High-quality full-field digital mammography has been available now for several years and is increasingly used for both diagnostic and screening mammography. A number of different detector technologies exist, which all have their specific advantages and disadvantages. Diagnostic accuracy of digital mammography has been shown to be at least equivalent to film-screen mammography in a general screening population. Digital mammography is superior to screen-film mammography in younger women with dense breasts due to its ability to selectively optimize contrast in areas of dense parenchyma. This advantage is especially important in women with a genetic predisposition for breast cancer, where intensified early detection programs may have to start from 25 to 30 years of age. Tailored image processing and computer-aided diagnosis hold the potential to further improve the early detection of breast cancer. However, at present no consensus exists among radiologists on which processing is optimal for digital mammograms. Image processing may also vary significantly among vendors with so far limited interoperability. This review aims to summarize the available information regarding the impact of digital mammography on workflow and breast cancer diagnosis.

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Digital mammography: what do we and what don’t we know?

Purpose: To prospectively determine in a fetal pig model whether diagnostic performance comparable to that of high-detail screen-film imaging can be achieved with computed radiography for the detection of simulated classic metaphyseal lesions (CMLs), by using Faxitron digital images as the reference standard, and whether radiation dose reduction is possible. Materials and Methods: This study was granted exempt status by the institutional review board and the animal care and use committee. Fractures simulating the CML were produced in distal femurs of 20 deceased fetal pigs. Twenty normal femurs served as control femurs. Femurs were imaged with a standard single-side–read 100-μm pixel sampling imaging plate (IP), a high-resolution dual-side–read 50-μm pixel sampling IP, and a high-detail screen-film imaging system. Eight tube current–time product settings (0.5–10.0 mAs) and two tube voltage selections (56 and 70 kVp) were employed. Two pediatric radiologists evaluated 920 images for fracture by using a fiv...

Detection of simulated inflicted metaphyseal fractures in a fetal pig model: image optimization and dose reduction with computed radiography.

The purpose of this study was to evaluate the basic imaging properties of the two latest digital radiographic X-ray systems, namely, the DynaDirect Winscope 6000 (abbr. as System A, Toshiba Medical Systems) and the Sonialvision Safire Multi (abbr. as System B, Shimadzu Corp.). These systems were based on a direct-conversion flat panel detector (FPD) of amorphous selenium. The basic imaging properties of the two systems were evaluated by measuring characteristic curves, presampled modulation transfer functions (MTFs), and noise power spectra (NPS) using DICOM images to which no resampling was performed with a matrix size of 2048x2048. In addition, noise equivalent quanta (NEQ) and detective quantum efficiency (DQE) calculated from the result of the basic imaging properties were evaluated. The characteristic curves of the two systems showed quite high linearity. The MTFs of the two systems indicated high-resolution properties, as is well known to be an advantage of the direct conversion FPD system. However, the NPS of System A showed better performance than System B under the same exposures. Therefore, the DQE of System A was higher than that of System B at all spatial frequencies.

https://www.jstage.jst.go.jp/article/jjrt/64/1/64_1_41/_pdf

Comparison of basic imaging properties for digital radiographic systems based on a direct conversion type of flat panel detector

Digital mammography is the technology of the future in breast diagnosis. This article provides an overview of all digital mammography units admitted by the Food and Drug Administration (FDA), results of clinical studies, soft copy reading, CAD (computer aided detection), and presents an overview on possible further developments. It is obvious that clinical results are equivalent to conventional screen film mammography and digital mammography.

Clinical results of digital mammography

A digital full-filed mammography system using phase-contrast technique has been developed. The system consists of a dedicated mammography unit, a computed radiography unit with a sampling rate of 43.75 microns, and a photothermographic printer with a printing rate of 25 microns for photothermographic film with the maximum optical density of 4.0. The sharpness of the output image is improved with an edge effect due to phase contrast and magnification. The image noise is reduced by an air-gap method with no bucky. In this paper, the image qualities of the phase-contrast mammography are described for full-filed mammography and spot-compression at 1.5x magnification.

Image qualities of phase-contrast mammography

PURPOSE To investigate the physical imaging properties and detection of simulated microcalcifications of a new computed radiography (CR) system with a pixel size of 50 microm for digital mammography. MATERIALS AND METHODS New and conventional CR were employed in this study. The new CR system included a high-resolution imaging plate coupled with the FCR5000MA (50 microm pixel pitch) including transparent support and a dual-sided reader. The conventional CR system was coupled with the FCR9000 (100 microm pixel pitch). Modulation transfer functions (MTFs) and Wiener spectra (WS) of the new and conventional CR systems were measured. Observer performance tests were conducted to compare the effects of pixel size (50 microm vs. 100 microm) on the diagnostic accuracy of CR systems in the detection of simulated microcalcifications. RESULTS The presampling MTF of the new CR system was higher at high frequencies than the conventional CR system. The WS of the new CR system was comparable to that of the conventional CR system at all frequencies. The area under the receiver operating characteristic (ROC) curve (Az) obtained with the new CR and the conventional CR systems were 0.84 and 0.79, respectively. Results showed that the detection of simulated clustered microcalcifications was significantly improved by use of the new CR system compared with the conventional CR system (p<0.05). CONCLUSION The new CR mammography system improved physical imaging properties and detection of simulated microcalcifications over conventional CR mammography.

