Ambient dose equivalent and effective dose from scattered x-ray spectra in mammography for Mo/Mo, Mo/Rh and W/Rh anode/filter combinations

In this study, scattered x-ray distributions were produced by irradiating a tissue equivalent phantom under clinical mammographic conditions by using Mo/Mo, Mo/Rh and W/Rh anode/filter combinations, for 25 and 30 kV tube voltages. Energy spectra of the scattered x-rays have been measured with a Cd(0.9)Zn(0.1)Te (CZT) detector for scattering angles between 30 degrees and 165 degrees . Measurement and correction processes have been evaluated through the comparison between the values of the half-value layer (HVL) and air kerma calculated from the corrected spectra and measured with an ionization chamber in a nonclinical x-ray system with a W/Mo anode/filter combination. The shape of the corrected x-ray spectra measured in the nonclinical system was also compared with those calculated using semi-empirical models published in the literature. Scattered x-ray spectra measured in the clinical x-ray system have been characterized through the calculation of HVL and mean photon energy. Values of the air kerma, ambient dose equivalent and effective dose have been evaluated through the corrected x-ray spectra. Mean conversion coefficients relating the air kerma to the ambient dose equivalent and to the effective dose from the scattered beams for Mo/Mo, Mo/Rh and W/Rh anode/filter combinations were also evaluated. Results show that for the scattered radiation beams the ambient dose equivalent provides an overestimate of the effective dose by a factor of about 5 in the mammography energy range. These results can be used in the control of the dose limits around a clinical unit and in the calculation of more realistic protective shielding barriers in mammography.     

Computation of beam quality parameters for Mo/Mo, Mo/Rh, Rh/Rh, and W/Al target/filter combinations in mammography

A computer program was implemented to predict mammography x-ray beam parameters in the range 20-40 kV for Mo/Mo, Mo/Rh, Rh/Rh, and W/Al target/filter combinations. The computation method used to simulate mammography x-ray spectra is based on the Boone et al. model. The beam quality parameters such as the half-value layer (HVL), the homogeneity coefficient (HC), and the average photon energy were computed by simulating the interaction of the spectrum photons with matter. The checking of this computation was done using a comparison of the results with published data and measured values obtained at the Netherlands Metrology Institute Van Swinden Laboratorium, National Institute of Standards and Technology, and International Atomic Energy Agency. The predicted values with a mean deviation of 3.3% of HVL, 3.7% of HC, and 1.5% of average photon energy show acceptable agreement with published data and measurements for all target/filter combinations in the 23-40 kV range. The accuracy of this computation can be considered clinically acceptable and can allow an appreciable estimation for the beam quality parameters.     

Scatter/primary ratios for x-ray spectra modified to enhance iodine contrast in screen-film mammography

Contrast mammography to detect the uptake of iodine-containing contrast material may be enhanced by spectral modification of the x-ray beam. Luminance scatter-to-primary ratios were measured for three candidate x-ray tube anode/filter combinations (Mo/Mo, W/Ce, and Ce/Ce). Results show that scattered radiation is significant for all tubes, is lowest for the Mo/Mo system and is essentially the same for the tungsten and cerium anode systems.     

A conversion method of air kerma from the primary, scatter, and leakage radiations to effective dose for calculating x-ray shielding barriers in mammography

In this study, a new approach has been introduced for derivation of the effective dose from air kerma to calculate shielding requirements in mammography facilities. This new approach has been used to compute the conversion coefficients relating air kerma to the effective dose for the mammography reference beam series of the Netherlands Metrology Institute Van Swinden Laboratorium, National Institute of Standards and Technology, and International Atomic Energy Agency laboratories. The results show that, in all cases, the effective dose in mammography energy range is less than 25% of the incident air kerma for the primary and the scatter radiations and does not exceed 75% for the leakage radiation.     

