vs. Breast Thic kness

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10


AG

D(m

Gy)

Lorad - Auto-Filt er

Siemens - OpComp - Mo/Mo

Siemens - OpComp - W/Rh

Slide 90


0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10

Breast Thic kness (cm)

AG

D(m

Gy)

GE 2000D - Con/Auto

GE DS - Std/Auto

GE Essen tial - Std/Au to

Lorad - Auto-Filt er


ACRIN - Film

Acrin-Dig ital

Slide 91

CD ScoresCD Scores

Slide 92

Contr ast -Detail Score vs . Breast Thickness

8

9

10

11

12

13

14

15

16

17

0 2 4 6 8 10


Co

ntr

ast-

Det

ailS

core

GE 2000D - Con/Auto

GE 2000D - Std/Auto

GE 2000D - Dos/Auto

GE DS - Con/Auto

GE DS - Std/Auto

GE DS - Dos/Auto

GE Essential - Con/Auto


GE Essential - Dos/Auto

Lorad - Auto-Filter



24

Slide 93

Contrast-Det ail Score vs. Breast Thickne ss

8

9

10

11

12

13

14

15

16

17

0 2 4 6 8 10


Co

ntr

ast-

Det

ailS

core

GE 2000D - Con/AutoGE 2000D - Std/AutoGE 2000D - Dos/Auto

Slide 94

Contrast- Detail Score vs. Breast Thickne ss

8

9

10

11

12

13

14

15

16

17

0 2 4 6 8 10


Co

ntr

ast-

Det

ailS

core

GE DS - Con/AutoGE DS - Std/AutoGE DS - Dos/Auto

Slide 95

Contrast-Det ail Score vs. Breast Thickne ss

8

9

10

11

12

13

14

15

16

17

0 2 4 6 8 10


Co

ntr

ast-

Det

ailS

core

GE Essential - Con /Auto


GE Essential - Dos/Auto

Slide 96

Contr ast -Detail Score vs . Breast Thickness

8

9

10

11

12

13

14

15

16

17

0 2 4 6 8 10

Breast Thicknes s (cm)

Co

ntr

ast-

Det

ailS

core

Lora d - Auto-F ilter



25

Slide 97

Contr ast-Detail Score vs. Breast Thickn ess

8

9

10

11

12

13

14

15

16

17

0 2 4 6 8 10


Co

ntr

ast-

Det

ailS

core

GE 2000D - Con/Auto

GE DS - Std/Auto


Lorad - Aut o-Filter

Siemens - OpCom p - W/Rh

Slide 98

ACRACRPhantomPhantom

Slide 99

AGD for the ACR Phantom

0.00

0.50

1.00

1.50

2.00

2.50

3.00

AG

D(m

Gy)

Con Std Dos

2000D

Con Std Dos Con Std Dos

DS Essent ial

AutoFilter

Lorad Siemen s

Mo/Mo W/Rh

Slide 100

Fibers for the ACR Phantom

0

1

2

3

4

5

6

7

Fib

ers

Con Std Dos

2000D


DS Essential

AutoFilter

Lorad Siemens

Mo/Mo W/Rh

26

Slide 101

Speck Groups for the ACR Phant om

0

1

2

3

4

5

6

Sp

eck

Gro

up

s

Con Std Dos

2000D


DS Essen tial

AutoFilter

Lorad Siemen s

Mo/Mo W/Rh

Slide 102

Masses for the ACR Phantom

0

1

2

3

4

5

6

Mas

ses

Con Std Dos

2000D


DS Essent ial

AutoFilter

Lorad Siemens

Mo/Mo W/Rh

Slide 103

ProposedACRProposedACRDigital PhantomDigital Phantom

Slide 104

AGD for "Propose d" ACR Digita l Phantom

0.00

0.50

1.00

1.50

2.00

2.50

3.00

AG

D(m

Gy)

