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MAN-00739, “ADDENDUM, OPTIMIZING MULTICARE IMAGE QUALITY”

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 Addendum, MultiCare Systems

Optimizing Image Quality

This document provides instructions to optimize MultiCare Systems for improved image quality.
Place this document with the Service Manual for the system (for future reference.)

Terms and Definitions

ACR American College of Radiology
AEC Automatic Exposure Control
CCD Charge-coupled Device
DN Digital Number
DSM Digital Spot Mammography
E0 A value representing a radiation measurement without additional
attenuation in the beam path, used by TLS-00788 to calculate x-ray
tube output.
E1, E2 Values representing radiation measurements with additional
attenuation in the beam path, used by TLS-00788 to calculate the
target values for AEC Calibration.
M512, M1024 mAs target values for AEC Calibration, calculated by TLS-00788.
ROI Region of Interest
targetN512 The new target DN value for 512 Mode exposures derived during AEC
Calibration.
targetN1024 The new target DN value for 1024 Mode exposures derived during
AEC Calibration.
TLS-00788 A Excel Spreadsheet tool used to calculate x-ray tube output and
target mAs values for AEC Calibration.
VDC Voltage, Direct Current

Note… Throughout this document, instructions refer to ranges of DN values that may be difficult to
confirm using the standard Histogram. For more precise DN information, use the Image Statistics
feature from the application menu.

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Discussion
In these procedures, you will record radiation measurements in an Excel spreadsheet (TLS-00788,
provided with this Addendum.) The calculations performed in the spreadsheet will return target mAs
values (M512 and M1024) that you will use to determine the target DN counts (targetN512 and
targetN1024) for AEC Calibration.
An overview of the spreadsheet appears below:

Enter x-ray tube output

measurements using
a range of Al filtration.

Calculated x-ray tube output

(mR/second.)

Target mAs for AEC Calibration

(expressed as M512 and
M1024.)

Figure 1: TLS-00788 Data Entry and Results

1.0 Set the Gain in the Power Up Defaults

The following procedure verifies proper settings for the Power Up Defaults.
1. Enter the DSM Setup Menu, then click on Set Power Up Defaults. The DSM shows the Set Power Up
Defaults dialog box.
2. Verify that the Gain (1024) field reads 88; otherwise change it to 88.
3. Verify that the Gain (512) field reads 22; otherwise change it to 22.
4. Verify that the White Field Gain field reads 44; otherwise change it to 44.

Caution: The White Field Gain in the Power Up Defaults must be 44.

5. When all of the defaults are properly set, click Save to store the Power Up defaults and return to the
DSM Setup Menu.
6. Click Done to exit the DSM Setup Menu.

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2.0 X-Ray Beam Quality

Note… If testing only for x-ray tube output, you need only complete step 1 through step 10 below.
Otherwise, follow all the steps below in preparation for AEC calibration. (Measurements for E0,
E1, and E2 are all required to calculate target mAs ranges for AEC Calibration.)
1. Set the breast platform to the 0 cm position. This places the breast platform at 4.5 cm from the typical
clinical position.
2. Remove the compression tray.
3. Position the Stage at the Home position (out of the x-ray field).
4. Install the Digital Stereo Aperture.
5. Connect a dosimeter to a 10 cm2 mammography ionization probe (small probe).
6. Set the dosimeter to record the radiation exposure in milliroentgens (mR).
7. Secure the probe in the center of the platform with its upper edge slightly lower than the chest wall
edge of the platform, so that the entire probe is inside the opening in the Compression Paddle.
8. Set the exposure techniques for Manual Exposure Mode, 28 kV, 240 mAs (3.0 second exposure at 80
mA).
9. Set the dosimeter to record, then immediately start the exposure.
10. At the end of the exposure:
a. Record the x-ray exposure (mR) from the dosimeter, E0.
E0 = _______________
b. Record the Output Rate (mR/second).
Output Rate = _______________
Contact Technical Support at (888) 505-7910 if results are less than 800 mR/second.
11. Cover the x-ray tube port using three (3) 0.1 mm sheets of 99.9% pure Mammography aluminum.
12. Set the exposure technique for Manual Exposure Mode, 28 kV and 240 mAs.
13. Start the exposure and record the x-ray exposure (mR) from the dosimeter, E1.
E1 = _______________
14. Cover the x-ray tube port using four (4) 0.1 mm sheets of 99.9% pure Mammography aluminum.
15. Set the exposure technique for Manual Exposure Mode, 28 kV and 240 mAs.
16. Start the exposure and record the x-ray exposure (mR) from the dosimeter, E2.
E2 = _______________

The spreadsheet will automatically calculate the target mAs values (M512 and m1024) for initial AEC
Calibration (used later in this procedure.)

