Mammography Physics

Jerry Allison, Ph.D.

Department of Radiology and Imaging
Medical College of Georgia
Augusta University
Augusta, GA
 Educational Objectives

Our educational objectives are to understand:

1. Why pay special attention to mammography physics?
2. Radiation Risk/Benefit Issues
3. Physical principles of mammography
4. Physical principles of full field digital mammography
(FFDM): 2D
5. Technical Details of Digital Breast Tomosynthesis
(DBT): 3D
 Why pay special attention
to mammography physics?
• Approximately 1 of 8 women will
develop breast cancer over a lifetime.
• 10-30% of women who have breast
cancer have negative mammograms.
• ~80% of masses biopsied are not
malignant (fibroadenomas, small
papillomas, proliferating dysplasia).
 Radiation Risk/Benefit Issues
• Radiation is a carcinogen (ionizing radiation, x-radiation,
radiation: National Toxicology Program 2004)
• "No woman has been shown to have developed breast
cancer as a result of mammography, not even from
multiple studies performed over many years with doses
higher than the current dose (~250 mRad)... However the
possibility of such risk has been raised because of
excessive incidence of breast cancer in women exposed to
much higher doses (100-2000 Rad: Japanese A-bomb
survivors, TB patients having chest fluoro and postpartum
mastitis patients treated w/radiation therapy).” ©1992
RSNA
• Radiation treatment of Hodgkin lymphoma associated
with radiation induced breast cancer
 Risk/Benefit

©NCRP 2006 (Report 149)

©1992 RSNA
The Challenge in Mammography

©1987 IOP
Publishing
 X-ray Spectra in Mammography
• X-ray spectral distribution is determined by:
– kV
– target/filter combination
– Mo/Mo, Mo/Rh, Rh/Rh for GE
– Mo/Mo, Mo/Rh, W/Rh for Siemens
– Mo/Mo, Mo/Rh or W/Rh, W/Ag for Hologic
– W/Rh, W/Ag, W/Al for Hologic DBT Tomo
– W/Rh for Giotto
– W/Rh for Fuji Saphire HD
– W/Rh, W/Ag for Planmed
– W/Al for Philips
X-ray spectra are variable
Compression (Redistribution?)
Scatter
Geometric blurring
Superposition
Increases the proportion of
the X-ray beam that is used
to image a breast
Motion
Beam hardening
Dose

©1994 Williams & Wilkins

 Scattered Radiation Control
• Linear Grids
– Grid ratio (height of lamina/distance between
laminae): 4:1 or 5:1 w/ 30-40 lines/cm.
– Conventional grids are 8:1 to 12:1 (up to 43
lines/cm).
– Breast dose is increased by grids (Bucky Factor:
x2 to x3) w/40% improvement in contrast.
– Laminae are focused to the focal spot to prevent
grid cut off.
Scattered Radiation Control
• High Transmission Cellular (HTC) Grids
– Focused
– Increased 2D absorption of scattered radiation
– Increase contrast
– Must move the grid a very precise distance
during exposure regardless of exposure duration
– Essentially same grid ratio and dose as
conventional linear grids
 HTC Grid

http://www.hologic.com/oem/pdf/W-BI-HTC_HTC%20GRID_09-04.pdf
 HTC Grid

http://www.hologic.com/oem/pdf/W-BI-HTC_HTC%20GRID_09-04.pdf
Magnification Mammography
• Magnification factor: x1.5 – x2.0
• Increases the size of the projected
anatomical structures compared
with the noise of the image
• Valuable for visualization of
calcifications and spiculations.
©1994 Williams & Wilkins
 Magnification
• Spot compression paddles

http://www.americanmammographics.com/mammopads.htm
 Magnification
• Reduction of effective image noise (less
quantum noise, more photons per object
area)
• Air gap between breast and image
receptor reduces scattered radiation
without attenuating primary photons or
increasing radiation dose (no grid!)
• Small focal spot: 0.1 - 0.15mm (low
mA, long exposure times)
• Increased dose (x2-x3)
Focal Spot and MTF

©1994 Williams & Wilkins

 Dose Limits
 FDA Dose limit for screening
mammograms
– 3 mGy (w/grid)
 Mean glandular dose
 Single view

 4.5cm compressed breast

 Average composition
 Physical Principles of Full Field
Digital Mammography (FFDM): 2D