Con Std Dos

2000D


DS Essential

AutoFilter

Lorad Siemens

Mo/Mo W/Rh

27

Slide 105

Fibers for "P ro posed" ACR Digit al Phan tom

0

1

2

3

4

5

6

7

8

Fib

ers

Con Std Dos

2000D


DS Essential

AutoFilter

Lorad Siemens

Mo/Mo W/Rh

Slide 106

Speck Groups for "Pro pos ed" ACR Digit al Phantom

0

1

2

3

4

5

6

7

8

Sp

eck

Gro

up

s

Con Std Dos

2000D


DS Essential

AutoFilter

Lorad Siemens

Mo/Mo W/Rh

Slide 107

Masses for "P roposed" ACR Digital Phantom

0

1

2

3

4

5

6

7

8

Mas

ses

Con Std Dos

2000D


DS Essential

AutoFilter

Lorad Siemens

Mo/Mo W/Rh

Slide 108

Vary DoseVary Dosefrom Rec.from Rec.

Techs.Techs.

28

Slide 109

Contrast- Detail Scor es vs. % Vendo r AGDFor 6 cm Breast Thickn ess

9.0

10.0

11.0

12.0

13.0

14.0

15.0

16.0

0% 50% 100% 150% 200% 250%

% Vendor AGD

Co

ntr

ast-

Det

ailS

core

s

GE 2000D - Con/Auto

GE 2000D - Std/Auto

GE DS - Con/Auto

GE DS - Std/Auto

GE Essential -Con/AutoGE Essential -Std/AutoLorad

Siem ens - Mo/Mo

Siem ens - W/Rh

Slide 110

Contrast-Detail Score s vs. % Vendor AGDFor 6 cm Breast Thickness

9.0

10.0

11.0

12.0

13.0

14.0

15.0

16.0

0% 50% 100% 150% 200% 250%

% Vendo r AGD

Co

ntr

ast-

Det

ailS

core

s

GE 2000D - Con/Auto

GE 2000D - Std/Auto

Rh/Rh– 29 kVp

Rh/Rh– 31 kVp

Slide 111

Contrast- Detail Scor es vs. % Vendo r AGDFor 6 cm Breast Thickn ess

9

10

11

12

13

14

15

16

0% 50% 100% 150% 200% 250%

% Vendor AGD

Co

ntr

ast-

Det

ailS

core

s GE DS - Con/AutoGE DS - Std/Auto

Rh/Rh– 29 kVp

Rh/Rh– 29 kVp

Slide 112

Contrast-Det ail Scores vs. % Vendo r AGDFor 6 cm Breast Thickness

9.0

10.0

11.0

12.0

13.0

14.0

15.0

16.0

0% 50% 100% 150% 200% 250%

% Vendo r AGD

Co

ntr

ast-

Det

ailS

core

s GE Essent ial - Con/Auto

GE Essent ial - Std/AutoRh/Rh– 29 kVp

Rh/Rh– 29 kVp

29

Slide 113

Contrast- Detail Scores vs. % Vendor AGDFor 6 cm Breast Thick ness

9.0

10.0

11.0

12.0

13.0

14.0

15.0

16.0

0% 50% 100% 150% 200% 250%

% Vendor AGD

Co

ntr

ast-

Det

ailS

core

s

Lora d

Siemens - Mo/Mo

Siemens - W/Rh

Mo/Mo – 29 kVp

28 kVp

28 kVp

Slide 114

VaryVary kVpkVp

Slide 115

Contrast- Detail Scores vs. kVpAt Matched Average Glandular Doses to Film and Digital