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3.0 Adjust the Dark Field and White Field Data

Dark Field data, along with White Field data, is used by the DSM software during image acquisition to
compensate for non-uniformities in the CCD system and x-ray source. Adjustments made to the Dark
Fields require adjusting the White Fields also.

Caution: Once the Dark and White Field Adjustment process has begun, at least 10 acceptable images
must be acquired for each and saved for both the 512 and 1024 modes before exiting the
calibration menu. Failure to do so results in lost Dark and White Field data, and/or computer
lock-up.

Caution: Images appearing very white or very dark are the result of random events that may cause very
high or very low pixel values. When the auto-histogram encounters these values, the display
contrast parameters are not optimized, resulting in an image displayed with poor contrast. If
this happens, re-acquire the image.

Note … During the Dark Field and White Field adjustment sequence, dialog boxes appears to help step
the user through the procedure. Do not move any of the dialog boxes from their default
locations.

3.1 Dark Fields

1. Hold down the Ctrl key and select File to enter the DSM Setup Menu.
2. Click Make White/Dark Files. The DSM shows the Make White/Dark Fields dialog box.
3. Under the heading Target System, click System 1 or System 2 (if there are multiple systems), then
select the MultiCare system from the drop down menu.
4. Under the heading File Type, click 512 Dark Field. Start the adjustment process by clicking Make at
the bottom of the dialog box. The DSM displays the Making System Files dialog box.
5. Click Acquire to capture the first dark field image.
Note... X-rays are not produced when acquiring dark field images.
6. After a short delay, an image appears on-screen along with the Window/Level Histogram. Process the
image as necessary, and verify that it appears uniform. (Adjust image contrast by rotating the
Trackball up and down; adjust image luminance (brightness) by rotating the Trackball right and left;
Invert and revert the image by pressing the spacebar on the DSM keyboard; Right-click to return the
image to its as acquired state.) To close the Window/Level window, click the trackball button.
7. Evaluate the image:
a. From the File menu, select Image Statistics to obtain the Region of Interest (ROI) and Image
Statistics box.
b. Press the right trackball button to change the size of the ROI to 32 x 32.
c. Using the trackball and the left and right arrow keys, position the ROI to the center of the screen.
The center of the ROI should be at (512, 512). Note the signal (or Average Pixel Value, shown as
“Ave” in the Image Statistics window).
d. Position the center of the ROI subsequently at the following coordinate locations: (200, 200),
(800, 200), (200, 800), and (800, 800). Note the signal at each of the locations.
The signal measured in each corner of the image should be within ± 15% of the signal measured
at the center of the field of view. If the resulting image is unacceptable, Click Retake to reacquire
the dark field image or click Done to cancel the sequence. Click Accept to save the dark field
image if it is acceptable.

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8. Repeat steps as above until a minimum of ten (10) dark field images have been accepted. For better
image quality, up to 16 images can be acquired.
9. When complete, click Done to bring the Save File dialog box to the screen. Click Yes to save the 10
images, otherwise click No.
10. The Make White/Dark Fields dialog box appears on-screen. Under the heading File Type, click 1024
Dark Field. Start the adjustment process by clicking Make at the bottom of the dialog box.
11. Repeat the entire Dark Field adjustment process for the 1024 image acquisition mode.

3.2 White Fields

1. Prepare the unit for White Fields by removing the compression paddle from the C-arm. Place 3.5 cm
of acrylic on the breast platform so that it is over the CCD Chip in the Image Receptor. The acrylic
must be clean; free of any scratches or artifacts.
2. Under the heading File Type, click 512 White Field. Start the adjustment process by clicking Make at
the bottom of the dialog box.
3. The DSM displays the Making System Files dialog box. Click Acquire to display the Image
Acquisition dialog box.
4. Set the unit for a Manual exposure at 28 kV and a target DN value of 3600 ± 300, typically less than
130 mAs. Step behind the x-ray shield and make the exposure. (If the obtained mAs greater than 130
mAs to obtain the target DN, measure the x-ray tube output. See Section 2.0, p. 3.)