New CR system with pixel size of 50 microm for digital mammography: physical imaging properties and detection of subtle microcalcifications.

The physical characteristics of a direct amorphous Selenium (a-Se) digital fluoroscopy and radiography system were investigated. Pre-sampled modulation transfer functions (MTF) were measured using a slit method. Noise power spectra were determined for different input exposures by fast Fourier transform of uniformly exposed samples. The MTFs of direct digital radiography systems showed significantly higher values than those of indirect digital radiography and screen-film systems. The direct digital radiography systems showed higher noise levels compared with those of indirect systems under roughly the same exposure conditions. Contrast-detail analysis was performed to compare detection by direct digital radiography systems with that of the screen-film (FUJI HG-M2/UR2) systems. The average contrast-detail curves of digital and film images were obtained from the results of observation. Image quality figures (IQF) were also calculated from the individual observer performance tests. The results indicated that digital contrast-detail curves and IQF are, on average, are equal those of the screen-film system.

https://www.jstage.jst.go.jp/article/jjrt/62/3/62_3_425/_pdf

Image quality and detection performance of a direct digital radiography system

In a computed radiography (CR) system, there are a number of different mechanisms that cause blurring. The aim of this study was to analyze intrinsic system factors of CR systems that could affect the modulation transfer function (MTF), such as afterglow during readout and the anti-alias filter before analog to digital converter. Methods and Materials: Mathematical slit and edge images were generated from analytical functions. These images were arranged perpendicularly to the laser scan and the plate scan directions, respectively. The influence of afterglow and the anti-alias filter was simulated by using Microsoft Excel. The MTF values calculated from those simulation images were compared with the theoretical MTF values obtained analytically. Results: MTF values in the laser scan direction measured with the slit and edge methods were significantly lower than MTF values in the plate scan direction. The degree of influence on MTF with respect to afterglow and the anti-alias filters was different depending on the measurement method and the scan directions of CR systems. The influence of the anti-alias filters mainly contributed to the differences between MTF values with the slit and edge methods in the laser scan direction.

Influence of readout process on presampled modulation transfer function in computed radiography system

The effects of lead equivalent and lens area of radiation-protective eyewear on lens exposure control were examined. The simulated patient underwent 10-min X-ray fluoroscopy, and the lens dose of the simulated surgeon wearing radiation protection glasses was measured using lens dosemeters attached to the corner of the eye and eyeball. In total, 10 types of radiation protection glasses were selected for measurement. Correlation analysis of the equivalent dose in the lens of the eye with lead equivalence and lens area was performed. The equivalent dose in the lens of the eye of the corner of the eye was negatively correlated with the area of the lens. The equivalent dose in the lens of the eye and the eyeball showed a strong negative correlation with lead equivalence. Lens dosemeters worn at the corner of the eye may overestimate the equivalent dose in the lens of the eye. Moreover, the reduction in exposure of the lens was significantly influenced by the lead equivalent.

Evaluation of factors associated with the effectiveness of radiation protection glasses.

Mammography is one of the most effective diagnostic methods for the early detection of breast cancer; however, it poses the risk of radiation exposure. To date, mammography dosimetry has been performed according to the mean glandular dose; however, the actual exposure in the breast has not been assessed. Here, we have measured dose distributions and depth doses using both radiochromic films and mammographic phantoms, and a three-dimensional intra-mammary dose assessment was conducted. The absorbed dose distribution at the surface was markedly higher on the chest wall side but lower on the nipple side. The absorbed doses in the depth direction exponentially decreased. The glandular tissue near the surface may be irradiated with an absorbed dose of 7.0 mGy or higher. Since LD-V1 could be placed inside the phantom, the absorbed dose inside the breast could also be evaluated in three dimensions.

Yasuyuki Kawaji

Papers

New CR system with pixel size of 50 microm for digital mammography: physical imaging properties and detection of subtle microcalcifications.

Image quality and detection performance of a direct digital radiography system

Influence of readout process on presampled modulation transfer function in computed radiography system

Evaluation of factors associated with the effectiveness of radiation protection glasses.

Dosimetry using a radiochromic film and a mammography phantom.