St. Elisabeth Hospital, Department of Radiology, Tilburg, The Netherlands. National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands. Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Objective: To experimentally indicate a lower limit of dose in mammographic imaging yielding adequate image quality for complementary diagnostic views, by evaluation of image series with different exposure parameters and additional image processing on mastectomy specimens with diverse pathology. Methods: Image series were obtained on seven specimens with different target-filter combinations at different exposure values. Three experienced radiologists assessed the lowest acceptable dose level per specimen using a relative grading technique. With the standard image as reference, fibroglandular tissue and pathological structures, including microcalcifications, were evaluated. Subsequently, a series of pixel binning processes was tested and subjectively assessed on the selected images. Results: The lowest dose level at which image quality was acceptable, and achieved with a W/Ag target-filter combination at 32 kV and 4 mAs. These images can be acquired with 10.4% to 22.4% of the average glandular dose in standard images. Post process pixel binning added to the interpretability of such low dose images. Conclusion: This specimen study suggests that dose level of mammography images might be reduced substantially by general application of a W/Ag spectrum, particularly when combined with post process noise reduction. Future studies should focus on the feasibility of this technique in clinical mammography.
Bluekens, A. , Engen, R. , Karssemeijer, N. , Schuur, K. , Broeders, M. , Heeten, G. and Heeten, G. (2013) Alternative Exposure Parameters and Post Process Noise Reduction Expect Considerable Dose Reduction in Single Mammography Views—Initial Experience on Mastectomy Specimens. Advances in Breast Cancer Research, 2, 91-96. doi: 10.4236/abcr.2013.23016.
[1] E. Samei, R. S. Saunders Jr., J. A. Baker and D. M. Delong, “Digital Mammography: Effects of a Reduced Radiation Dose on Diagnostic Performance,” Radiology, Vol. 243, No. 2, 2007, pp. 396-404. doi:10.1148/radiol.2432061065 [2] A. S. Chawla, E. Samei, R. Saunders, C. Abbey and D. Delong, “Effect of Dose Reduction on the Detection of Mammographic Lesions: A Mathematical Observer Model Analysis,” Medical Physics, Vol. 34, No. 8, 2007, pp. 3385-3398. doi:10.1118/1.2756607 [3] T. Svahn, B. Hemdal, M. Ruschin, D. P. Chakraborty, I. Andersson and A. Tingberg, “Dose Reduction and Its Influence on Diagnostic Accuracy and Radiation Risk in Digital Mammography: An Observer Performance Study Using an Anthropomorfic Breast Phantom,” British Journal of Radiology, Vol. 80, No. 955, 2007, pp. 557-562. doi:10.1259/bjr/29933797 [4] D. R. Dance, A. K. Thilander, M. Sandborg, C. L. Skinner, I. A. Castellano and G. A. Carlsson, “Influence of Anode/ Filter Material and Tube Potential on Contrast, Signalto-Noise Ratio and Average Absorbed Dose in Mammography: A Monte Carlo Study,” British Journal of Radiology, Vol. 73, No. 874, 2000, pp. 1056-1067. [5] P. Bernhardt, T. Mertelmeier and M. Hoheisel, “X-Ray Spectrum Optimization of Full-Field Digital Mammography: Simulation and Phantom Study,” Medical Physics, Vol. 33, No. 11, 2006, pp. 4337-4349. doi:10.1118/1.2351951 [6] E. L. Siegel and R. Khorasani, “To Compress or Not to Compress: A Compressed Debate,” Journal of the American College of Radiology, Vol. 1, No. 12, 2004, pp. 981-983. doi:10.1016/j.jacr.2004.09.014 [7] R. de Gelder, G. Draisma, E. A. Heijnsdijk and H. J. de Koning, “Population-Based Mammography Screening Below Age 50: Balancing Radiation-Induced vs Prevented Breast Cancer Deaths,” British Journal of Cancer, Vol. 104, No. 7, 2011, pp. 1214-1220. doi:10.1038/bjc.2011.67 [8] M. J. Yaffe and J. G. Mainprize, “Risk of Radiation-Induced Breast Cancer from Mammographic Screening,” Radiology, Vol. 258, No. 1, 2011, pp. 98-105. doi:10.1148/radiol.10100655 [9] P. Baldelli, N. Phelan and G. Egan, “Investigation of the Effect of Anode/Filter Materials on the Dose and Image Quality of a Digital Mammography System Based on an Amorphous Selenium Flat Panel Detector,” British Journal of Radiology, Vol. 83, No. 988, 2010, pp. 290-295. doi:10.1259/bjr/60404532 [10] A. Burgess, “Human Observer Detection Experiments with Mammograms and Power-Law Noise,” Medical Physics, Vol. 28, No. 4, 2001, pp. 419-437. doi:10.1118/1.1355308 [11] L. M. Warren, A. Mackenzie, J. Cooke, R. M. Given-Wilson, M. G. Wallis and D. P. Chakraborty, “Effect of Image Quality on Calcification Detection in Digital Mammography,” Medical Physics, Vol. 39, No. 6, 2012, pp. 3202-3213. doi:10.1118/1.4718571 [12] D. Gur, G. S. Abrams, D. M. Chough, M. A. Ganott, C. M. Hakim and R. L. Perrin, “Digital Breast Tomosynthesis: Observer Performance Study,” AJR American Journal of Roentgenology, Vol. 193, No. 2, 2009, pp. 586-591. doi:10.2214/AJR.08.2031 [13] A. M. Bluekens, N. Karssemeijer, D. Beijerinck, J. J. Deurenberg, R. E. van Engen and M. J. Broeders, “Consequences of Digital Mammography in Population-Based Breast Cancer Screening: Initial Changes and Long-Term Impact on Referral Rates,” European Radiology, Vol. 20, No. 9, 2010, pp. 2067-2073. doi:10.1007/s00330-010-1786-7 [14] N. J. Wald, P. Murphy, P. Major, C. Parkes, J. Townsend and C. Frost, “UKCCCR Multicentre Randomised Controlled Trial of One and Two View Mammography in Breast Cancer Screening,” BMJ, Vol. 311, No. 7014, 1995, pp. 1189-1193. doi:10.1136/bmj.311.7014.1189 [15] U. Bick and F. Diekmann, “What Do We and What Don’t We Know?” European Radiology, Vol. 17, No. 8, 2007, pp. 1931-1942. doi:10.1007/s00330-007-0586-1 [16] R. G. Blanks, S. M. Moss and M. G. Wallis, “Use of Two View Mammography Compared with One View in the Detection of Small Invasive Cancers: Further Results from the National Health Service Breast Screening Programme,” Journal of Medical Screen, Vol. 4, 1997, pp. 98-101. [17] C. C. Riedl, S. Jaromi, D. Floery, G. Pfarl, M. H. Fuchsjaeger and T. H. Helbich, “Potential of Dose Reduction after Marker Placement with Full-Field Digital Mammography,” Invest Radiology, Vol. 40, No. 6, 2005, pp. 343-348. doi:10.1097/01.rli.0000163743.63063.9f