Warning: Observe all radiation protection procedures when making exposures.

5. After a short delay, an image appears on-screen along with the Window/Level Histogram. Click to
close the histogram.
6. Select the File menu, then select Image Statistics. The window statistics will now appear below the
image along with the histogram, and a square Region of Interest (ROI) window.
7. Using the right trackball button, change the ROI window size to 32x32.
8. Use the trackball to position the ROI window over the center of the homogenous area of the image
and observe the “AVE” value in the statistical area. Adjust mAs value accordingly to achieve a DN
value that is as close to 3600 +/- 300 as possible.
To close the ROI window and statistical preferences, simply press the left trackball button once.
Repeat this process until the target DN range is achieved.
9. The DSM shows the Making System Files dialog box. If the resulting image is unacceptable, click
Retake to reacquire the white field image or click Done to cancel the sequence.
10. Click Accept to save the white field image if it is acceptable (no artifacts).
Note… Wait a minimum of 30 seconds between exposures!
11. Repeat as above until a minimum of ten (10) white field images have been accepted. For better image
quality, up to 16 images can be acquired. When complete, click Done to bring the Save File dialog
box to the screen. Click Yes to save the 10 images, otherwise click No.
12. The Make White/Dark Fields dialog box appears on-screen. Under the heading File Type, click on
1024 White Field. Start the adjustment process by clicking Make at the bottom of the dialog box.
Note… Wait a minimum of 30 seconds between exposures!
Repeat the entire White Field adjustment process for the 1024 image acquisition mode using 28 kV and a
target DN value of 5400 ± 300, typically less than 160 mAs. (If the obtained mAs is greater than 160 mAs
to obtain the target DN, measure the x-ray tube output. See Section 2.0, p. 3.)

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4.0 Automatic Exposure Control (AEC) Calibration

The goal of this calibration procedure is to adjust the AEC Gain and Offset parameters for each kV setting
and for each DSM Acquisition Mode (512) and (1024) so that in Auto-Time mode the system can
automatically adjust the x-ray exposure time for optimum image quality for varying anatomy thickness
and density. Before the AEC is calibrated, verify that:
1. The filament starting currents for all kV stations and mA waveforms are calibrated. Check to verify kV
accuracy before making any changes to the mA waveforms. (Refer to the service manual if necessary.)
2. The AEC Preamp Gain has been adjusted to provide 9.5 VDC ± 0.3 VDC at TP 33 on the Host
microprocessor with 2.0 cm of BR 12 at 30 kV.

4.1 AEC Detector Gain Calibration

1. Center 2cm of Breast Equivalent Material (BR12) on the Breast Tray so it covers the AEC
detectors. Install a compression paddle.
2. Set the unit for a Manual Mode exposure at 30kV, 100mAs.
3. Connect an Oscilloscope to TP33 (AEC) on the microprocessor board. Connect the
Oscilloscope ground to TP25 (A GND) on the microprocessor board. Set the oscilloscope
sweep time to 10ms/div and the vertical sensitivity to 2V/div. Select Normal Trigger mode
with positive - going edge trigger.
4. Set the 4 gain switches to OFF. (NOTE: These switches are located inside the receptor mount.
Removal of rear cover is necessary to access these switches.)
5. Initiate an exposure and record the voltage at 25ms after the trigger point:_________VDC.
The recorded voltage should be between 9.2 and 9.8 volts. If measurement is not between
9.2 and 9.8 V, calculate a gain value using the calculation below:
9.50 ÷ (Recorded voltage/2) = _________ Calculated Gain
6. Set DIP switches on AEC to desired gain which most closely matches the calculated gain
value per the table below.

