A comparison between objective and subjective image quality measurements for a full field digital mammography system

A spiculated mass target model for clinical image quality control in digital mammography

OBJECTIVES

Quality assurance of breast imaging has a long history of using test objects to optimize and follow up imaging devices. In particular, the evaluation of new techniques benefits from suitable test objects. The applicability of a phantom consisting of spiculated masses to assess image quality and its dependence on dose in flat field digital mammography (FFDM) and digital breast tomosynthesis systems (DBT) is investigated.

METHODS

Two spiculated masses in five different sizes each were created from a database of clinical tumour models. The masses were produced using 3D printing and embedded into a cuboid phantom. Image quality is determined by the number of spicules identified by human observers.

RESULTS

The results suggest that the effect of dose on spicule detection is limited especially in cases with smaller objects and probably hidden by the inter-reader variability. Here, an average relative inter-reader variation of the counted number of 31% was found (maximum 83%). The mean relative intra-reader variability was found to be 17%. In DBT, sufficiently good results were obtained only for the largest masses.

CONCLUSIONS

It is possible to integrate spiculated masses into a cuboid phantom. It is easy to print and should allow a direct and prompt evaluation of the quality status of the device by counting visible spicules. Human readout presented the major uncertainty in this study, indicating that automated readout may improve the reproducibility and consistency of the results considerably.

ADVANCES IN KNOWLEDGE

A cuboid phantom including clinical objects as spiculated lesion models for visual assessing the image quality in FFDM and DBT was developed and is introduced in this work. The evaluation of image quality works best with the two larger masses with 21 spicules.

Task-based detectability in anatomical background in digital mammography, digital breast tomosynthesis and synthetic mammography

Objective.Determining the detectability of targets for the different imaging modalities in mammography in the presence of anatomical background noise is challenging. This work proposes a method to compare the image quality and detectability of targets in digital mammography (DM), digital breast tomosynthesis (DBT) and synthetic mammography.Approach. The low-frequency structured noise produced by a water phantom with acrylic spheres was used to simulate anatomical background noise for the different types of images. A method was developed to apply the non-prewhitening observer model with eye filter (NPWE) in these conditions. A homogeneous poly(methyl) methacrylate phantom with a 0.2 mm thick aluminium disc was used to calculate 2D in-plane modulation transfer function (MTF), noise power spectrum (NPS), noise equivalent quanta, and system detective quantum efficiency for 30, 50 and 70 mm thicknesses. The in-depth MTFs of DBT volumes were determined using a thin tungsten wire. The MTF, system NPS and anatomical NPS were used in the NPWE model to calculate the threshold gold thickness of the gold discs contained in the CDMAM phantom, which was taken as reference. Main results.The correspondence between the NPWE model and the CDMAM phantom (linear Pearson correlation 0.980) yielded a threshold detectability index that was used to determine the threshold diameter of spherical microcalcifications and masses. DBT imaging improved the detection of masses, which depended mostly on the reduction of anatomical background noise. Conversely, DM images yielded the best detection of microcalcifications.Significance.The method presented in this study was able to quantify image quality and object detectability for the different imaging modalities and levels of anatomical background noise.

Seven general radiography x-ray detectors with pixel sizes ranging from 175 to 76μm: technical evaluation with the focus on orthopaedic imaging

Aim. Flat panel detectors with small pixel sizes general can potentially improve imaging performance in radiography applications requiring fine detail resolution. This study evaluated the imaging performance of seven detectors, covering a wide range of pixel sizes, in the frame of orthopaedic applications.Material and methods. Pixel sizes ranged from 175 (detector A175) to 76μm (detector G76). Modulation transfer function (MTF) and detective quantum efficiency (DQE) were measured using International Electrotechnical Commission (IEC) RQA3 beam quality. Threshold contrast (CT) and a detectability index (d') were measured at three air kerma/image levels. Rabbit shoulder images acquired at 60 kV, over five air kerma levels, were evaluated in a visual grading study for anatomical sharpness, image noise and overall diagnostic image quality by four radiologists. The detectors were compared to detector E124.Results. The 10% point of the MTF ranged from 3.21 to 4.80 mm-1, in going from detector A175to detector G76. DQE(0.5 mm-1) measured at 2.38μGy/image was 0.50 ± 0.05 for six detectors, but was higher for F100at 0.62. High frequency DQE was superior for the smaller pixel detectors, howeverCTfor 0.25 mm discs correlated best with DQE(0.5 mm-1). Correlation betweenCTand the detectability model was good (R2= 0.964).CTfor 0.25 mm diameter discs was significantly higher for D150and F100compared to E124. The visual grading data revealed higher image quality ratings for detectors D125and F100compared to E124. An increase in air kerma was associated with improved perceived sharpness and overall quality score, independent of detector. Detectors B150, D125, F100and G76, performed well in specific tests, however only F100consistently outperformed the reference detector.Conclusion. Pixel size alone was not a reliable predictor of small detail detectability or even perceived sharpness in a visual grading analysis study.

Performance evaluation of digital breast tomosynthesis systems: physical methods and experimental data

Digital breast tomosynthesis (DBT) has become a well-established breast imaging technique, whose performance has been investigated in many clinical studies, including a number of prospective clinical trials. Results from these studies generally point to non-inferiority in terms of microcalcification detection and superior mass-lesion detection for DBT imaging compared to digital mammography (DM). This modality has become an essential tool in the clinic for assessment and ad-hoc screening but is not yet implemented in most breast screening programmes at a state or national level. While evidence on the clinical utility of DBT has been accumulating, there has also been progress in the development of methods for technical performance assessment and quality control of these imaging systems. DBT is a relatively complicated ‘pseudo-3D’ modality whose technical assessment poses a number of difficulties. This paper reviews methods for the technical performance assessment of DBT devices, starting at the component level in part one and leading up to discussion of system evaluation with physical test objects in part two. We provide some historical and basic theoretical perspective, often starting from methods developed for DM imaging. Data from a multi-vendor comparison are also included, acquired under the medical physics quality control protocol developed by EUREF and currently being consolidated by a European Federation of Organisations for Medical Physics working group. These data and associated methods can serve as a reference for the development of reference data and provide some context for clinical studies.

