1470例乳腺X线摄影技术探讨

乳腺疾病是女性好发病之一 ,尤其是乳腺癌的发病率有不断增加趋势。影像学检查是早期检出、诊断的关键[1] 。优质的乳腺摄影是准确诊断的重要基础 ,本研究回顾性分析、研究14 70例乳腺X线摄影技术 ,以期提高摄影质量。1　材料和方法1.1　一般资料　 1994 0 6～ 2 0 0 2 12我院共行乳腺X线摄影14 70例 ,其中正常体检 3 5 6例 ,有临床症状或体征者 1114例。年龄 19～ 67岁 ,平均 43岁。双侧 782例 ,单侧 688例。1.2　乳房大小　按乳房摄影前受压后的前后径 ,即乳头至前胸壁的深度分为 :前后径≤ 5 .5cm为小乳房 ,3 81例 ;5 .6cm～10cm为中乳…     

卫生部发布乳腺X线摄影、计算机X线摄影（CR）质控检测规范

据卫生部《卫通[2007]6号》通告批准发布《乳腺X射线摄影质量控制检测规范》（GBI186-2007）及《计算机X线摄影（CR）质量控制检测规范》（GBI187-2007）等质控检测规范。上述两项质控检测规范的发布有利于目前X线摄影中量大面广的相关技术工作有章可循，对我国影像质量的管理起到有益的作用。     

卫生部发布乳腺X线摄影、计算机X线摄影（CR）质控检测规范

据卫生部《卫通（2007）6号》通告批准发布《乳腺X射线摄影质量控制检测规范》（GB1186—2007）及《计算机X线摄影（Ca）质量控制检测规范》（GB1187—2007）等质控检测规范。上述两项质控检测规范的发布有利于目前X线摄影中量大面广的相关技术工作有章可循，对我国影像质量的管理起到有益的作用。     

计算机X线摄影质量控制

计算机X线摄影(Computed Radiography,CR)具有操作简单、数字影像清晰度高、曝光宽容度大、后处理功能强等优点,现已在临床广泛应用.我院自2002年引进美国柯达CR-900系统以来,开展了一系列质量控制工作.如针对IP对CR影像质量的影响、CR伪影的认识和处理、激光打印机对CR影像质量的影响等问题开展工作,积累了一些直接认识和体会,现小结归纳如下.     

数字乳腺X线摄影技术的研究进展

随着数字化乳腺X线检查技术的发展,屏/片系统乳腺X线摄影(SFM)技术已逐步被取代,一些技术改进的优势已在致密型乳腺的女性中得到证实。比较数字乳腺体层摄影(DBT)技术、对比增强双能数字乳腺X线摄影(CEDM)技术及常规数字乳腺X线摄影(DM)技术,并综述数字乳腺摄影技术发展中一些新技术的特点,分析其优势、局限性及对病人的潜在影响等,从而预测它们的发展前景。     

屏胶乳腺X线摄影和数字化乳腺X线摄影的对比研究

数字乳腺X线摄影（DM）较屏胶乳腺X线摄影（SFM）具有更多的优势,其对于图像的获取、储存和显示都是相互分离的,每个系统都能优化产生最佳效果,而且数字图像能够由计算机处理并显示为多种形式。因此,DM系统正逐渐替代SFM系统并成为筛查及诊断乳腺癌的常规手段。就DM和SFM的成像原理、图像质量、图像处理以及临床应用进行比较。     

屏胶乳腺X线摄影和数字化乳腺X线摄影的对比研究

数字乳腺X线摄影(DM)较屏胶乳腺X线摄影(SFM)具有更多的优势,其对于图像的获取、储存和显示都是相互分离的,每个系统都能优化产生最佳效果,而且数字图像能够由计算机处理并显示为多种形式。因此,DM系统正逐渐替代SFM系统并成为筛查及诊断乳腺癌的常规手段。就DM和SFM的成像原理、图像质量、图像处理以及临床应用进行比较。     

