Master in Medical Physics 2015 to 2016

Quality control in Mammography

Francisco J.Hernndez Flores
International Centre for Theoretical Physics
franciscohernandez_f2010@hotmail.com

August 3, 2015

Abstract
This report it is about the quality control in mammography, the importance in
accurately diagnosing breast cancer, particularly in earlier stage cancers, reducing
its high mortality rate in women, it is essential that all mammograms be performed
and interpreted with the highest possible quality standards. The existence of and
strict adherence to quality assurance (QA) and quality control (QC) measures
and guidelines must be practiced in all mammography facilities in order to assure
the most accurate diagnoses for all patients. The following report will discuss
current QC and QA measures in mammography, including the Phantom exposure
for determine the mean glandularly dose, determination of incident air Kerma
and determination of Half Value Layer. In the case of mean glandular dose
was evaluated for the manufacturer this measure was compared with the mean
glandular dose obtained in practice using k i and HVL, the difference obtained
was 14.2%.the value obtained for HVL during the practice was 0.64 mmAl using
28KVand 74mAs, the incident air kerma was 5.026 mGy.

I.

Introduction

Breast dosimetry is an important

part of mammographic quality control and is an essential element of
the optimization of ionizing-radiationbased breast imaging procedures. For
conventional projection mammography there are various standard protocols for the estimation of breast dose
which provide conversion factors to
relate the incident air kerma at the up-

Physics

per surface of the breast to the mean

dose to the glandular tissues within
the breast (mean glandular dose). The
determination of the mean glandular dose and HVL was made using xray spectra from a W/Ag target/filter
combination at 28 kV using ionization
chamber and electrometer PTW for
obtain the measured and compared
with the manufacturer value.

of diagnostic X ray 2

Master in Medical Physics 2015 to 2016

II.
I.

Theory

Half-Value Layer

The half-value layer (HVL) is defined

as the thickness of material required
to reduce the intensity (e.g., air kerma
rate) of an x-ray or gamma-ray beam
to one half of its initial value. The
HVL of a beam is an indirect measure of the photon energies (also referred to as the quality) of a beam,
when measured under conditions of
narrow- beam geometry. The HVL of
a diagnostic x-ray beam, measured in
millimeters of aluminum under narrow beam conditions, is a surrogate
measure of the penetrability of an xray spectrum. It is important to understand the relationship between
and HVL. In Equation 1, N is equal
to No/2 when the thickness of the

absorber is 1 HVL. The HVL can be

easily calculated from the linear attenuation coefficient, and vice versa. the
mathematically form of evaluation it
is show in the equation 2 [3]. The
condition for obtain the HVL in mammography during the measurements
is take into account compression plate
Select the target, filter and the value
for tube voltage and typical tube loading that would be used for the routine
clinical examination of the breast being simulated (see figure 1 Scheme of
measurement HVL in reference condition).
N0
= N0 e( HVL)
2
HVL =

ln2

(1)
(2)

Figure 1: Measurements scheme HVL [4]

II.

Mean glandular dose

The Mean Glandular Dose (MGD)

is the special dose quantity used in

mammography. It is defined as the

mean, or average, dose to the glandular tissue within the breast. The
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Master in Medical Physics 2015 to 2016

assumption is that the glandular tissue, and not the fat, is the tissue at risk
from radiation exposure. Obviously, it
is just about impossible to determine
the actual dose to the glandular tissue
during a specific mammographic procedure because of variations in breast
size and distribution of glandular tissue within the breast. The MGD is
based on some standard breast parameters. MGD values are determined by
following a standard two-step protocol.

tion and comparative dose determinations.

Conversion coefficient to estimate
mean glandular dose from incident air
kerma are dependent on the glandularity of each breast. Two approches
are possible: Assume glandularity of
50% estimate the effective glandularity.

The first step is to determine the

entrance surface exposure, or air
kerma, to the breast. This can
be measured directly with small
dosimeters placed on the breast
or calculated from the know calibration factors for the mammography equipment.

sion factor, in mGy/mGy, used to calculate the mean glandular dose to

breast of 50% gladularity from incident air kerma, S is the factor for
different mammographic target/filter
combinations, Ki is the incident air
kerma. [4]
Estimation of PMMA equivalence:
for the dosimetry protocols under
consideration, MGD may be determined using exposures of slabs of
PMMA which are equivalent to specified model breasts. The equivalent
thickness of PMMA is the thickness of
PMMA that gives the same incident
air kerma at its upper surface as that
for a model breast of specified thickness and composition. [4]

Then, the MGD is determined

by multiplying the surface exposure value by published dose
factors. The dose factor values
are tabulated according to breast
size and composition and the
penetrating characteristics of the
x-ray beam as determined by the
anode material, filtration, and
KV.
For comparison of imaging techniques, evaluation of equipment performance, general dose management,
and regulatory and accreditation purposes, the MGD to a "standard" breast
is used. The standard is a 4.2cm thick
compressed breast consisting of 50%
glandular tissue and 50% fat. This
corresponds to the standard phantom
that is used for image quality evalua-

DG = CDG50 ,ki ,PMMA S Ki

(3)

Where CDG50 ,ki ,PMMA is the Conver-

Figure 2: mounting for MGD

Master in Medical Physics 2015 to 2016

III.