Machine learning framework for automatic image quality evaluation involving a mammographic American College of Radiology phantom

PURPOSE

The image quality (IQ) of mammographic images is essential when making a diagnosis, but the quality assurance process for radiological equipment is subjective. We therefore aimed to design an automatic IQ evaluation architecture based on a support vector machine (SVM) dedicated to evaluating images taken of mammography American College of Radiology (ACR) phantom.

METHODS

A total of 461 phantom images were acquired using mammographic equipment from 10 vendors. Two experienced medical physicists scored the images by consensus. The phantom datasets were randomly divided into training (80%) and testing (20%) sets. Each phantom image (with 6 fibers, 5 specks, and 5 masses) was detected by using bounding boxes, then cropped and divided into 16 pattern images. We identified 159 features for each pattern image. Manual scores were used to assign 3 labels (visible, invisible, and semivisible) to each pattern image. Multiclass-SVM models were trained with 3 types of patterns. Sub-datasets were randomly selected at 10% increments of the total dataset to determine a minimal effective training subset size for the automatic framework. A feature combination test and an analysis of variance were performed to identify the most influential features.

RESULTS

The accuracy of the model in evaluating fiber, speck, and mass patterns was 90.2%, 98.2%, and 88.9%, respectively. The performance was equivalent when the sample size was at least 138 (30% of 461) phantom images. The most influential feature was the position feature.

CONCLUSIONS

The proposed SVM-based automatic IQ evaluation framework applied to a mammographic ACR phantom accurately matched manual evaluations.

Radiomics software for breast imaging optimization and simulation studies

BACKGROUND AND OBJECTIVE

The development, control and optimisation of new x-ray breast imaging modalities could benefit from a quantitative assessment of the resulting image textures. The aim of this work was to develop a software tool for routine radiomics applications in breast imaging, which will also be available upon request.

METHODS

The tool (developed in MATLAB) allows image reading, selection of Regions of Interest (ROI), analysis and comparison. Requirements towards the tool also included convenient handling of common medical and simulated images, building and providing a library of commonly applied algorithms and a friendly graphical user interface. Initial set of features and analyses have been selected after a literature search. Being open, the tool can be extended, if necessary.

RESULTS

The tool allows semi-automatic extracting of ROIs, calculating and processing a total of 23 different metrics or features in 2D images and/or in 3D image volumes. Computations of the features were verified against computations with other software packages performed with test images. Two case studies illustrate the applicability of the tool - (i) features on a series of 2D 'left' and 'right' CC mammograms acquired on a Siemens Inspiration system were computed and compared, and (ii) evaluation of the suitability of newly proposed and developed breast phantoms for x-ray-based imaging based on reference values from clinical mammography images. Obtained results could steer the further development of the physical breast phantoms.

CONCLUSIONS

A new image analysis toolbox was realized and can now be used in a multitude of radiomics applications, on both clinical and test images.

Application of DQE for quantitative assessment of detectors to estimate AEC efficiency in digital mammography

Optimisation of the detector’s exposure parameters settings for image quality and patient dose is an important task in digital mammography. Assessment of a digital detector’s performance can be done objectively and without operator bias by determining the Detective Quantum Efficiency (DQE). The authors of this article aim to prove that the performance of the AEC system can be objectively portrayed through DQE. The results were examined for influence of KAD changes on DQE values and to determine if it was possible to obtain similar DQE values for different exposures. While analysing the effect of the operation of the AEC system described with DQE, the doses received by women during mammography examinations were considered, as well.

The AEC system’s exposure control mechanism cannot guarantee the same DQE value for different object thicknesses. When the object thickness increases, the AEC system should increase the KAD value to obtain the same DQE value. The result of increasing KAD would be the increase of mean glandular dose for some women. However, assuming that DQE is a good indicator of image quality, introducing the proposed changes to the AEC system’s operation would result in the same image quality for all breast thicknesses.

This approach to DQE use for AEC system evaluation is independent of the image processing procedure and can be the basis for changes to system calibration done by the manufacturer’s technical support team.

Technical characterization of five x-ray detectors for paediatric radiography applications

Physical image quality of five x-ray detectors used in the paediatric imaging department is characterized with the aim of establishing the range/scope of imaging performance provided by these detectors for neonatal imaging. Two computed radiography (CR) detectors (MD4.0 powder imaging plate (PIP) and HD5.0 needle imaging plate (NIP), Agfa HealthCare NV, B-2640 Mortsel, Belgium) and three flat panel detectors (FPD) (the Agfa DX-D35C and DX-D45C and the DRX-2530C (Carestream Health Inc., Rochester, NY 14608, USA)) were assessed. Physical image quality was characterized using the detector metrics given by the International Electrotechnical Commission (IEC 62220-1) to measure modulation transfer function (MTF), the noise power spectrum (NPS) and the detective quantum efficiency (DQE) using the IEC-specified beam qualities of RQA3 and RQA5. The DQE was evaluated at the normal operating detector air kerma (DAK) level, defined at 2.5 µGy for all detectors, and at factors of 1/3.2 and 3.2 times the normal level. MTF curves for the different detectors were similar at both RQA3 and RQA5 energies; the average spatial frequency for the 50% point (MTF0.5) at RQA3 was 1.26 mm^-1, with a range from 1.20 mm^-1 to 1.37 mm^-1. The DQE of the NIP CR compared to the PIP CR was notably greater and similar to that for the FPD devices. At RQA3, average DQE for the FPD and NIP (at 0.5 mm^-1; 2.5 µGy) was 0.57 compared to 0.26 for the PIP CR. At the RQA5 energy, the DRX-2530C and the DX-D45C had the highest DQE (~0.6 at 0.5 mm^-1; 2.5 µGy). Noise separation analysis using the polynomial model showed higher electronic noise for the DX-D35C and DRX-2530C detectors; this explains the reduced DQE seen at 0.7 µGy/image. The NIP CR detector offers notably improved DQE performance compared to the PIP CR system and a value similar to the DQE for FPD devices at the RQA3 energy.