乳腺X线摄影若干技术要素的研究

通过对乳腺摄影若干技术要素的解析及研究,提高摄质量及诊断准确性。方法对２１家医院的摄影质量进行调研。对常用的增感并－胶片组合的成像质量进行测试,并与计算机摄影进行比较研究。对摄影位置及操作技术进行研究。结果乳腺摄影的重要影像细节显示及诊断要求的符合率甚低,均为２４％,其主要原因在于机器设备不符合要求。国人乳腺摄影的加压以１２ｋｇ左右为最佳。结论机器设备成像性能的改进应引起必要的关注。操作技术的改进     

Trends in Attaining Mammography Quality Benchmarks With Repeated Participation in a Quality Measurement Program: Going Beyond the Mammography Quality Standards Act to Address Breast Cancer Disparities

PurposeThe Mammography Quality Standards Act requires that mammography facilities conduct audits, but there are no specifications on the metrics to be measured. In a previous mammography quality improvement project, the authors examined whether breast cancer screening facilities could collect the data necessary to show that they met certain quality benchmarks. Here the authors present trends from the first 5 years of data collection to examine whether continued participation in this quality improvement program was associated with an increase in the number of benchmarks met for breast cancer screening.MethodsParticipating facilities across the state of Illinois (n = 114) with at least two time points of data collected (2006, 2009, 2010, 2011, and/or 2013) were included. Facilities provided aggregate data on screening mammographic examinations and corresponding diagnostic follow-up information, which was used to estimate 13 measures and corresponding benchmarks for patient tracking, callback, cancer detection, loss to follow-up, and timeliness of care.ResultsThe number of facilities able to show that they met specific benchmarks increased with length of participation for many but not all measures. Trends toward meeting more benchmarks were apparent for cancer detection, timely imaging, not lost at biopsy, known minimal status (P < .01 for all), and proportion of screening-detected cancers that were minimal and early stage (P < .001 for both).ConclusionsParticipation in the quality improvement program seemed to lead to improvements in patient tracking, callback and detection, and timeliness benchmarks.     

乳腺摄影降低辐射量的优化选择

目的:研究乳腺X线摄影中降低射线剂量曝光条件的优化选择.方法:在全自动(kV和mAs均自动,即auto filter)和半自动(手动kV、mAs自动,即auto time)曝光模式下对不同厚度的模体进行曝光,对所得照片影像质量进行评分,并测其剂量.结果:同一厚度模体在不同曝光务件下所得照片影像质量差异无显著性意义,不同厚度模体在autofilter模式下所得照片影像质量差异无显著性意义,即自动曝光控制(automatic exposure contol,AEC)装置工作状态正常.在各种曝光条件组合中,kV高的曝光条件组合X线摄影剂量低;auto filter模式下X线摄影剂量均不是最低的.结论:在乳腺X线摄影的实际工作中,首先应确保AEC的正常工作状态;在不影响照片影像质量的情况下,选用AEC装置的autotime模式适当提高kV,降低摄影剂量.     

Clinical Image Quality in Daily Practice of Breast Cancer Mammography Screening

Objective

To assess the quality of screening mammograms performed in daily practice in the Quebec Breast Cancer Screening Program.

Subjects and Methods

Clinical image quality of a random subsample of 197 screening mammograms performed in 2004-2005 was independently evaluated by 2 radiologists based on the criteria by Canadian Association of Radiologists (CAR). When disagreement occurred for overall judgement or positioning score, the mammograms were reviewed by a third radiologist. Cohen's kappas for interrater agreement were computed. Multivariable robust Poisson regression models were used to study associations of overall quality and positioning with body mass index (BMI) and breast density.

Results

The CAR criteria were not satisfied for 49.7% of the mammograms. Positioning was the quality attribute most often deficient, with 37.2% of mammograms failing positioning. Interrater agreement ranged from slight (kappa = 0.02 for compression and sharpness) to fair (kappa = 0.30 for exposure). For overall quality, women with a BMI ≥ 30 kg/m² had a failure proportion of 67.5% compared with 34.9% for women with a BMI<25 kg/m² (risk ratio 2.1 [95% confidence interval, 1.5-3.0]). For positioning, women with a BMI ≥ 30 kg/m² had a failure proportion of 53.8% compared with 27.9% for women with a BMI < 25 kg/m² (risk ratio 1.9 [95% confidence interval, 1.2-3.1]). Effects of breast density on image quality differed among radiologists.