• FFDM Technologies
– Direct detectors
– Indirect detectors
– Computed radiography (CR)
– Slit scanning technology
 Certification statistics
August 6, 2018
• Total certified facilities / Total accredited units
• 8,688 / 19,242
• Certified facilities with FFDM units /
Accredited FFDM units
• 8,622 / 12,817
• Certified facilities with DBT units /
Accredited DBT units
• 4,526 / 6,341
http://www.fda.gov/Radiation-
EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorec
ard/ucm113858.htm
 FFDM Technologies
“INDIRECT” Detectors (GE)
• Scintillating phosphor (CsI columns) on an array of amorphous silicon
photodiodes using thin-film transistor (TFT) flat panel technology (GE)
– ~100 micron pixels, ~5 lp/mm
“DIRECT” Detectors (Siemens, Hologic, Giotto, Planmed, Fuji)
• Amorphous selenium (direct conversion)
• (TFT) flat panel technology
• ~70-85 micron pixels , ~7 lp/mm
• Direct optical switching technology (Fuji Aspire HD))
• ~50 micron pixels , ~10 lp/mm
Computed radiography (Fuji, Carestream, Agfa, Konica, iCRco)
– ~50 micron pixels, ~10 lp/mm
– ~100 micron pixels, ~5 lp/mm
Slit scanning technology (Philips)
– ~50 micron pixels, ~10 lp/mm
Does pixel size matter?
• As pixel size decreases:
– Spatial resolution improves
– Noise increases
– Signal-to-noise decreases
• Yet another set of imaging tradeoffs
 Detector Technology Overview
Independent (“Indirect”) Conversion: Dependent (“Direct”) Conversion:
CsI Converter + aSi Substrate Sensor aSe Converter + aSi Substrate Sensor
Matrix Matrix
X-Ray Photons
Electrode
X-Ray Photons Dielectric

X-ray
Selenium
X-ray

2,600+ Volts
K-edge
CsI Fluoresence

Light

Electrons
Photodiode Photodiode Blocking
Layer
Electrons
Read Out Electronics Electrode
Digital Capacitor Electrons
Data
Read Out Electronics
Digital
Data
Courtesy: Jill Spear, GE Women’s Healthcare
Fuji CR Digital Mammography
• Deleted (obsolete)
 Slit Scanning Technology

• Philips MicroDose
• 650 installed worldwide (June 2015)
• 35 installed USA (June 2015)
 Slit Scanning Technology

• Slit Scanning • X-ray generates electron-hole pairs

Technology creating a short electrical signal
(multi-slit)
http://incenter.medical.philips.com/doclib/enc/fetch/2000/4504/577242/577260/593280/593
431/8477093/Photon_Counting_White_Paper.pdf%3fnodeid%3d8477094%26vernum%3d1
 Philips MicroDose
• Multi-slit scanning (~ 26 slits)
• Pre & post collimation
• Photon counting
• 50 micron pixels
• Silicon strip detectors (tapered toward focal spot)
• Mean glandular dose ~50% of other FFDM approaches
 Philips Micro Dose

• 3-15 sec exposures

• Can sort photon events into high energy
and low energy (spectral imaging) for
quantitative breast density measurements
 Breast Dose in FFDM
• Systems display breast dose with image
– Mean Glandular Dose < 3 mGy
– Dose recorded in DICOM image header
 Entrance skin exposure and/or mean glandular dose
 Vendors use different dose calculation algorithms

• Dance

• Wu & Barnes

• U.S. Method

• As of the 3.4.2 software upgrade, Hologic “ follows the latest

EUREF adopted method if the system is set up to use EUREF
dose calculation”
 Technical Details of Digital Breast
Tomosynthesis (DBT)
• FDA Approved DBT Units
• Hologic Selenia Dimensions Digital Breast Tomosynthesis (DBT) System on 2/11/11
• GE SenoClaire Digital Breast Tomosynthesis (DBT) System on 8/26/14
• Siemens Mammomat Inspiration with Tomosynthesis Option (DBT) System on 4/21/15
• Fujifilm ASPIRE Cristalle on 1/10/17
• GE Senpgraphe Pristina on 3/3/2017

http://www.fda.gov/Radiation-
EmittingProducts/MammographyQualityStandardsActandProgram/FacilityCertificationandInspectio
n/ucm114148.htm
 Breast tomosynthesis
Hologic Selenia Dimensions

http://www.hologic.com/data/WP-00007_Tomo_08-08.pdf
http://www.hologic.com/data/WP-00007_Tomo_08-08.pdf