Detectability comparison between a high energy x-ray phase sensitive and mammography systems in imaging phantoms with varying glandular-adipose ratios

The objective of this study was to demonstrate the potential benefits of using high energy x-rays in comparison with the conventional mammography imaging systems for phase sensitive imaging of breast tissues with varying glandular-adipose ratios. This study employed two modular phantoms simulating the glandular (G) and adipose (A) breast tissue composition in 50 G-50 A and 70 G-30 A percentage densities. Each phantom had a thickness of 5 cm with a contrast detail test pattern embedded in the middle. For both phantoms, the phase contrast images were acquired using a micro-focus x-ray source operated at 120 kVp and 4.5 mAs, with a magnification factor (M) of 2.5 and a detector with a 50 µm pixel pitch. The mean glandular dose delivered to the 50 G-50 A and 70 G-30 A phantom sets were 1.33 and 1.3 mGy, respectively. A phase retrieval algorithm based on the phase attenuation duality that required only a single phase contrast image was applied. Conventional low energy mammography images were acquired using GE Senographe DS and Hologic Selenia systems utilizing their automatic exposure control (AEC) settings. In addition, the automatic contrast mode (CNT) was also used for the acquisition with the GE system. The AEC mode applied higher dose settings for the 70 G-30 A phantom set. As compared to the phase contrast images, the dose levels for the AEC mode acquired images were similar while the dose levels for the CNT mode were almost double. The observer study, contrast-to-noise ratio and figure of merit comparisons indicated a large improvement with the phase retrieved images in comparison to the AEC mode images acquired with the clinical systems for both density levels. As the glandular composition increased, the detectability of smaller discs decreased with the clinical systems, particularly with the GE system, even at higher dose settings. As compared to the CNT mode (double dose) images, the observer study also indicated that the phase retrieved images provided similar or improved detection for all disc sizes except for the disk diameters of 2 mm and 1 mm for the 50 G-50 A phantom and 3 mm and 0.5 mm for the 70 G-30 A phantom. This study demonstrated the potential of utilizing a high energy phase sensitive x-ray imaging system to improve lesion detection and reduce radiation dose when imaging breast tissues with varying glandular compositions.

Tailoring automatic exposure control toward constant detectability in digital mammography

PURPOSE

The automatic exposure control (AEC) modes of most full field digital mammography (FFDM) systems are set up to hold pixel value (PV) constant as breast thickness changes. This paper proposes an alternative AEC mode, set up to maintain some minimum detectability level, with the ultimate goal of improving object detectability at larger breast thicknesses.

METHODS

The default "opdose" AEC mode of a Siemens MAMMOMAT Inspiration FFDM system was assessed using poly(methyl methacrylate) (PMMA) of thickness 20, 30, 40, 50, 60, and 70 mm to find the tube voltage and anode/filter combination programmed for each thickness; these beam quality settings were used for the modified AEC mode. Detectability index (d'), in terms of a non-prewhitened model observer with eye filter, was then calculated as a function of tube current-time product (mAs) for each thickness. A modified AEC could then be designed in which detectability never fell below some minimum setting for any thickness in the operating range. In this study, the value was chosen such that the system met the achievable threshold gold thickness (Tt) in the European guidelines for the 0.1 mm diameter disc (i.e., Tt ≤ 1.10 μm gold). The default and modified AEC modes were compared in terms of contrast-detail performance (Tt), calculated detectability (d'), signal-difference-to-noise ratio (SDNR), and mean glandular dose (MGD). The influence of a structured background on object detectability for both AEC modes was examined using a CIRS BR3D phantom. Computer-based CDMAM reading was used for the homogeneous case, while the images with the BR3D background were scored by human observers.

RESULTS

The default opdose AEC mode maintained PV constant as PMMA thickness increased, leading to a reduction in SDNR for the homogeneous background 39% and d' 37% in going from 20 to 70 mm; introduction of the structured BR3D plate changed these figures to 22% (SDNR) and 6% (d'), respectively. Threshold gold thickness (0.1 mm diameter disc) for the default AEC mode in the homogeneous background increased by 62% in going from 20 to 70 mm PMMA thickness; in the structured background, the increase was 39%. Implementation of the modified mode entailed an increase in mAs at PMMA thicknesses >40 mm; the modified AEC held threshold gold thickness constant above 40 mm PMMA with a maximum deviation of 5% in the homogeneous background and 3% in structured background. SDNR was also held constant with a maximum deviation of 4% and 2% for the homogeneous and the structured background, respectively. These results were obtained with an increase of MGD between 15% and 73% going from 40 to 70 mm PMMA thickness.

CONCLUSIONS

This work has proposed and implemented a modified AEC mode, tailored toward constant detectability at larger breast thickness, i.e., above 40 mm PMMA equivalent. The desired improvement in object detectability could be obtained while maintaining MGD within the European guidelines achievable dose limit. (A study designed to verify the performance of the modified mode using more clinically realistic data is currently underway.).