Optimization of x-ray spectra in digital mammography through Monte Carlo simulations

In this work, a Monte Carlo code was used to investigate the performance of different x-ray spectra in digital mammography, through a figure of merit (FOM), defined as FOM = CNR2/(ˉ)D(g), with CNR being the contrast-to-noise ratio in image and [Formula: see text] being the average glandular dose. The FOM was studied for breasts with different thicknesses t (2 cm ≤ t ≤ 8 cm) and glandular contents (25%, 50% and 75% glandularity). The anode/filter combinations evaluated were those traditionally employed in mammography (Mo/Mo, Mo/Rh, Rh/Rh), and a W anode combined with Al or K-edge filters (Zr, Mo, Rh, Pd, Ag, Cd, Sn), for tube potentials between 22 and 34 kVp. Results show that the W anode combined with K-edge filters provides higher values of FOM for all breast thicknesses investigated. Nevertheless, the most suitable filter and tube potential depend on the breast thickness, and for t ≥ 6 cm, they also depend on breast glandularity. Particularly for thick and dense breasts, a W anode combined with K-edge filters can greatly improve the digital technique, with the values of FOM up to 200% greater than that obtained with the anode/filter combinations and tube potentials traditionally employed in mammography. For breasts with t < 4 cm, a general good performance was obtained with the W anode combined with 60 μm of the Mo filter at 24-25 kVp, while 60 μm of the Pd filter provided a general good performance at 24-26 kVp for t = 4 cm, and at 28-30 and 29-31 kVp for t = 6 and 8 cm, respectively.     

X-ray spectrum optimization of full-field digital mammography: simulation and phantom study

In contrast to conventional analog screen-film mammography new flat detectors have a high dynamic range and a linear characteristic curve. Hence, the radiographic technique can be optimized independently of the receptor exposure. It can be exclusively focused on the improvement of the image quality and the reduction of the patient dose. In this paper we measure the image quality by a physical quantity, the signal difference-to-noise ratio (SDNR), and the patient risk by the average glandular dose (AGD). Using these quantities, we compare the following different setups through simulations and phantom studies regarding the detection of microcalcifications and tumors for different breast thicknesses and breast compositions: Monochromatic radiation, three different anode/filter combinations: Molybdenum/molybdenum (Mo/Mo), molybdenum/rhodium (Mo/Rh), and tungsten/rhodium (W/Rh), different filter thicknesses, use of anti-scatter grids, and different tube voltages. For a digital mammography system based on an amorphous selenium detector it turned out that, first, the W/Rh combination is the best choice for all detection tasks studied. Second, monochromatic radiation can further reduce the AGD by a factor of up to 2.3, maintaining the image quality in comparison with a real polychromatic spectrum of an x-ray tube. And, third, the use of an anti-scatter grid is only advantageous for breast thicknesses larger than approximately 5 cm.     

A search for optimal x-ray spectra in iodine contrast media mammography

The aim of this work was to search for the optimal x-ray tube voltage and anode-filter combination in digital iodine contrast media mammography. In the optimization, two entities were of interest: the average glandular dose, AGD, and the signal-to-noise ratio, SNR, for detection of diluted iodine contrast medium. The optimum is defined as the technique maximizing the figure of merit, SNR2/AGD. A Monte Carlo computer program was used which simulates the transport of photons from the x-ray tube through the compression plate, breast, breast support plate, anti-scatter grid and image detector. It computes the AGD and the SNR of an iodine detail inside the compressed breast. The breast thickness was varied between 2 and 8 cm with 10-90% glandularity. The tube voltage was varied between 20 and 55 kV for each anode material (Rh, Mo and W) in combination with either 25 microm Rh or 0.05-0.5 mm Cu added filtration. The x-ray spectra were calculated with MCNP4C (Monte Carlo N-Particle Transport Code System, version 4C). A CsI scintillator was used as the image detector. The results for Rh/0.3 mmCu, Mo/0.3 mmCu and W/0.3 mmCu were similar. For all breast thicknesses, a maximum in the figure of merit was found at approximately 45 kV for the Rh/Cu, Mo/Cu and W/Cu combinations. The corresponding results for the Rh/Rh combination gave a figure of merit that was typically lower and more slowly varying with tube voltage. For a 4 cm breast at 45 kV, the SNR2/AGD was 3.5 times higher for the Rh/0.3 mmCu combination compared with the Rh/Rh combination. The difference is even larger for thicker breasts. The SNR2/AGD increases slowly with increasing Cu-filter thickness. We conclude that tube voltages between 41 and 55 kV and added Cu-filtration will result in significant dose advantage in digital iodine contrast media mammography compared to using the Rh/Rh anode/filter combination at 25-32 kV.     