Conclusion

Despite measures to ensure high-quality imaging, including CAR accreditation, approximately half of this random sample of screening mammograms failed the CAR quality standards. It would be important to define quality targets for screening mammograms carried out in daily practice to interpret such observations.     

回顾性探讨冠状动脉造影的质量控制

目的:探讨冠状动脉造影的质量控制,就其对比剂的选择及注射、摄影体位的选择、曝光参数设定及其它操作因素的分析提出质量控制措施。方法:常规Seldinger导管法,选择好造影技术参数,常规呼吸训练及心电监护,分别进行左右冠状动脉造影、多体位摄影,并对其图像质量进行综合分析评价。结果:检查155例病例(PTCA19例,CAG136例),获取930个曝光采集序列(Sequences),洗印1220幅图像,其中图像质量优秀的776个序列,占83.4%;图像质量良好的121个序列,占13%;图像质量差的33个序列,占3.6%。结论:不同病例、不同部位的图像采集应用不同的摄影体位;使用非离子型对比剂有利于提高检查图像质量;绝大多数病例造影要利用密度补偿;手推对比剂要注意总量、压力、流率控制及血管充盈情况;术中监护与呼吸训练必不可少。     

局部点压摄影在乳腺疾病诊断中的应用价值

目的:探讨局部点压摄影技术在乳腺病变诊断中的应用价值.方法:对60例常规乳腺钼钯摄影中发现的可疑病变区行局部区域的无放大点压摄影检查,将所获得的图像与原图像进行比较.结果:经过局部点压的图像,乳腺组织结构及病灶的清晰度增加,特别是病灶边缘显示更好.60例病例中,13例病灶较深或紧贴胸壁,病灶显示不佳或不完整,通过点压后显示满意.21例乳腺中的致密影、19例局限性密度增高影及1例斑片状影通过局部点压后诊断更加明确.6例腋下病灶通过点压显示清楚.结论:局部点压摄影技术可以提高乳腺组织结构及病灶的清晰度,为乳腺内可疑病变的诊断提供帮助.     

Quality assurance of mammograms in the Norwegian Breast Cancer Screening Program

This study compared the proportion of mammograms classified as perfect, good, moderately good or inadequate by a radiographer specially trained for doing such a classification at a breast centre (local-PGMI radiographer) with the proportion similarly assessed by an expert-PGMI radiographer. The results were compared with the recommendations given in the quality assurance manual of the Norwegian Breast Cancer Screening Programme. The reasons for classifying the mammograms into other than perfect, such as good, moderately good or inadequate were investigated.The quality of the mammograms was measured by using the PGMI system, which is a quality-review model that classifies the images into the four categories according to positioning, compression, exposure, noise, artefacts, and movement. A total of 1280 mammograms from all 16 breast centres in the screening programme were classified.The distribution of perfect, good, moderately good, and inadequate mammograms differed between the local-PGMI radiographers and the expert radiographer, for both the cranio-caudal (CC) and mediolateral-oblique (MLO) mammograms (P < 0.001 for both). The expert radiographer classified a higher proportion of both CC (28%) and MLO (14%) mammograms as inadequate than did the local-PGMI radiographers (7% and 3%, respectively; P < 0.001 for both). The guidelines recommend ≤3% of the mammograms to be inadequate. The reason given for the inadequate classifications by the expert radiographer was predominantly “parts of the breast missing” for both the CC and the MLO mammograms.There is room to improve the quality of the mammograms in the screening programme in Norway. Attention should be given to positioning and the use of standardized terms in the PGMI classification.     