Table 1-1: Gain Table

SW1 SW2 SW3 SW4 Gain SW1 SW2 SW3 SW4 Gain
Off Off Off Off 2.000 On Off Off Off 3.599
Off Off Off On 2.198 On Off Off On 3.797
Off Off On Off 2.398 On Off On Off 3.997
Off Off On On 2.597 On Off On On 4.195
Off On Off Off 2.798 On On Off Off 4.397
Off On Off On 2.996 On On Off On 4.595
Off On On Off 3.196 On On On Off 4.795
Off On On On 3.395 On On On On 4.994

7. Final DIP Switch Setting for Factory-Adjust Gain (circle correct settings):

Table 1-2: DIP Switch Setting

SW1 SW2 SW3 SW4
Off / On Off / On Off / On Off / On

Final Voltage:_____________VDC

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4.2 Determine AEC Target Counts for 512 mode and 1024 mode
1. Ensure that the Power Up Defaults are set correctly (“Set the Gain in the Power Up Defaults”
on page 2) and DSM camera calibrations (white fields and dark fields) are completed at these
settings.

Caution: The White Field Gain in the Power Up Defaults must be 44.

2. Set the breast platform to the 4.5 cm position.

3. Place ACR phantom on the platform.
4. From the spreadsheet, record the mAs value calculated as M512: ___________ mAs.
(This is the calculated mAs required for 180 mrad dose level in 512 mode.)
5. Select 512 imaging mode.
6. Set the exposure technique for Manual Exposure Mode, 28 kV and M512 mAs (recorded
above).
7. Take an exposure.
8. Measure the AEC target count for 512 mode:
a. Measure the mean pixel value at the center of the phantom image. Make sure that the
ROI for this measurement is located as close to the center of the phantom as possible,
but does not overlap with phantom features (fibers, microcalcifications and masses.)
Reduce the ROI box size if necessary.
b. Record the mean pixel value: _______________ (referred to as “targetN512”)
9. From the spreadsheet, record the mAs value calculated as M1024: ____________ mAs.
(This is the calculated mAs required for 270 mrad dose level in 1024 mode.)
10. Select 1024 imaging mode.
11. Set the exposure technique for Manual Exposure Mode, 28 kV and M1024 mAs (recorded
above).
12. Take an exposure.
13. Measure the AEC target count for 1024 mode:
a. Measure the mean pixel value at the center of the phantom image. Make sure that the
ROI for this measurement is located as close to the center of the phantom as possible,
but does not overlap with phantom features (fibers, microcalcifications and masses.)
Reduce the ROI box size if necessary.
b. Record the mean pixel value: _______________ (referred to as “targetN1024”)
14. Proceed to the AEC calibration procedure and use targetN512 and targetN1024 as the AEC
calibration target values for 512 mode and 1024 mode respectively.

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4.3 AEC Calibration, 512 Acquisition Mode

Preparation:
1. To access calibration mode, switch S2-1 on the Microprocessor board must be set to On.
2. Check that S2-3 is set to On and DSM Receptor is Selected.
3. Go to Calibration Mode, Screen 2.
4. Set the M-Density to 50.
5. Set the unit for 28 kV, Auto-Time.
6. Set the Breast Platform at 4.5 cm.
Procedure:
1. Select a 512 mode scout exposure on the DSM terminal for this section.
2. Referring to Table 1-3, “Data Sheet 1—512 Mode,” on page 9, place 3 cm of BR12 on the
Breast Tray.
Note… Hold the CTRL key down when selecting the Acquire button, so the DSM does not save the
acquired image.
Note… The targetN512 value below is determined in Section 4.2.
3. Take an exposure and record the gain and DN values on the data sheet.
4. Adjust the AEC Gain to obtain the target DN value as close to targetN512 as possible. If the
value obtained is too high, increase the Gain setting. If the value obtained is too low,
decrease the Gain setting.
5. Record the offset and DN settings on Table 1-3, “Data Sheet 1—512 Mode,” on page 9.
6. Following the Data Sheet, place 6 cm of BR12 on the Breast Tray.
7. Take an exposure and adjust the AEC Offset to obtain the target DN value as close to
targetN512 as possible.
Note… The difference between the first and third thickness of any given kV should not differ by more
than 150 counts in the DN value column.
8. Repeat as above until the exposures at the low and high thickness both produce a DN value
as close to targetN512 as possible.
9. Following the Data Sheet, place 4.5 cm of BR12 on the Breast Tray. Take an exposure and
record on the data sheet the DN value obtained. The mAs should be equal to M512.
10. Check the value of mAs. The value of mAs is typically less than 160 mAs. If not, measure the
x-ray tube output. See Section 2.0, p. 3.
11. Following the Data Sheet, repeat steps 1 through 10 for 22 kV through 34 kV using the
recommended BEM attenuation from the Data Sheet.
12. Record the Final AEC Gain, Offset, DN, mAs, and AEC AVG values on the data sheet.