High-resolution imager for digital mammography: physical characterization of a prototype sensor

The physical performance characteristics of a high-resolution sensor module for digital mammography were investigated. The signal response of the imager was measured at various detector entrance air kerma and was found to be linear. The spatial resolution was determined by measuring the presampling modulation transfer function, MTF(f), of the system. The noise power spectra, NPS(f), of the system were estimated using 26 kVp: Mo/Mo, 28 kVp: Mo/Rh and 30 kVp: Rh/Rh, with polymethyl methacrylate (PMMA) 'tissue equivalent material' of thickness 20, 45 and 57 mm for each of three x-ray spectra at detector entrance air kerma in the range between approximately 80.2 and 92.3 microGy. The noise equivalent quanta, NEQ(f), and detective quantum efficiencies, DQE(f), for the various spectral conditions were computed. In addition, dose dependence of NPS(f) and DQE(f) was studied at various detector entrance air kerma ranging from 9.4 to 169.7 microGy. A spatial resolution of about 10 cycles mm(-1) was obtained at the 10% MTF(f) level. A small increase in NEQ(f)was observed under higher energy spectral conditions while the DQE(f) decreased marginally. For a given spectrum, increasing PMMA filtration produced negligible change in DQE(f). The estimated DQE values at zero frequency were in the range between 0.45 and 0.55 under the conditions investigated in this study.     

Patient dose in digital mammography

In the present investigation, we analyze the dose of 5034 patients (20,137 images) who underwent mammographic examinations with a full-field digital mammography system. Also, we evaluate the system calibration by analyzing the exposure factors as a function of breast thickness. The information relevant to this study has been extracted from the image DICOM header and stored in a database during a 3-year period (March 2001-October 2003). Patient data included age, breast thickness, kVp, mAs, target/filter combination, and nominal dose values. Entrance surface air kerma (ESAK) without backscatter was calculated from the tube output as measured for each voltage used under clinical conditions and from the tube loading (mAs) included in the DICOM header. Mean values for the patient age and compressed breast thickness were 56 years (SD: 11) and 52 mm (SD: 13), respectively. The majority of the images was acquired using the STD (for standard) automatic mode (98%). The most frequent target/filter combination automatically selected for breast smaller than 35 mm was Mo/Mo (75%); for intermediate thicknesses between 35 and 65 mm, the combinations were Mo/Rh (54%) and Rh/Rh (38.5%); Rh/Rh was the combination selected for 91% of the cases for breasts thicker than 65 mm. A wide kVp range was observed for each target/filter combination. The most frequent values were 28 kVp for Mo/Mo, 29 kVp for Mo/Rh, and 29 and 30 kV for Rh/Rh. Exposure times ranged from 0.2 to 4.2 s with a mean value of 1.1 s. Average glandular doses (AGD) per exposure were calculated by multiplying the ESAK values by the conversion factors tabulated by Dance for women in the age groups 50 to 64 and 40 to 49. This approach is based on the dependence of breast glandularity on breast thickness and age. The total mean average glandular dose (AGD(T)) was calculated by summing the values associated with the pre-exposure and with the main exposure. Mean AGD(T) per exposure was 1.88 mGy (CI 0.01) and the mean AGD(T) per examination was 3.8 mGy, with 4 images per examination on average. The mean dose for cranio-caudal view (CC) images was 1.8 mGy, which is lower than that for medio-lateral oblique (MLO) view because the thickness for CC images was on average 10% lower than that for MLO images. Mean AGD(T) for the oldest group of women (1.90) was 3% higher than the AGD(T) for the younger group (1.85) due to the larger compressed breast thickness of women in the older group (10% on average). Differences between the corresponding AGD(T) values of each age group were lowest for breast thicknesses in the range 40-60 mm, being slightly higher for the women in the older group.     

Characterization of the effects of the FineView algorithm for full field digital mammography

The aim of this study was to characterize the effect of an image processing algorithm (FineView) on both quantitative image quality parameters and the threshold contrast detail response of the GE Senographe DS full-field digital mammography system. The system was characterized using signal transfer property, pre-sampling modulation transfer function (MTF), normalized noise power spectrum (NNPS) and detective quantum efficiency (DQE) of the system. An algorithmic modulation transfer function (MTF(a)) was calculated from images acquired at a reduced detector air kerma (DAK) and with the FineView algorithm enabled. Two sets of beam conditions were used: Mo/Mo/28 kV and Rh/Rh/29 kV, both with 2 mm added Al filtration at the x-ray tube. Images were acquired with and without FineView at four DAK levels from 14 to 378 μGy. The threshold contrast detail response was assessed using the CDMAM contrast-detail test object which was imaged under standard clinical conditions with and without FineView at three DAK levels from 24 to 243 μGy. The images were scored by both human observers and by automated scoring software. Results indicated an improvement of up to 125% at 5 mm?1 in MTF(a) when FineView was activated, particularly at high DAK levels. A corresponding increase of up to 425% at 5 mm?1 was also seen in the NNPS, again with the same DAK dependence. FineView did not influence DQE, an indication that the signal to noise ratio transfer of the system remained unchanged. FineView did not affect the threshold contrast detectability of the system, a result that is consistent with the DQE results.     