Incident Air Kerma

The incident air kerma, Ki , is the

kerma to air from an incident X ray
beam measured on the central beam
axis at the position of the patient or
phantom surface (Fig. 1). Only the
radiation incident on the patient or
phantom and not the backscattered radiation is included. Unit: J/kg. The
name for the unit of kerma is gray
(Gy). [2]

Figure 3: mounting for Ki

III. Methods
I. Evaluation of different
points in quality control of
mammography

(see figure 2).

In this practical exercise we use the

mammograph giotto, chamber parallel plate PTW, phantom PMMA and
meter measure, for measurement the
distance focus chamber.

The first measurement was about

the phantom exposure, we positioning
the PMMA phantom with two different: thickness, filters, KV and mAs at
the same distance in the equipment of
mammography giotto, these parameter it is show in table 1.

I.1

I.2

Evaluation of MGD use the

manufacturer value

The standard method of estimating

the MGD dose on patients undergoing
mammography X-ray examinations
is based on the incident air kerma
measurements without backscatter
and the conversion to glandular dose
using appropriate conversion factors
depending on the type of phantom
used. The air kerma value may be
determined either for patients or for a
standard breast phantom; polymethyl
methacrylate (PMMA) is normally
used as a breast substitute phantom

Determination of incident air

Kerma

In this case was evaluate X-ray tube

output values of the free in air incident air Kerma to the chamber for a
mammography systems target and filter combination, kV, mAs, and source
to chamber distance (see figure 3). Assume that a mammography system
with a tungsten target and silver filter, uses 28 kV and 74 mAs for a Focus Chamber Distance of 56.5cm. The
chamber was positioning down the
compressor plate the follow parameter use are expressed in the table 2.
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Master in Medical Physics 2015 to 2016

I.3

Determination of Half Value

Layer

The this part was determined of the

HVL added different thickness of
mmAl betwen the radiation beam and
ionization chamber, we went collected

IV.

each incident air kerma obtained for

different thickness, After these measures were plotted incident air kerma
vs thickness and interpolate to find
the value of HVL the value was expressed in graph 4

Results and discussion

Focus table distance

Phantom thickness
Anode
Filter
KV
mAs

61.7cm
61.7cm
4.5cm
2cm
Tungsten Tungsten
Ag
Rh
28
25
74
40

Table 1: Determine the mean glandular dose for the manufacturer value

The data shown in this table were

used to determine mean glandular
dose using the manufacturer values,
in this case we evaluate the mean glandular dose for two different thickness
of PMMA using two different combination of anode filter, for the com-

bination tungsten anode with silver

filter for standard thickness to 45mm
PPM the mean glandular dose was
1.6mGy, for the case when we combine tungsten anode with Rh filter,
20 mm PMMA thick we obtained 0.8
mGy of mean glandular dose.

Focus table distance

56.5cm
Anode
Tungsten
Filter
Ag
KV
28
mAs
74
Polarization of electromiter
200volt
RQR
M2
Factor of chamber calibration 4.385 1008 cGy/C
reading I
5.025mGy
reading II
5.015mGy
reading III
5.035mGy
reading IV
5.030mGy
mean of the reading
5.026mGy
Table 2: Determination of incident Air Kerma

Master in Medical Physics 2015 to 2016

The graph 4 shows the half-value
layer, in which the relation of the intensity of the kerma in air with thick

of aluminium, the result of HVL is

0.64mmAl was obtained by interpolation.

Fit HVL(mmAl ) = 5.0002e1.075x

Ki (mGy)

5.00

4.00

3.00

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Thickness (mmAl)
Figure 4: Determination of half value layer; adding mm aluminum filter

The result of the Mean Glandular Dose was find using these follow value:
HVL=0.64 mm,Ki = 5.026mGy and CDG50 ,ki ,PMMA = 0.349mGy/mGy using the
equation 3 MGD=1.83 mGy.

V. Conclusion
The difference of MGD between
manufacturer and MGD obtained for measure value during
the practice was 14.2% this outcome is high because the condi-

tion take into account during the

measure was not the adequate,
according to the specific conditions for determining HVL.

References
[1] AAPM report Number 49, Equipment requirements and Quality Control
for Mammography,
[2] IAEA TRS 457Dosimetry in Diagnostic Radiology: An international
of code of practice, IAEA , 2007
[3] Jerrold T Bushberg the Essential Physics of Medical Imaging,second edition,
Lippincott Williams-Wilkins, 2012
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Master in Medical Physics 2015 to 2016

[4] Paola Bregant , Lecture Physics of Diagnostic with x-ray 2, ICTP Trieste Italy,
2015