Performance evaluation of a retrofit digital detector-based mammography system

A retrofit flat panel detector was integrated with a GE DMR+ analog mammography system and characterized using detective quantum efficiency (DQE). Technical system performance was evaluated using the European Guidelines protocol, followed by a limited evaluation of clinical image quality for 20 cases using image quality criteria in the European Guidelines. Optimal anode/filter selections were established using signal difference-to-noise ratio measurements. Only small differences in peak DQE were seen between the three anode/filter settings, with an average value of 0.53. For poly(methyl methacrylate) (PMMA) thicknesses above 60 mm, the Rh/Rh setting was the optimal anode/filter setting. The system required a mean glandular dose of 0.54 mGy at 30 kV Rh/Rh to reach the Acceptable gold thickness limit for 0.1 mm details. Imaging performance of the retrofit unit with the GE DMR+ is notably better than of powder based computed radiography systems and is comparable to current flat panel FFDM systems.

The simulation of 3D mass models in 2D digital mammography and breast tomosynthesis

PURPOSE

This work proposes a new method of building 3D breast mass models with different morphological shapes and describes the validation of the realism of their appearance after simulation into 2D digital mammograms and breast tomosynthesis images.

METHODS

Twenty-five contrast enhanced MRI breast lesions were collected and each mass was manually segmented in the three orthogonal views: sagittal, coronal, and transversal. The segmented models were combined, resampled to have isotropic voxel sizes, triangularly meshed, and scaled to different sizes. These masses were referred to as nonspiculated masses and were then used as nuclei onto which spicules were grown with an iterative branching algorithm forming a total of 30 spiculated masses. These 55 mass models were projected into 2D projection images to obtain mammograms after image processing and into tomographic sequences of projection images, which were then reconstructed to form 3D tomosynthesis datasets. The realism of the appearance of these mass models was assessed by five radiologists via receiver operating characteristic (ROC) analysis when compared to 54 real masses. All lesions were also given a breast imaging reporting and data system (BIRADS) score. The data sets of 2D mammography and tomosynthesis were read separately. The Kendall's coefficient of concordance was used for the interrater observer agreement assessment for the BIRADS scores per modality. Further paired analysis, using the Wilcoxon signed rank test, of the BIRADS assessment between 2D and tomosynthesis was separately performed for the real masses and for the simulated masses.

RESULTS

The area under the ROC curves, averaged over all observers, was 0.54 (95% confidence interval [0.50, 0.66]) for the 2D study, and 0.67 (95% confidence interval [0.55, 0.79]) for the tomosynthesis study. According to the BIRADS scores, the nonspiculated and the spiculated masses varied in their degrees of malignancy from normal (BIRADS 1) to highly suggestive for malignancy (BIRADS 5) indicating the required variety of shapes and margins of these models. The assessment of the BIRADS scores for all observers indicated good agreement based on Kendall's coefficient for both the 2D and the tomosynthesis evaluations. The paired analysis of the BIRADS scores between 2D and tomosynthesis for each observer revealed consistent behavior for the real and simulated masses.

CONCLUSIONS

A database of 3D mass models, with variety of shapes and margins, was validated for the realism of their appearance for 2D digital mammography and for breast tomosynthesis. This database is suitable for use in future observer performance studies whether in virtual clinical trials or in patient images with simulated lesions.

Effective detective quantum efficiency for two mammography systems: measurement and comparison against established metrics

PURPOSE

The aim of this paper was to illustrate the value of the new metric effective detective quantum efficiency (eDQE) in relation to more established measures in the optimization process of two digital mammography systems. The following metrics were included for comparison against eDQE: detective quantum efficiency (DQE) of the detector, signal difference to noise ratio (SdNR), and detectability index (d') calculated using a standard nonprewhitened observer with eye filter.

METHODS

The two systems investigated were the Siemens MAMMOMAT Inspiration and the Hologic Selenia Dimensions. The presampling modulation transfer function (MTF) required for the eDQE was measured using two geometries: a geometry containing scattered radiation and a low scatter geometry. The eDQE, SdNR, and d' were measured for poly(methyl methacrylate) (PMMA) thicknesses of 20, 40, 60, and 70 mm, with and without the antiscatter grid and for a selection of clinically relevant target/filter (T/F) combinations. Figures of merit (FOMs) were then formed from SdNR and d' using the mean glandular dose as the factor to express detriment. Detector DQE was measured at energies covering the range of typical clinically used spectra.

RESULTS

The MTF measured in the presence of scattered radiation showed a large drop at low spatial frequency compared to the low scatter method and led to a corresponding reduction in eDQE. The eDQE for the Siemens system at 1 mm(-1) ranged between 0.15 and 0.27, depending on T/F and grid setting. For the Hologic system, eDQE at 1 mm(-1) varied from 0.15 to 0.32, again depending on T/F and grid setting. The eDQE results for both systems showed that the grid increased the system efficiency for PMMA thicknesses of 40 mm and above but showed only small sensitivity to T/F setting. While results of the SdNR and d' based FOMs confirmed the eDQE grid position results, they were also more specific in terms of T/F selection. For the Siemens system at 20 mm PMMA, the FOMs indicated Mo/Mo (grid out) as optimal while W/Rh (grid in) was the optimal configuration at 40, 60, and 70 mm PMMA. For the Hologic, the FOMs pointed to W/Rh (grid in) at 20 and 40 mm of PMMA while W/Ag (grid in) gave the highest FOM at 60 and 70 mm PMMA. Finally, DQE at 1 mm(-1) averaged for the four beam qualities studied was 0.44 ± 0.02 and 0.55 ± 0.03 for the Siemens and Hologic detectors, respectively, indicating only a small influence of energy on detector DQE.