Simulation study of a quasi-monochromatic beam for x-ray computed mammotomography

The purpose of this simulation study was to evaluate the feasibility, benefits, and potential operating parameters of a quasi-monochromatic beam from a tungsten-target x-ray source yielding projection images. The application is intended for newly developed cone beam computed mammotomography (CmT) of an uncompressed breast. The value of a near monochromatic x-ray source for a fully 3D CmT application is the expected improved ability to separate tissues with very small differences in attenuation coefficients. The quasi-monochromatic beam is expected to yield enhanced tomographic image quality along with a low dose, equal to or less than that of dual view x-ray mammography. X-ray spectra were generated with a validated projection x-ray simulation tool (XSpect) for a range of tungsten tube potentials (40-100 kVp), filter materials (Z=51-65), and filter thicknesses (10th to 1000th value layer determined at 60 kVp). The breast was modeled from ICRU-44 breast tissue specifications, and a breast lesion was modeled as a 0.5 cm thick mass. The detector was modeled as a digital flat-panel detector with a 0.06 cm thick CsI x-ray absorption layer. Computed figures of merit (FOMs) included the ratio of mean beam energy post-breast to pre-breast and the ratio of lesion contrasts for edge-located and center-located lesions as indices of breast beam hardening, and SNR2/exposure and SNR2/dose as indices of exposure and dose efficiencies. The impact of optimization of these FOMs on lesion contrast is also examined. For all simulated filter materials at each given attenuation thickness [10th, 100th, 500th, 1000th value layers (VLs)], the mean and standard deviation of the pre-breast spectral full-width at tenth-maximum (FWTM) were 16.1 +/- 2.4, 10.3 +/- 2.2, 7.3 +/- 1.4, and 6.5 +/- 1.5 keV, respectively. The change in beam width at the tenth maximum from pre-breast to post-breast spectra ranged from 4.7 to 1.1 keV, for the thinnest and thickest filters, respectively. The higher Z filters (Z=57-63) produced a quasi-monochromatic beam that allowed the widest tube potential operating range (50-70 kVp) while maintaining minimal beam hardening and maximal SNR2/exposure and SNR2/dose, and providing a contrast greater than that obtained in the unfiltered case. Figures of merit improved with increasing filter thickness, with diminishing returns beyond the 500th value layer attenuation level. Operating parameters required to produce optimal spectra, while keeping exposures equal to that of dual view mammography, are within the capability of the commercial x-ray tube proposed for our experimental study, indicating that use of these highly attenuating filters is viable. Additional simulations comparing Mo/Mo, Mo/Rh, and W/Rh target/filter combinations indicate that they exhibit significantly lower SNR2/exposure than the present approach, precluding them from being used for computed mammotomography, while maintaining dose limitations and obtaining sufficient SNR. Beam hardening was also much higher in the existing techniques (17%-42%) than for our technique (2%). Simulations demonstrate that this quasi-monochromatic x-ray technique may enhance tissue separation for a newly developed cone beam computed mammotomography application for an uncompressed breast.     

Technique factors and their relationship to radiation dose in pendant geometry breast CT