8.0

9.0

10.0

11.0

12.0

13.0

14.0

15.0

16.0

17.0

23 25 27 29 31 33 35 37 39 41 43 45 47 49

kVp

Co

ntr

ast-

Det

ailS

core

s

GE 2000D - Mo/Mo - Film

GE 2000D - Mo/Rh - Film

GE 2000D - Rh/Rh - Fi lm

GE 2000D - Mo/Mo - Digital

GE 2000D - Mo/Rh - Digi tal

GE 2000D - Rh/Rh - Digital

GE DS - Mo/Mo - Film

GE DS - Mo/Rh - Film

GE DS - Rh/Rh - Film

GE DS - Mo/Mo - Dig ital

GE DS - Mo/Rh - Digital

GE DS - Rh/Rh - Digit al

GE Esse ntial - Mo/Mo - Fil m

GE Esse ntial - Mo/Rh - Film

GE Esse ntial - Rh/Rh - Film

GE Esse ntial - Mo/Mo - Digi tal

GE Esse ntial - Mo/Rh - Digit al

GE Esse ntial - Rh/Rh - Dig ital

Lorad - Mo/Mo - Film

Lorad - Mo/Rh - Film

Lorad - Mo/Mo - Digital

Lorad - Mo/Rh - Digital

Siemens - Mo/Mo - Film

Siemens - Mo/Mo - Dig ital

Siemens - W/Rh - Film

Siemens - W/Rh - Digital

Slide 116

SummarySummar y

Average Glandular Dose vs. Breast Thickness

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10


AG

D(m

Gy)

GE 2000D - Con/Auto

GE DS - Std/Auto


Lorad - Aut o-Fil ter


Contrast-Detail Score vs. Breast Thickness

8

9

10

11

12

13

14

15

16

17

0 2 4 6 8 10


Co

ntr

ast-

Det

ailS

core

GE 2000D - Con/Aut o

GE DS - Std/Auto


Lorad - Auto-Fil ter


30

Slide 117

�� WhatWhat’’s responsible for different images responsible for different image

quality scores?quality scores?

–– Better calibration files on some digitalBetter calibration files on some digital

manufacturermanufacturer’’s systems fewer artifactss systems fewer artifacts

–– Different breast dosesDifferent breast doses

–– Different postDifferent post--processing algorithmsprocessing algorithms

ConclusionsConclusions

�� Better calibration files on some digitalBetter calibration files on some digitalmanufacturermanufacturer’’s systemss systems

vs.


Slide 119

�� DoseDose

–– Digital in general has lower doses than filmDigital in general has lower doses than film

–– For the same phantom, dose varies widely by modeFor the same phantom, dose varies widely by mode

–– Breast thickness makes big contribution to doseBreast thickness makes big contribution to dose

–– Dose by thickness tracks pretty well across all vendorsDose by thickness tracks pretty well across all vendors

–– Dose is affected by selection of mode being usedDose is affected by selection of mode being used

ConclusionsConclusionsSlide 120

�� Image QualityImage Quality

–– Digital in general has higher image quality scoresDigital in general has higher image quality scores

–– For the same phantom, image quality varies widely byFor the same phantom, image quality varies widely by

modemode

–– Breast thickness has big effect on image qualityBreast thickness has big effect on image quality

–– Image quality by thickness tracks pretty well across allImage quality by thickness tracks pretty well across all

vendorsvendors

–– Image quality is affected by selection of mode being usedImage quality is affected by selection of mode being used


31

Slide 121

�� Still to be doneStill to be done

–– Phantom images scored by several readersPhantom images scored by several readers

–– Analyzed for statistical differences and trendsAnalyzed for statistical differences and trends

�� What I didnWhat I didn’’t mentiont mention

–– Viewing conditionsViewing conditions

–– Vendor QCVendor QC

–– Monitor calibrationMonitor calibration

–– SNR DataSNR Data


�� Take home messagesTake home messages

–– Dose makes more of a difference on image quality thanDose makes more of a difference on image quality than

kVpkVp

–– Digital has lower doses than FilmDigital has lower doses than Film

–– Some systems may set dose to low for theirSome systems may set dose to low for their

recommended moderecommended mode

–– Pay attention to what mode is used clinicallyPay attention to what mode is used clinically


Slide 123

�� Take home messagesTake home messages

–– Digital mammography needs a more sensitive phantomDigital mammography needs a more sensitive phantom

–– There is a wide range of image quality scores and dosesThere is a wide range of image quality scores and doses

across FFDM systemsacross FFDM systems

–– Evaluate systems the way they are to be used clinicallyEvaluate systems the way they are to be used clinically

–– Manufacturer only recommends AEC mode, userManufacturer only recommends AEC mode, user

ultimately decides how the system is to be usedultimately decides how the system is to be used


Thank YouThank You

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