CONCLUSIONS

Both the DQE and eDQE data showed only a small sensitivity to T/F setting for these two systems. The eDQE showed clear preferences in terms of scatter reduction, being highest for the grid-in geometry for PMMA thicknesses of 40 mm and above. The SdNR and d' based figures of merit, which contain additional weighting for contrast and dose, pointed to specific T/F settings for both systems.

Comparative power law analysis of structured breast phantom and patient images in digital mammography and breast tomosynthesis

PURPOSE

This work characterizes three candidate mammography phantoms with structured background in terms of power law analysis in the low frequency region of the power spectrum for 2D (planar) mammography and digital breast tomosynthesis (DBT).

METHODS

The study was performed using three phantoms (spheres in water, Voxmam, and BR3D CIRS phantoms) on two DBT systems from two different vendors (Siemens Inspiration and Hologic Selenia Dimensions). Power spectra (PS) were calculated for planar projection, DBT projection, and reconstructed images and curve fitted in the low frequency region from 0.2 to 0.7 mm(-1) with a power law function characterized by an exponent β and magnitude κ. The influence of acquisition dose and tube voltage on the power law parameters was first explored. Then power law parameters were calculated from images acquired with the same anode∕filter combination and tube voltage for the three test objects, and compared with each other. Finally, PS curves for automatic exposure controlled acquisitions (anode∕filter combination and tube voltages selected by the systems based on the breast equivalent thickness of the test objects) were compared against PS analysis performed on patient data (for Siemens 80 and for Hologic 48 mammograms and DBT series). Dosimetric aspects of the three test objects were also examined.

RESULTS

The power law exponent (β) was found to be independent of acquisition dose for planar mammography but varied more for DBT projections of the sphere-phantom. Systematic increase of tube voltage did not affect β but decreased κ, both in planar and DBT projection phantom images. Power spectra of the BR3D phantom were closer to those of the patients than these of the Voxmam phantom; the Voxmam phantom gave high values of κ compared to the other phantoms and the patient series. The magnitude of the PS curves of the BR3D phantom was within the patient range but β was lower than the average patient value. Finally, PS magnitude for the sphere-phantom coincided with the patient curves for Siemens but was lower for the Hologic system. Close agreement of doses for all three phantoms with patient doses was found.

CONCLUSIONS

Power law parameters of the phantoms were close to those of the patients but no single phantom matched in terms of both magnitude (κ) and texture (β) for the x-ray systems in this work. PS analysis of structured phantoms is feasible and this methodology can be used to suggest improvements in phantom design.

Quality assurance and quality control in mammography: a review of available guidance worldwide

Objectives

Review available guidance for quality assurance (QA) in mammography and discuss its contribution to harmonise practices worldwide.

Methods

Literature search was performed on different sources to identify guidance documents for QA in mammography available worldwide in international bodies, healthcare providers, professional/scientific associations. The guidance documents identified were reviewed and a selection was compared for type of guidance (clinical/technical), technology and proposed QA methodologies focusing on dose and image quality (IQ) performance assessment.

Results

Fourteen protocols (targeted at conventional and digital mammography) were reviewed. All included recommendations for testing acquisition, processing and display systems associated with mammographic equipment. All guidance reviewed highlighted the importance of dose assessment and testing the Automatic Exposure Control (AEC) system. Recommended tests for assessment of IQ showed variations in the proposed methodologies. Recommended testing focused on assessment of low-contrast detection, spatial resolution and noise. QC of image display is recommended following the American Association of Physicists in Medicine guidelines.

Conclusions

The existing QA guidance for mammography is derived from key documents (American College of Radiology and European Union guidelines) and proposes similar tests despite the variations in detail and methodologies. Studies reported on QA data should provide detail on experimental technique to allow robust data comparison. Countries aiming to implement a mammography/QA program may select/prioritise the tests depending on available technology and resources.

Main messages

•An effective QA program should be practical to implement in a clinical setting.

•QA should address the various stages of the imaging chain: acquisition, processing and display.

•AEC system QC testing is simple to implement and provides information on equipment performance.

Dose sensitivity of three phantoms used for quality assurance in digital mammography

Technical quality assurance (QA) is one of the key issues in breast cancer screening protocols. For this QA task, three different methods are commonly used to assess image quality. The European protocol suggests a contrast-detail phantom (e.g. the CDMAM phantom), while in North America the American College of Radiology (ACR) accreditation phantom is proposed. Alternatively, phantoms based on image quality parameters from applied system theory such as the noise-equivalent number of quanta (NEQ) are applied (e.g. the PAS 1054 phantom). The aim of this paper was to correlate the changes in the output of the three evaluation methods (CDMAM, ACR and NEQ) with changes in dose. We varied the time-current product within a range of clinically used values (40-140 mAs, corresponding to 3.5-12.4 mGy entrance dose and detector dose of 32-110 μGy). For the ACR phantom, the examined parameter was the number of detected objects. With the CDMAM phantom we chose the diameters 0.10, 0.13, 0.20, 0.31 and 0.5 mm and recorded the threshold thicknesses. With respect to the third method, we evaluated the NEQ at typical spatial frequencies to calculate the relative changes in NEQ. Plotting NEQ versus dose increment shows a linear relationship and can be described by a linear function (with R > 0.99). Every manually selectable current- time product increment can be detected. With the ACR phantom, the number of detected objects increases only in the lower dose range and reaches saturation at about 9 mGy entrance dose (80 μGy detector dose). The CDMAM can detect a 50% increase in dose over the examined dose range with all five diameters, although the increases of threshold thickness are not monotonous. We conclude that an NEQ-based method has the potential to replace the established detail phantom methods to detect dose changes in the course of QA.