The use of breast computed tomography (CT) as an alternative to mammography in some patients is being studied at several institutions. However, the radiation dosimetry issues associated with breast CT are markedly different than in the case of mammography. In this study, the spectral properties of an operational breast CT scanner were characterized both by physical measurement and computer modeling of the kVp-dependent spectra, from 40 to 110 kVp (Be window W anode with 0.30 mm added Cu filtration). Previously reported conversion factors, normalized glandular dose for CT-DgN(ct), derived from Monte Carlo methods, were used in concert with the output spectra of the breast scanner to compute the mean glandular dose to the breast based upon different combinations of x-ray technique factors (kVp and mAs). The mean glandular dose (MGD) was measured as a function of the compressed breast thickness (2-8 cm) and three different breast compositions (0%, 50%, and 100% glandular fractions) in four clinical mammography systems in our institution. The average MGD from these four systems was used to compute the technique factors for breast CT systems that would match the two-view mammographic dose levels. For a 14 cm diameter breast (equivalent to a 5 cm thick compressed breast in mammography), air kerma levels at the breast CT scanner's isocenter (468 mm from the source) of 4.4, 6.4, and 9.0 mGy were found to deliver equivalent mammography doses for 0%, 50%, and 100% glandular breasts (respectively) at 80 kVp. At 80 kVp (where air kerma was 11.3 mGy/100 mAs at the isocenter), 57 mAs (integrated over the entire scan) was required to match the mammography dose for a 14 cm 50% glandular breast. At 50 kVp, 360 mAs is required to match mammographic dose levels. Tables are provided for both air kerma at the isocenter and mAs for 0%, 50%, and 100% glandular breasts. Other issues that impact breast CT technique factors are also discussed.     

Characterization of a fiber-optic-coupled radioluminescent detector for application in the mammography energy range

Fiber-optic-coupled radioluminescent (FOC) dosimeters are members of a new family of dosimeters that are finding increased clinical applications. This study provides the first characterization of a Cu doped quartz FOC dosimeter at diagnostic energies, specifically across the range of x-ray energies and intensities used in mammographies. We characterize the calibration factors, linearity, angular dependence, and reproducibility of the FOC dosimeters. The sensitive element of each dosimeter was coupled to a photon counting photomultiplier module via 1 m long optical fibers. A computer controlled interface permitted real-time monitoring of the dosimeter output and rapid data acquisition. The axial-angular responses for all dosimeter models show nearly uniform response without any marked decrease in sensitivity. However, the normal-to-axial angular response showed a marked decrease in sensitivity of about 0 degrees C and 180 degrees C. In most clinical applications, appropriate dosimeter positioning can minimize the contributions of the varying normal-to-axial response. The FOC dosimeters having the greatest sensitive length provided the greatest sensitivity, with greatest to lowest sensitivity observed for 4.0, 1.9, 1.6, and 1.1 mm length sensitive elements. The average sensitivity of the dosimeters varies linearly with sensitive volume (R2=95%) and as a function of tube potential and target/filter combinations, generally exhibiting an increased sensitivity for higher energies. The dosimeter sensitivity as a function of tube potential had an average increase of 4.72 +/- 2.04% for dosimeter models and three target-filter combinations tested (Mo/Mo, Mo/Rh, and Rh/Rh) over a range of 25-31 kVp. All dosimeter models exhibited a linear response (R2 > or = 0.997) to exposure for all target-filter combinations, tube potentials, and tube current-time product stations evaluated and demonstrated reproducibility within 2%. All of the dosimeters examined in this study provided a response adequate for the accurate measurement of doses in clinical mammography applications.     

Quality control measurements for digital x-ray detectors

This paper describes a digital radiography (DR) quality control protocol for DR detectors from the forthcoming report from the Institute of Physics and Engineering in Medicine (IPEM). The protocol was applied to a group of six identical caesium iodide (CsI) digital x-ray detectors to assess reproducibility of methods, while four further detectors were assessed to examine the wider applicability. Twelve images with minimal spatial frequency processing are required, from which the detector response, lag, modulation transfer function (MTF), normalized noise power spectrum (NNPS) and threshold contrast-detail (c-d) detectability are calculated. The x-ray spectrum used was 70 kV and 1 mm added copper filtration, with a target detector air kerma of 2.5 μGy for the NNPS and c-d results. In order to compare detector performance with previous imaging technology, c-d data from four screen/film systems were also acquired, at a target optical density of 1.5 and an average detector air kerma of 2.56 μGy. The DR detector images were typically acquired in 20 min, with a further 45 min required for image transfer and analysis. The average spatial frequency for the 50% point of the MTF for six identical detectors was 1.29 mm(-1) ± 0.05 (3.9% coefficient of variation (cov)). The air kerma set for the six systems was 2.57 μGy ± 0.13 (5.0% cov) and the NNPS at this air kerma was 1.42 × 10(-5) mm(2) (6.5% cov). The detective quantum efficiency (DQE) measured for the six identical detectors was 0.60 at 0.5 mm(-1), with a maximum cov of 10% at 2.9 mm(-1), while the average DQE was 0.56 at 0.5 mm(-1) for three CsI detectors from three different manufacturers. Comparable c-d performance was found for these detectors (5.9% cov) with an average threshold contrast of 0.46% for 11 mm circular discs. The average threshold contrast for the S/F systems was 0.70% at 11 mm, indicating superior imaging performance for the digital systems. The protocol was found to be quick, reproducible and gave an in-depth assessment of performance for a range of digital x-ray detectors.     

