18 research outputs found

    Diagnostic Reference Levels for digital mammography in Australia

    Get PDF
    Aims: In 3 phases, this thesis explores: radiation doses delivered to women during mammography, methods to estimate mean glandular dose (MGD), and the use of mammographic breast density (MBD) in MGD calculations. Firstly, it examines Diagnostic reference levels (DRLs) for digital mammography in Australia, with novel focus on the use of compressed breast thickness (CBT) and detector technologies as a guide when determining patient derived DRLs. Secondly, it analyses the agreement between Organ Dose estimated by different digital mammography units and calculated MGD for clinical data. Thirdly, it explores the novel use of MBD in MGD calculations, suggesting a new dose estimation called the actual glandular dose (AGD), and compares MGD to AGD. Methods: DICOM headers were extracted from 52405 anonymised mammograms using 3rd party software. Exposure and QA information were utilised to calculate MGD using 3 methods. LIBRA software was used to estimate MBD for 31097 mammograms. Median, 75th and 95th percentiles were calculated across MGDs obtained for all included data and according to 9 CBT ranges, average population CBT, and for 3 detector technologies. The significance of the differences, correlations, and agreement between MGDs for different CBT ranges, calculation methods, and different density estimation methods were analysed. Conclusions: This thesis have recommended DRLs for mammography in Australia, it shows that MGD is dependent upon CBT and detector technology, hence DRLs were presented as a table for different CBTs and detectors. The work also shows that Organ Doses reported by vendors vary from that calculated using established methodologies. Data produced also show that the use of MGD calculated using standardised glandularities underestimates dose at lower CBTs compared to AGD by up to 10%, hence, underestimating radiation risk. Finally, AGD was proposed; it considers differences in breast composition for individualised radiation-induced risk assessment

    Imaging of the Breast

    Get PDF
    Early detection of breast cancer combined with targeted therapy offers the best outcome for breast cancer patients. This volume deal with a wide range of new technical innovations for improving breast cancer detection, diagnosis and therapy. There is a special focus on improvements in mammographic image quality, image analysis, magnetic resonance imaging of the breast and molecular imaging. A chapter on targeted therapy explores the option of less radical postoperative therapy for women with early, screen-detected breast cancers

    Risk of radiation-induced cancer from screening mammography

    Get PDF
    Background and Objectives: When the benefits and risks of mammography are considered, the risk of radiation-induced cancer is calculated only for the breast using the mean glandular dose (MGD). Whilst MGD is a useful concept, it has many limitations. This thesis aims to establish a novel method to determine and convey radiation risk from full field digital mammography (FFDM) screening using lifetime effective risk. Method: For effective risk calculations, organ doses as well as examined breast MGD are required. Screening mammography was simulated by exposing a breast phantom for cranio-caudal and medio-lateral oblique for each breast using 16 FFDM machines. An anthropomorphic dosimetry phantom loaded with thermo-luminescent detectors (TLDs) was positioned in contact with the breast phantom to simulate the client’s body. Once the risk per individual was calculated, total effective lifetime risk across 48 worldwide screening programmes was calculated. The total effective risk data sets were analysed to establish a regression model to predict the effective risk of any screening programme. Graphs were generated to extrapolate the total effective risk of any screening programme of specific screening commencement age and frequency considering the MGD differences of different FFDM machines. Since the highest radiation dose after examined breast was received by contralateral breast, the effect of a contralateral breast lead shield on effective risk was also investigated. Results: Large differences in the effective lifetime risk exist between worldwide screening programmes. The effective lifetime risk varied from approximately 50 cases/106 to more than 1000 cases/106. These differences were mainly attributed to the commencement age and frequency of screening. Since tissue radio-sensitivity reduces with age, the cessation age of screening mammography does not result in a noteworthy effect on the total effective risk. The use of contralateral breast shield reduces the total effective risk by about 1.5% for most worldwide screening programmes.Conclusion: A novel method has been proposed to assess radiation-induced cancer risk from FFDM screening which considers the radiation dose received by all body tissues in addition to the examined breast. Using effective risk, the data is more likely to be understandable by screening clients and referring clinicians, unlike MGD which is not readily available or understandable by the general populace. This novel method and the data are compatible with the incoming European Commission legislation about giving the patient information on radiation risk

    Enhancing the image quality of digital breast tomosynthesis

    Get PDF
    A novel imaging technology, digital breast tomosynthesis (DBT), is a technique that overcomes the tissue superposition limitation of conventional mammography by acquiring a limited number of X-ray projections from a narrow angular range, and combining these projections to reconstruct a pseudo-3D image. The emergence of DBT as a potential replacement or adjunct to mammographic screening mandates that solutions be found to two of its major limitations, namely X-ray scatter and mono-energetic reconstruction methods. A multi-faceted software-based approach to enhance the image quality of DBT imaging has the potential to increase the sensitivity and specificity of breast cancer detection and diagnosis. A scatter correction (SC) algorithm and a spectral reconstruction (SR) algorithm are both ready for implementation and clinical evaluation in a DBT system and exhibit the potential to improve image quality. A principal component analysis (PCA) based model of breast shape and a PCA model of X-ray scatter optimize the SC algorithm for the clinical realm. In addition, a comprehensive dosimetric characterization of a FDA approved DBT system has also been performed, and the feasibility of a new dual-spectrum, single-acquisition DBT imaging technique has also been evaluated.Ph.D

    Experimental evaluation of the z-resolution in different clinical Digital Breast Tomosynthesis systems using commercial phantoms

    Get PDF
    Digital Breast Tomosynthesis (DBT) is an advanced mammography technique based on the reconstruction of a pseudo-volumetric image. To date, image quality represents the most deficient section of DBT quality control protocols. In fact, related tests are not yet characterized by either action levels or typical values. This thesis work focuses on the evaluation of one aspect of image quality: the z-resolution. The latter is studied in terms of Artifact Spread Function (ASF), a function that describes the signal spread of a detail along the reconstructed focal planes. To quantify the ASF numerically, its Full Width at Half Maximum (FWHM) is calculated and used as a representative index of z-resolution. Experimental measurements were acquired in 24 DBT systems, of 7 different models, currently in use in 20 hospital facilities in Italy. The analysis, performed on the clinical reconstructed images, of 5 different commercial phantoms, lead to the identification of characteristic FWHM values for each type of DBT system. The ASF clearly showed a dependence on the size of the detail, providing higher FWHM values for larger objects. The z-resolution was found to be positively influenced by the acquisition angle: Fujifilm sistematically showed wider ASF profiles in ST mode (15°) than in HR mode (40°). However, no clear relationship was found between angular range and ASF, among different DBT systems, due to the influence of the peculiarities of each reconstruction algorithm. The experimental approach shown in this thesis work can be proposed as a z-resolution quality control test procedure. Contextually, the values found could be used as a starting point for identifying typical values to be included in the test, in a DBT protocol. Clearly, a statistically significant number of images is needed to do this. The equipment involved in this work is located in hospitals and is not available for research purposes, so only a limited amount of data was acquired and processed
    corecore