4.4 AEC Calibration, 1024 Acquisition Mode

Note… Select a 1024 mode scout exposure on the DSM terminal for this section.
Note… The targetN1024 value below is determined in Section 4.2.
1. Set the M-Density to 100.
2. Repeat the procedure stated in Section 4.3 above for 1024 mode, calibrating for the DN
value as close to targetN1024 as possible. Refer to Table 1-4, “Data Sheet 2—1024 Mode,”
on page 10.

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5.0 AEC Data Sheets

Table 1-3: Data Sheet 1—512 Mode

kV cm BEM Gain Offset DN mAs AEC Avg
22 1
2
3
23 1
2
3
24 2
3
4
25 2
3
4
26 2
3
5
27 3
4
5
28 3
4.5
6
29 4
5
6
30 4
5
6
31 4
5
6
32 5
6
7
33 5
6
7
34 6
7
7.5

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Table 1-4: Data Sheet 2—1024 Mode

kV cm BEM Gain Offset DN mAs AEC Avg
22 1
2
3
23 1
2
3
24 2
3
4
25 2
3
4
26 2
3
5
27 3
4
5
28 3
4.5
6
29 4
5
6
30 4
5
6
31 4
5
6
32 5
6
7
33 5
6
7
34 6
7
7.5

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6.0 Verification of Image Quality (ACR Phantom Test)

This procedure verifies the imaging quality of the MultiCare system.

6.1 Image Quality Test Setup

1. Move the breast platform to the 4.5 cm position
2. Place the ACR phantom on the breast platform and place it under the Biopsy Compression
Paddle to hold it in place.
3. Set the unit to make an exposure at 28 kV, Auto-Time mode.

6.2 Fiber Test

1. Position the phantom so that the evaluation objects (fibers) are positioned within the biopsy
window.
2. Click Acquire 512 from the DSM Main Menu. Annotate the image as an Evaluation Fiber Test
- 512, then make the exposure. Process the image as necessary to evaluate the image.
3. Repeat this test for the 1024 mode. Annotate the image as an Evaluation Fiber Test - 1024.
4. The DSM image must clearly show the 5th fiber (mammographic phantom) or the 3rd fiber
(mini-phantom).
Note... If the evaluation fails for either mode, check for correct exposure factors, and for proper phantom
positioning in the biopsy window.

6.3 Calcification (Speck Group) Test

1. Move the phantom so that the evaluation objects (speck groups) are beneath the biopsy
window. Click on Acquire 512, annotate it as an Evaluation Speck Test - 512, then make the
exposure. Process the image as necessary to evaluate the image.
2. Repeat this test for 1024 mode. Annotate the image as an Evaluation Speck Test - 1024.
3. The DSM image must clearly show the 4th speck group (mammographic phantom), or the
3rd speck group (mini phantom).
Note... If the evaluation fails for either mode, check for correct exposure factors, and for proper phantom
positioning in the biopsy window.

6.4 Mass Test

1. Move the phantom so that the evaluation objects (masses) are beneath the biopsy window.
Click on Acquire 512, annotate it as an Evaluation Mass Test - 512, then make the exposure.
Process the image as necessary to evaluate the image.
2. Repeat this test for 1024 mode. Annotate the image as an Evaluation Mass Test - 1024.
3. The DSM image must clearly show 3.5 masses (mammographic phantom) or 2.5 masses
(mini phantom).
Note... If the evaluation fails for either mode, check for correct exposure factors, and for proper phantom
positioning in the biopsy window.