Measurements of system sharpness for two digital breast tomosynthesis systems

The aim of this work was to propose system sharpness parameters for digital breast tomosynthesis (DBT) systems that include the influence of focus size and focus motion for use in quality assurance protocols. X-ray focus size was measured using a multiple pinhole test object, while detector presampling modulation transfer function (MTF) was measured from projection images of a 10 cm × 10 cm, 1 mm thick steel edge, for the Siemens Inspiration and Hologic Selenia Dimensions DBT systems. The height of the edge above the table was then varied from 1 to 78 mm. The MTF expected from theory for the projection images was calculated from the measured detector MTF, focus size MTF and focus motion MTF and was compared against measured curves. Two methods were used to measure the in-plane MTF in the DBT volume: a tungsten wire of diameter 25 µm and an Al edge 0.2 mm thick, both imaged with a 15 mm thick poly(methyl methacrylate) (PMMA) plate. The in-depth point spread function (PSF) was measured using an angled tungsten wire. The full 3D MTF was estimated with a 0.5 mm diameter aluminium bead held in a 45 mm thick PMMA phantom, with the bead 15 and 65 mm above the table. Inspiration DBT projection images are saved at native detector resolution (85 µm), while the Dimensions re-bins projections to 140 µm pixels (2 × 2 binning); both systems used 2 × 2 binning of projection data before reconstruction. The 50% point for the MTF (MTF(0.50)) measured in the DBT projection images for the tube-travel direction fell as a function of height above the table from 3.60 to 0.90 mm(-1) for the Inspiration system and from 2.50 to 1.20 mm(-1) for the Dimensions unit. The maximum deviation of measured MTF(0.50) from the calculated value was 13%. MTF(0.50) measured in-plane (tube-travel direction) fell as a function of height above the table from 1.66 to 0.97 mm(-1) for the Inspiration system and from 2.21 to 1.31 mm(-1) for the Dimensions system. The full-width half-maximum for the in-depth PSF was 3.0 and 5.9 mm for the Inspiration and Dimensions systems, respectively. There was no difference in the 3D MTF curves, sectioned in the tube-travel direction, for bead heights of 15 and 65 mm above the table. A 25 µm tungsten wire held within a 15 mm thick PMMA plate was found to be a suitable test object for measurement of in-plane MTF. Evaluation of MTF as a function of height above the table, both in the projection images and in the reconstructed planes, provides important information on the impact of focus size and focus motion on the DBT system's imaging performance.

Comparison of signal to noise ratios from spatial and frequency domain formulations of nonprewhitening model observers in digital mammography

PURPOSE

Image quality indices based upon model observers are promising alternatives to laborious human readings of contrast-detail images. This is especially appealing in digital mammography as limiting values for contrast thresholds determine, according to some international protocols, the acceptability of these systems in the radiological practice. The objective of the present study was to compare the signal to noise ratios (SNR) obtained with two nonprewhitening matched filter model observer approaches, one in the spatial domain and the other in the frequency domain, and with both of them worked out for disks as present in the CDMAM phantom.

METHODS

The analysis was performed using images acquired with the Siemens Novation and Inspiration digital mammography systems. The spatial domain formulation uses a series of high dose CDMAM images as the signal and a routine exposure of two flood images to calculate the covariance matrix. The frequency domain approach uses the mathematical description of a disk and modulation transfer function (MTF) and noise power spectrum (NPS) calculated from images.

RESULTS

For both systems most of the SNR values calculated in the frequency domain were in very good agreement with the SNR values calculated in the spatial domain. Both the formulations in the frequency domain and in the spatial domain show a linear relationship between SNR and the diameter of the CDMAM discs.

CONCLUSIONS

The results suggest that both formulations of the model observer lead to very similar figures of merit. This is a step forward in the adoption of figures of merit based on NPS and MTF for the acceptance testing of mammography systems.

Quantification of scattered radiation in projection mammography: four practical methods compared

PURPOSE

Four different practical methodologies of quantifying scattered radiation for two different digital mammographic systems are compared. The study considered both grid in and grid out geometries for two different antiscatter grid types, a typical linear grid and a cellular grid design. The aim was to find quick and reproducible methods that could be used in place of the beam stop technique.

METHODS

The scatter to primary ratio (SPR) and the scatter fraction (SF) were used to quantify scattered radiation as a function of poly(methyl methacrylate) (PMMA) thickness, grid position, and beam quality. The four scatter estimation methods applied were (1) the beam stop method, (2) a hybrid method that combined measured detector (scatter-free) modulation transfer function (MTF) data and a Monte Carlo simulation of the scatter point spread function, (3) from the low frequency drop data taken from the system MTF, and (4) from the edge spread function (ESF) measured in the presence of PMMA. Repeatability error was assessed for all methods.

RESULTS

SPR results acquired with the beam stop method ranged from 0.052 to 0.187 for the system with linear grid and from 0.012 to 0.064 for the cellular grid system, as PMMA thickness was increased from 20 to 80 mm. With the grid removed, beam stop SPR was similar for both systems, ranging between 0.268 and 1.124, for corresponding MTF thicknesses. The direct MTF method had a maximum difference of 24% from the beam stop SPR and SF data for all conditions except the cellular grid in geometry, where maximum difference in SPR was 0.044 (164%). The ESF technique gave large differences from the beam stops for both grid geometries but agreement was within 21% for the grid out geometry. Repeatability error with beam stops was between 1% and 5% for the grid out geometries, while for the grid in cases it was 13% and 87% for the linear and cellular grids, respectively. Repeatability error for the direct MTF method applied to both systems and grid geometries ranged between 3% and 12%.