Cone Beam Breast CT

 University of Rochester
 300 views
 10 seconds
Breast tomosynthesis

©www.hologic.com/data/W-BI-001_EmergTech_08-06.pdf
Breast tomosynthesis

http://www.hologic.com/data/WP-00007_Tomo_08-08.pdf
 DQE in Breast Tomosynthesis

• Mean glandular dose (MGD) for tomosynthesis is

expected to be the same as for projection mammography
(< 300 mRad)
• Since breast tomosynthesis requires several exposures
(e.g.15), low exposure DQE performance of digital
detectors used in breast tomosynthesis is important
• A grid might not be used in breast tomosynthesis, which
reduces dose (x2 – x3)
 Characteristics: DBT Breast Tomo

• Tiling of very large breasts (more than one view to

cover very large breasts) may not work since tissue
outside of FOV can cause artifacts
Characteristics: Hologic DBT Breast Tomo

Modes/ views:

•2D: one conventional FFDM image

•3D Tomo: 15 views used to reconstruct tomographic
slices
•Combo: acquisition of both 2D and 3D tomo (still < 3
mGy)
•Synthetic view: reconstruction of a pseudo projection
mammogram from a stack of tomographic images
Characteristics: Hologic DBT Breast Tomo

• Data acquisition (tomo)

– 15 discrete views (exposures)
– Limited arc (± 7.5 degrees)
– 4 sec
• Anode
– Tungsten
Characteristics: Hologic DBT Breast Tomo

• Filters
– Rh: for 2D only
– Ag: for 2D only (thick/dense breasts)
– Al: for 3D tomo only
• Density control
– None
• No grid during tomo
• No MAGnification in tomo
Characteristics: Hologic DBT Breast Tomo
• Pixel binning
– In 3D tomo mode, pixels are “ binned” into groups
of 2x2 pixels (140 micron pitch)
• Reconstruction
– 1 mm thick
– Number of tomo images: (compressed breast
thickness/ 1mm => 40 – 80)
• Interpretation
– 1mm tomographic slices
– 15 individual projection views (good for motion
detection)
– May also have a conventional 2D view and/or
synthetic view
 Hologic DBT MGD

• 2D: 1.2 mGy

• 3D Tomo: 1.45 mGy
• Combo*: 2.65 mGy

*Combo: 2D and 3D tomo of the same

breast view (e.g. MLO)
Characteristics: DBT Breast Tomo
General Hologic Siemens
Electric Selenia Mammomat
DBTSystem Essential Dimensions Inspiration
Type of geometry Full-field Full-field Full-field
Energy Energy Energy
Detector type integrating integrating integrating
Detector material CsI-Si a-Se a-Se
Detector element size
(μm) 100 70 85
Focal plane pixel size 100 95-117 85
Step-and
X-ray tube motion shoot Continuous Continuous
Target Mo/ Rh W W
Mo: 30μm
Filter Rh: 25 μm Al: 700 μm Rh: 50 μm
Angular range 25 15 50
Number of projection
images 9 15 25
Source to detector
distance (mm) 660 700 655
Distance between
detector and centre of
rotation (mm) 40 0 47

Reconstruction Filtered back

algoorithm Iterative projection? Analytic
no (scatter
correction
Grid used for tomo yes no software)
Detector binning for
tomo no yes ?
 References
– ©NCRP 2006
NCRP Report 149, “A Guide to Mammography and Other Breast
Imaging Procedures” National Council on Radiation Protection and
Measurements, 2004
– ©1994 Williams & Wilkins
Bushberg, JT, Seibert, JA, Leidholdt, EM Jr., Boone, JM, ”The Essential
Physics of Medical Imaging” Williams & Wilkins, Baltimore,
Maryland, 1994
– ©1993 RSNA
Haus, AG, Yaffe, MJ, Eds., “ Syllabus: A Categorical Course in Physics
Technical Aspects of Breast Imaging” , 2nd Edition, RSNA, 1993
– ©1992 RSNA
Haus, AG, Yaffe, MJ, Eds., “ Syllabus: A Categorical Course in Physics
Technical Aspects of Breast Imaging” , RSNA, 1992
– ©1987 IOP Publishing
Johns, PC, Yaffe, MJ, “ X-Ray characterisation 675-695
of normal and neoplastic breast tissues” , Phys Med Biol, 1987, 32,