A comparison of the performance of digital mammography systems

An objective analysis of image quality parameters was performed for six digital mammography systems. The presampled modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE) for the systems were determined at different doses, for 28 kVp with a Mo/Mo or W/Al target/filter combination and 2 mm of additional aluminium filtration. The flat-panel units have higher MTF and DQE in the mid to high frequency range than standard CR systems. The highest DQE, over the whole dose range, is for the slit-scanning direct photon counting system. Dual-side read CR can overcome the inherent x-ray absorption and signal collection limitations of standard CR mammography, improving the low-frequency DQE by 40%, to the same level as full-field systems, but it does not improve the poor spatial resolution of phosphor.     

Multitapered x-ray capillary optics for mammography

X-ray mammography is currently the primary tool used for breast cancer detection. However, studies have shown that 5%-15% of breast cancers are not visualized mammographically. The long term goal of this project is to improve the x-ray mammographic imaging system using capillary optics. A post-patient capillary optic lens has the potential to increase spatial resolution and eliminate the detection of scattered x rays, thereby improving image contrast and the signal-to-noise ratio (SNR). Several individual and two prototype multitapered optics were studied to determine the feasibility of a full-field multitapered optic. Scatter fraction, contrast, transmission, uniformity, and the modulation transfer function (MTF) were measured for a Mo target tube/computed radiography (CR) imaging system when this prototype was applied. The results were compared with standard grid and airgap techniques. The multitapered optic lens removed 85% of the scattered photons as compared to 66% and 39% for the air gap and grid methods, respectively. This resulted in an improvement of contrast by approximately 80% for the optics, 51% for the air gap, and 30% for grid methods. The single optic lens improved the limiting resolution (5% MTF level) of the CR detector by 78% due to magnification with very little focal spot blurring, while the multitapered prototype improved resolution significantly, but not as much as the single optic. These measurements have shown that it is feasible to create a multitapered optic lens that significantly improves system MTF and virtually eliminates scatter. With continued improvements in fabrication techniques, a full-field multitapered lens will be feasible.     

Suitability of new anode materials in mammography: dose and subject contrast considerations using Monte Carlo simulation

Mammography is the technique with the highest sensitivity and specificity, for the early detection of nonpalpable lesions associated with breast cancer. As screening mammography refers to asymptomatic women, the task of optimization between the image quality and the radiation dose is critical. A way toward optimization could be the introduction of new anode materials. A method for producing the x-ray spectra of different anode/filter combinations is proposed. The performance of several mammographic spectra, produced by both existing and theoretical anode materials, is evaluated, with respect to their dose and subject contrast characteristics, using a Monte Carlo simulation. The mammographic performance is evaluated utilizing a properly designed mathematical phantom with embedded inhomogeneities, irradiated with different spectra, based on combinations of conventional and new (Ru, Ag) anode materials, with several filters (Mo, Rh, Ru, Ag, Nb, Al). An earlier developed and validated Monte Carlo model, for deriving both image and dose characteristics in mammography, was utilized and overall performance results were derived in terms of subject contrast to dose ratio and squared subject contrast to dose ratio. Results demonstrate that soft spectra, mainly produced from Mo, Rh, and Ru anodes and filtered with k-edge filters, provide increased subject contrast for inhomogeneities of both small size, simulating microcalcifications and low density, simulating masses. The harder spectra (W and Ag anode) come short in the discrimination task but demonstrate improved performance when considering the dose delivered to the breast tissue. As far as the overall performance is concerned, new theoretical spectra demonstrate a noticeable good performance that is similar, and in some cases better compared to commonly used systems, stressing the possibility of introducing new materials in mammographic practice as a possible contribution to its optimization task. In the overall optimization task in terms of subject contrast to dose ratio, tube voltage was found to have a minor effect, while with respect to the filter material, a lesion specific performance was noticed, with Al filtered spectra showing improved characteristics in case of the inhomogeneities simulating microcalcifications, while softer k-edge filtered spectra are more suitable for the discrimination of inhomogeneities simulating masses.     