乳房X射线成像术的质量控制

乳房X射线成像术是发现乳房病变的最可靠的方法。这项技术能够探查出清晰的临床症状前的微小病变。由于在乳房中的正常组织与病变部位的对比不很明显,因此,乳房X射线成像术对操作要求的标准很高。要在低剂量照射的情况下研究获得高质量图像的可能,质量控制就受到了放射医师、放射人员及医学物理师的高度关注。本文列举了乳房X射线成像术的质量控制实验(QCT)的重点,这些实验是最基本的,往往每年至少要进行一次,以确保乳房X射线成像系统功能的稳定。     

Screen-Film Mammography and Soft-Copy Full-Field Digital Mammography: Comparison in the Patients with Microcalcifications

Objective

We wanted to compare the ability of screen-film mammography (SFM) and soft-copy full-field digital mammography (s-FFDM) on two different monitors to detect and characterize microcalcifications.

Materials and Methods

The images of 40 patients with microcalcifications (three patients had malignant lesion and 37 patients had benign lesion), who underwent both SFM and FFDM at an interval of less than six months, were independently evaluated by three readers. Three reading sessions were undertaken for SFM and for FFDM on a mammography-dedicated review workstation (RWS, 2K×2.5K), and for FFDM on a high-resolution PACS monitor (1.7K×2.3K). The image quality, breast composition and the number and conspicuity of the microcalcifications were evaluated using a three-point rating method, and the mammographic assessment was classified into 4 categories (normal, benign, low concern and moderate to great concern).

Results

The image quality, the number and conspicuity of the microcalcifications by s-FFDM (on the RWS, PACS and both) were superior to those by SFM in 85.0%, 80.0% and 52.5% of the cases, respectively (p < 0.01), and those by the s-FFDM on the two different monitors were similar in 15.0%, 12.5% and 35.0% of the cases, respectively (p > 0.01). The mammographic assessment category for the microcalcifications in the three reading sessions was similar.

Conclusion

s-FFDM gives a superior image quality to SFM and it is better at evaluating microcalcifications. In addition, s-FFDM with the PACS monitor is comparable to s-FFDM with the RWS for evaluating microcalcifications.     

Quality control of the physical and technical aspects of mammography in the Norwegian breast-screening programme

The aim of this study was to establish a system for quality control of technical and physical aspects of mammography in the national Norwegian breast-screening programme, and to evaluate test results obtained during the 4-year pilot project period. Quality control (QC) procedures for the X-ray unit, film and processing, cassettes and screens, view boxes, and image quality were described in two QC manuals. Frequent and relatively simple tests were performed by radiographers on-site and results reported semi-annually to an inspection group established at the Norwegian Radiation Protection Authority (NRPA). Tests requiring special equipment were performed prior to start of screening (first status controls), then annually by the NRPA group, which also assembled and analysed the data from the first 4 years. The analyses were done mainly with reference to stated standard or guidance levels and the degree of deviation from such values. Results for tests of i.a. focal spot size, exposure time, radiation output, mean absorbed glandular dose, reference optical density, sensitometry, and AEC performance are presented. The standard of the equipment tested was in general high. Although some deviations from optimal performance were seen throughout the project, the equipment mostly performed well within the stated limiting values.     

参数自动优化模式选择对乳腺DR图像质量及平均腺体剂量影响的评估

目的:评估不同的参数自动优化(AOP)曝光模式对乳腺数字化放射成像(DR)图像质量和平均腺体剂量的影响,为乳腺DR摄影的质量及剂量控制提供参考.方法:选用AOP提供的剂量(DOSE)模式、标准(STD)模式和对比度(CNT)模式三种曝光模式对乳腺模体进行曝光,每种曝光模式重复4次,记录每次曝光的平均腺体剂量(AGD).然后由两位资深的乳腺影像诊断医师分别在同一乳腺图像工作站的5MP显示器上观察,独立对所获得的12幅乳腺模体图像按美国放射学会(ACR)推荐方法评分.所有曝光数据和评分数据进行统计学分析.结果:在相同压力和乳腺厚度条件下,DOSE曝光模式的AGD最低,STD、CNT曝光模式下的AGD较之分别增加了21.9%、146.2%;3组12幅图像质量均通过ACR评分,3组图像数据分析差异无统计学意义(P＞0.05).结论:乳腺DR的AOP曝光模式选择中,CNT模式的AGD明显增高.应警慎使用,DOSE模式能有效降低AGD,并且对图像质量无明显影响.