CONCLUSIONS

All three alternative methods to the beam stop technique gave reasonable estimates of SPR without grid, with a maximum difference of 24% (mean difference 8%). For the grid in geometry, the direct MTF method gave a maximum difference of 24% for the linear grid system, while maximum percentage difference was 119% (absolute difference of 0.042) for the system with the cellular grid, where SPR values were low. Except for cases where the SPR is very low, the direct MTF method offers a quick and reproducible alternative to the beam stop technique.

Physical evaluation of a needle photostimulable phosphor based CR mammography system

PURPOSE

Needle phosphor based computed radiography (CR) systems promise improved image quality compared to powder phosphor based CR units for x-ray screening mammography. This paper compares the imaging performance of needle CR cassettes, powder based CR cassettes and a well established amorphous selenium (a-Se) based flat panel based mammography system, using consistent beam qualities.

METHODS

Detector performance was assessed using modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE). Mammography system performance was assessed against levels from the European Guidelines, including threshold gold thickness (c-d), relative signal difference to noise (SdNR) and mean glandular dose, for automatic exposure control settings suggested by the manufacturers. The needle based Agfa HM5.0 CR detector was compared against the single sided readout Agfa MM3.0R and dual sided readout Fuji Profect CS powder CR plates using a 28 kV Mo/Rh spectrum, while a 28 kV W/Rh spectrum was used to compare the Agfa HM5.0 against the Siemens MAMMOMAT Inspiration a-Se based system.

RESULTS

MTF at 5 mm(-1) was 0.16 and 0.24 for the needle CR detector in the fast and slow scan directions, respectively, indicating a slight improvement (∼20%) over the two powder CR systems but remained 50% lower than the result at 5 mm(-1) for the a-Se detector (∼0.55). Structured screen noise was lower for the needle phosphor compared to the powder plates. CR system gain, estimated from the measured absorption fraction and NNPS results, was 6.3 for the (single sided) needle phosphor and 5.1 and 7.2 for the single sided and dual sided powder phosphor systems. Peak DQE at ∼100 μGy was 0.47 for the needle system compared to peak DQE figures of 0.33 and 0.46 for the single sided readout powder plates and dual sided readout plates. The high frequency DQE (at 5 mm(-1)) was 0.19 for the needle CR plates, a factor of approximately 3 greater than for the powder CR plates. At 28 kV W/Rh, 2 mm Al, peak DQE for the needle CR system was 0.45 against a value of 0.50 for the a-Se detector. The needle CR detector reached the Acceptable limit for 0.1 mm details in the European Guidelines at a mean glandular dose (MGD) of approximately 1.31 mGy imaged at 28 kV Mo/Rh, compared to figures of 2.19 and 1.43 mGy for the single sided and dual sided readout powder CR systems. The a-Se detector could reach the limit at 0.65 mGy using a 28 kV W/Rh spectrum, while the needle CR system required 1.09 mGy for the same spectrum.

CONCLUSIONS

Imaging performance for the needle CR phosphor technology, characterized using MTF and DQE and threshold gold thickness demonstrated a clear improvement compared to both single and dual sided reading powder phosphor based CR systems.

The simulation of 3D microcalcification clusters in 2D digital mammography and breast tomosynthesis

PURPOSE

This work proposes a new method of building 3D models of microcalcification clusters and describes the validation of their realistic appearance when simulated into 2D digital mammograms and into breast tomosynthesis images.

METHODS

A micro-CT unit was used to scan 23 breast biopsy specimens of microcalcification clusters with malignant and benign characteristics and their 3D reconstructed datasets were segmented to obtain 3D models of microcalcification clusters. These models were then adjusted for the x-ray spectrum used and for the system resolution and simulated into 2D projection images to obtain mammograms after image processing and into tomographic sequences of projection images, which were then reconstructed to form 3D tomosynthesis datasets. Six radiologists were asked to distinguish between 40 real and 40 simulated clusters of microcalcifications in two separate studies on 2D mammography and tomosynthesis datasets. Receiver operating characteristic (ROC) analysis was used to test the ability of each observer to distinguish between simulated and real microcalcification clusters. The kappa statistic was applied to assess how often the individual simulated and real microcalcification clusters had received similar scores ("agreement") on their realistic appearance in both modalities. This analysis was performed for all readers and for the real and the simulated group of microcalcification clusters separately. "Poor" agreement would reflect radiologists' confusion between simulated and real clusters, i.e., lesions not systematically evaluated in both modalities as either simulated or real, and would therefore be interpreted as a success of the present models.

RESULTS

The area under the ROC curve, averaged over the observers, was 0.55 (95% confidence interval [0.44, 0.66]) for the 2D study, and 0.46 (95% confidence interval [0.29, 0.64]) for the tomosynthesis study, indicating no statistically significant difference between real and simulated lesions (p > 0.05). Agreement between allocated lesion scores for 2D mammography and those for the tomosynthesis series was poor.

CONCLUSIONS

The realistic appearance of the 3D models of microcalcification clusters, whether malignant or benign clusters, was confirmed for 2D digital mammography images and the breast tomosynthesis datasets; this database of clusters is suitable for use in future observer performance studies related to the detectability of microcalcification clusters. Such studies include comparing 2D digital mammography to breast tomosynthesis and comparing different reconstruction algorithms.