Characterization of the scattered radiation field around an x-ray tube

To determine patient doses or doses to the medical staff, Monte Carlo calculations are frequently applied. In these kinds of calculations the x-ray tube is often simplified to make the calculations faster. The purpose of this study is to investigate the influence of simplifications in the Monte Carlo set-up of the x-ray tube on the observed differences between measurements and calculations in the scattered field. At a distance of 50 and 100 cm from the focal spot, air kerma calculations are done for different angles from -90° to 90° from the central beam axis in steps of 15° with the Monte Carlo software code MCNP-X. Different calculations were performed where each time a component of the simulated x-ray tube (collimator, filters, etc) or the environment (walls) is included. Scattered doses are also measured with thermoluminescent dosemeters. For the most simplified geometry of the x-ray tube, measurements are on average 70% larger than the calculated results. A much better agreement with the measurements is observed for more realistic calculations. The current work applies to a particular source in the SCK?CEN calibration laboratory; therefore the obtained results are representative and relevant for studies in calibration laboratories. As clinical sources have more shielding material and as in real imaging situations the scatter generated at the patient is much larger than the scatter leaking from the source, the results of this study have a limited impact on the wider field of clinical dosimetry.     

Experimental investigation of the dose and image quality characteristics of a digital mammography imaging system

Our purpose in this study was to investigate the image quality and absorbed dose characteristics of a digital mammography imaging system with a CsI scintillator, and to identify an optimal x-ray tube voltage for imaging simulated masses in an average size breast with 50% glandularity. Images were taken of an ACR accreditation phantom using a LORAD digital mammography system with a Mo target and a Mo filter. In one experiment, exposures were performed at 80 mAs with x-ray tube voltages varying between 24 and 34 kVp. In a second experiment, the x-ray tube voltage was kept constant at 28 kVp and the technique factor was varied between 5 and 500 mAs. The average glandular dose at each x-ray tube voltage was determined from measurements of entrance skin exposure and x-ray beam half-value layer. Image contrast was measured as the fractional digital signal intensity difference for the image of a 4 mm thick acrylic disk. Image noise was obtained from the standard deviation in a uniformly exposed region of interest expressed as a fraction of the background intensity. The measured digital signal intensity was proportional to the mAs and to the kVp5.8. Image contrast was independent of mAs, and dropped by 21% when the x-ray tube voltage increased from 24 to 34 kVp. At a constant x-ray tube voltage, image noise was shown to be approximately proportional to (mAs)(-05), which permits the image contrast to noise ratio (CNR) to be modified by changing the mAs. At 80 mAs, increasing the x-ray tube voltage from 24 to 34 kVp increased the CNR by 78%, and increased the average glandular dose by 285%. At a constant lesion CNR, the lowest average glandular dose value occurred at 27.3 kVp. Increasing or decreasing the x-ray tube voltage by 2.3 kVp from the optimum kVp increased the average glandular dose values by 5%. These results show that imaging simulated masses in a 4.2 cm compressed breast at approximately 27 kVp with a Mo/Mo target/filter results in the lowest average glandular dose.     

Scatter fractions from linear accelerators with x-ray energies from 6 to 24 MV.

Computation of shielding requirements for a linear accelerator must take into account the amount of radiation scattered from the patient to areas outside the primary beam. Currently, the most frequently used data are from NCRP 49 that only includes data for x-ray energies up to 6 MV and angles from 30 degrees to 135 degrees. In this work we have determined by Monte Carlo simulation the scattered fractions of dose for a wide range of energies and angles of clinical significance including 6, 10, 18, and 24 MV and scattering angles from 10 degrees to 150 degrees. Calculations were made for a 400 cm2 circular field size impinging onto a spherical phantom. Scattered fractions of dose were determined at 1 m from the phantom. Angles from 10 degrees to 30 degrees are of concern for higher energies where the scatter is primarily in the forward direction. An error in scatter fraction may result in too little secondary shielding near the junction with the primary barrier. The Monte Carlo code ITS (Version 3.0) developed at Sandia National Laboratory and NIST was used to simulate scatter from the patient to the barrier. Of significance was the variation of calculated scattered dose with depth of measurement within the barrier indicating that accurate values may be difficult to obtain. Mean energies of scatter x-ray spectra are presented.