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7.0 QAS Needle Test

1. Place the needle guide mount on the Stage Z axis:
a. Mount and position the needle guides and Calibration needle.
b. Tape the needle hub against the rear needle guide.
2. Ready the needle guidance Stage:
a. Install the Biopsy / Compression Tray.
b. Place a 5.0 cm air phantom between the biopsy window and breast platform.
c. Apply full compression and lock the compression device in place.
3. Zero the Z axis:
a. Press Z Position and Motor Enable to move the Stage Z axis to X=0.00, Y=+4.00.
b. Use the Control knobs to move the mock lesion over biopsy tray’s reference hole.
c. Move the Stage in the Z direction until the mock lesion just touches the reference hole. Be sure
that the hub of the needle does not move off the needle guide.
d. Press Z Zero to zero the Z axis (indicated by 0.0 as the Stage Z value).
e. Turn Z control to slightly raise the mock lesion off of the reference hole.
f. Use the Control knobs to move the mock lesion over the biopsy window (about +5.0 mm).
g. Use the Z control to slowly lower the mock lesion until the Stage Z coordinate indicates +0.5
mm.
h. Press Z Zero to complete the sequence.
Note... This test should be performed with the C-arm to the left and to the right. If the pivot point
calibration is not correct, X accuracy is correct in one direction, but not in the other.
Note... The hub of the needle must remain against the upper needle guide during the entire procedure,
otherwise erroneous results occur.
4. Position the mock lesion:
a. Move the mock lesion in the X axis until the Stage X coordinate reads +10.0 mm.
b. Move the mock lesion in the Y axis until the Stage Y coordinate reads +20.0 mm.
c. Move the mock lesion in the Z axis until the Stage Z-coordinate reads +30.0 mm.

7.1 Acquire a Stereo Pair

1. Set exposure techniques for Manual Mode, 28 kV and 3 mAs.
2. Obtain the first Stereo Image:
a. Click Acquire Stereo 512 on the DSM.
b. Annotate the image appropriately for a QAS test.
c. Rotate the C-arm to the +15° position for the first view.
d. Conduct the x-ray, then adjust Contrast and Luminance of the image.
Note... The +15° image must be taken first for correct determination of the coordinates.
3. Obtain the second Stereo Image:
a. Rotate the C-arm to the -15° position for the second view.
b. Conduct the x-ray, then adjust Contrast and Luminance of the image.
c. Click Done to complete the Stereo Image acquisition process.
Note... If any of the acquired images appear saturated, lower the kV level to lower the signal.

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7.2 Determine the Lesion Coordinates

1. Initiate Coordinate Calculation Sequence:
a. Click on Stereo Target to start the sequence.
b. Verify the reference cursor positions when prompted. Correct if necessary.
2. Mark Area of Interest in both Images:
a. Mark lesion position in Left Side Image.
b. Mark lesion position in Right Side Image.

7.3 Verification of Coordinates

Transmit the lesion coordinates:
1. Click Transmit to send the coordinates to the MultiCare Stage.
2. Check that the coordinates appear on the Pass coordinate line.
3. Verify that the Pass coordinates match the Stage coordinates within ±1.0 mm.
If the coordinates on the Pass line do not match the coordinates for the Stage, repeat the System
Verification procedure.

8.0 Prepare the new Technique Tables for the Customer

1. Make a photocopy of the “Revised MultiCare Technique Tables” on page 14 of this document.
2. Review the targetN512 and targetN1024 values from “Determine AEC Target Counts for 512 mode
and 1024 mode” on page 7.
3. Round the “targetN512” value up to the nearest 100, then record this new 512 Imaging Mode DN
Target value on the photocopied page.

For example, if “targetN512” was 3425, then record ‘3500’ on page 14.

4. Round the “targetN1024” value up to the nearest 100, then record this new 1024 Imaging Mode DN
Target value on the photocopied page.

For example, if “targetN1024” was 5315, then record ‘5400’ on page 14.
5. Provide the new page of Technique Tables to the customer.

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Revised MultiCare Technique Tables

512 Imaging Mode: DN Target = __________ +/- 500

Thickness kV
2 22
3 25
4 28
4.5 (ACR Phantom)* 28
5 30
6 32
7 34
7.5** 34

*The 4.5 cm thick ACR Phantom is equivalent to 4.2 cm thick 50% glandular tissue and 50% fat breast.
**If the system returns an AEC error, use Manual Exposure Mode at 34 kV 240 mAs.

1024 Imaging Mode: DN Target = __________ +/- 500

Thickness kV
2 23
3 26
4 28
4.5 (ACR Phantom)* 28
5 31
6 33
7 34
7.5** 34

*The 4.5 cm thick ACR Phantom is equivalent to 4.2 cm thick 50% glandular tissue and 50% fat breast.
**If the system returns an AEC error, use Manual Exposure Mode at 34 kV, 350 mAs.

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