Factors for conversion between human and automatic read-outs of CDMAM images

PURPOSE

According to the European protocol for the quality control of the physical and technical aspects of mammography screening (EPQCM) image quality of digital mammography devices has to be assessed using human evaluation of the CDMAM contrast-detail phantom. This is accomplished by the determination of threshold thicknesses of gold disks with different diameters (0.08-2 mm) and revealed to be very time consuming. Therefore a software solution based on a nonprewhitening matched filter (NPW) model was developed at the University of Nijmegen. Factors for the conversion from automatic to human readouts have been determined by Young et al. [Proc. SPIE 614206, 1-13 (2006) and Proc. SPIE 6913, 69131C1 (2008)] using a huge amount of data of both human and automatic readouts. These factors depend on the observer groups and are purely phenomenological. The authors present an alternative approach to determine the factors by using the Rose observer model.

METHODS

Their method uses the Rose theory which gives a relationship between threshold contrast, diameter of the object and number of incident photons. To estimate the conversion factors for the five diameters from 0.2 to 0.5 mm they exposed with five different current-time products which resulted in 25 equations with five unknowns.

RESULTS

The theoretical conversion factors (in dependence of the diameters) amounted to be 1.61 ± 0.02 (0.2 mm diameter), 1.67 ± 0.02 (0.25 mm), 1.85 ± 0.02 (0.31 mm), 2.09 ± 0.02 (0.4 mm), and 2.28 ± 0.02 (0.5 mm). The corresponding phenomenological factors found in literature are 1.74 (0.2 mm), 1.78 (0.25 mm), 1.83 (0.31 mm), 1.88 (0.4 mm), and 1.93 (0.5 mm).

CONCLUSIONS

They transferred the problem of determining the factors to a well known observer model which has been examined for many years and is also well established. This method reveals to be reproduceable and produces factors comparable to the phenomenological ones.

Computation of realistic virtual phantom images for an objective lesion detectability assessment in digital mammography

Image quality assessment is required for an optimal use of mammographic units. On the one hand, there are objective image quality assessment methods based on the measurement of technical parameters such as modulation transfer function (MTF), noise power spectrum (NPS) or detection quantum efficiency (DQE) describing performances of digital detectors. These parameters are, however, without direct relationship with lesion detectability in clinical practice. On the other hand, there are image quality assessment methods involving time consuming procedures, but presenting a direct relationship with lesion detectability. This contribution describes an X-ray source/digital detector model leading to the simulation of virtual contrast-detail phantom (CDMAM) images. The virtual image computation method requires the acquisition of only few real images and allows for an objective image quality assessment presenting a direct relationship with lesion detectability. The transfer function of the proposed model takes as input physical parameters (MTF* and noise) measured under clinical conditions on mammographic units. As presented in this contribution, MTF* is a modified MTF taking into account the effects due to X-ray scatter in the breast and magnification. Results obtained with the structural similarity index prove that the simulated images are quite realistic in terms of contrast and noise. Tests using contrast detail curves highlight the fact that the simulated and real images lead to very similar data quality in terms of lesion detectability. Finally, various statistical tests show that quality factors computed for both the simulated images and the real images are very close for the two data sets.

Quality control measurements for digital x-ray detectors

This paper describes a digital radiography (DR) quality control protocol for DR detectors from the forthcoming report from the Institute of Physics and Engineering in Medicine (IPEM). The protocol was applied to a group of six identical caesium iodide (CsI) digital x-ray detectors to assess reproducibility of methods, while four further detectors were assessed to examine the wider applicability. Twelve images with minimal spatial frequency processing are required, from which the detector response, lag, modulation transfer function (MTF), normalized noise power spectrum (NNPS) and threshold contrast-detail (c-d) detectability are calculated. The x-ray spectrum used was 70 kV and 1 mm added copper filtration, with a target detector air kerma of 2.5 µGy for the NNPS and c-d results. In order to compare detector performance with previous imaging technology, c-d data from four screen/film systems were also acquired, at a target optical density of 1.5 and an average detector air kerma of 2.56 µGy. The DR detector images were typically acquired in 20 min, with a further 45 min required for image transfer and analysis. The average spatial frequency for the 50% point of the MTF for six identical detectors was 1.29 mm(-1) ± 0.05 (3.9% coefficient of variation (cov)). The air kerma set for the six systems was 2.57 µGy ± 0.13 (5.0% cov) and the NNPS at this air kerma was 1.42 × 10(-5) mm(2) (6.5% cov). The detective quantum efficiency (DQE) measured for the six identical detectors was 0.60 at 0.5 mm(-1), with a maximum cov of 10% at 2.9 mm(-1), while the average DQE was 0.56 at 0.5 mm(-1) for three CsI detectors from three different manufacturers. Comparable c-d performance was found for these detectors (5.9% cov) with an average threshold contrast of 0.46% for 11 mm circular discs. The average threshold contrast for the S/F systems was 0.70% at 11 mm, indicating superior imaging performance for the digital systems. The protocol was found to be quick, reproducible and gave an in-depth assessment of performance for a range of digital x-ray detectors.

Using a NPWE model observer to assess suitable image quality for a digital mammography quality assurance programme

A method of objectively determining imaging performance for a mammography quality assurance programme for digital systems was developed. The method is based on the assessment of the visibility of a spherical microcalcification of 0.2 mm using a quasi-ideal observer model. It requires the assessment of the spatial resolution (modulation transfer function) and the noise power spectra of the systems. The contrast is measured using a 0.2-mm thick Al sheet and Polymethylmethacrylate (PMMA) blocks. The minimal image quality was defined as that giving a target contrast-to-noise ratio (CNR) of 5.4. Several evaluations of this objective method for evaluating image quality in mammography quality assurance programmes have been considered on computed radiography (CR) and digital radiography (DR) mammography systems. The measurement gives a threshold CNR necessary to reach the minimum standard image quality required with regards to the visibility of a 0.2-mm microcalcification. This method may replace the CDMAM image evaluation and simplify the threshold contrast visibility test used in mammography quality.