Dose reduction and its influence on diagnostic accuracy and radiation risk in digital mammography: an observer performance study using an anthropomorphic breast phantom

Svahn, Tony; Hemdal, Bengt; Ruschin, Mark; Chakraborty, Dev P.; Andersson, Ingvar; Tingberg, Anders; Mattsson, Sören

doi:10.1259/bjr/29933797

Cited by 21 publications

(17 citation statements)

References 19 publications

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“…This result differs from previous study findings that conservatively suggested a 50% dose reduction in mammography [1][2][3]. One factor might be the use of mastectomy specimens here as study substrate.…”

Section: Discussioncontrasting

confidence: 99%

“…As a result, digital mammography has the potential to obtain and optimise images with a low radiation dose level for specific purposes. Dosimetry studies carried out for digital mammography [1][2][3], suggest a possible 50% dose reduction, as the radiologists' performance in standard and dose reduced images did not differ significantly. All of these were experimental and performed with phantoms or manipulated mammography images.…”

Section: Introductionmentioning

confidence: 96%

“…Most studies focus on generalised dose reduction in mammography, with consequent concerns about the potential loss of image quality and the resultant effect on diagnostic efficacy [1][2][3]. The aim of this pilot study is to investigate whether a differentiated approach could be feasible, such as dose reduction in specific views only.…”

Section: Introductionmentioning

confidence: 99%

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Alternative Exposure Parameters and Post Process Noise Reduction Expect Considerable Dose Reduction in Single Mammography Views—Initial Experience on Mastectomy Specimens

Bluekens¹,

Engen²,

Karssemeijer³

et al. 2013

ABCR

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Objective: To experimentally indicate a lower limit of dose in mammographic imaging yielding adequate image quality for complementary diagnostic views, by evaluation of image series with different exposure parameters and additional image processing on mastectomy specimens with diverse pathology. Methods: Image series were obtained on seven specimens with different target-filter combinations at different exposure values. Three experienced radiologists assessed the lowest acceptable dose level per specimen using a relative grading technique. With the standard image as reference, fibroglandular tissue and pathological structures, including microcalcifications, were evaluated. Subsequently, a series of pixel binning processes was tested and subjectively assessed on the selected images. Results: The lowest dose level at which image quality was acceptable, and achieved with a W/Ag target-filter combination at 32 kV and 4 mAs. These images can be acquired with 10.4% to 22.4% of the average glandular dose in standard images. Post process pixel binning added to the interpretability of such low dose images. Conclusion: This specimen study suggests that dose level of mammography images might be reduced substantially by general application of a W/Ag spectrum, particularly when combined with post process noise reduction. Future studies should focus on the feasibility of this technique in clinical mammography.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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Alternative Exposure Parameters and Post Process Noise Reduction Expect Considerable Dose Reduction in Single Mammography Views—Initial Experience on Mastectomy Specimens

Bluekens¹,

Engen²,

Karssemeijer³

et al. 2013

ABCR

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“…Mammography studies on dosimetry suggested that the radiologists' performance in detecting abnormalities with standard radiation dose images and markedly dose-reduced images (33-55%) does not differ significantly. [2][3][4] These results motivated us to perform a small-scale study on breast specimen with the objective to determine a threshold dose level for single views. The results of this experimental study show that application of a tungsten/silver (W/Ag) beam quality for low-dose imaging permits a substantial reduction of the average glandular dose (AGD), possibly up to 90%, in single digital mammographic images, irrespective of breast thickness, particularly in combination with post-process noise reduction.…”

Section: Discussionmentioning

confidence: 99%

The potential use of ultra-low radiation dose images in digital mammography—a clinical proof-of-concept study in craniocaudal views

Bluekens

Veldkamp²,

Schuur³

et al. 2015

BJR

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Objective: To estimate the potential of low-dose images in digital mammography by analysing the effect of substantial dose reduction in craniocaudal (CC) views on clinical performance. Methods: At routine mammography, additional CC views were obtained with about 10% of the standard dose. Five radiologists retrospectively read the standard [mediolateral oblique (MLO) 1 CC] and combination low-dose mammograms (standard MLO 1 low-dose CC). If present, lesion type, conspicuity and suggested work-up were recorded. Final diagnoses were made by histology or follow up. A t-test or x 2 test was used to compare results. Results: 421 cases were included, presenting 5 malignancies, 66 benign lesions and multiple non-specific radiologic features. Using MLO with low-dose CC, all lesions were detected by at least one reader, but altogether less often than with standard mammography (sensitivity, 73.9%vs 81.5%). Missed lesions concerned all types. Lesions detected with both protocols were described similarly (p 5 0.084) with comparable work-up recommendations (p 5 0.658). Conclusion: Mammography with ultra-low-dose CC images particularly influences detection. While sensitivity decreased, specificity was unaffected. In this proof-ofconcept study a lower limit was to be determined that is not intended nor applicable for clinical practice. This should facilitate further research in optimization of a lowdose approach, which has potential in a relatively young and largely asymptomatic population. Advances in knowledge: Tungsten/silver-acquired mammography images might facilitate substantial dose reduction. Ultra-low-dose CC images reduce sensitivity, but not specificity. Low-dose images have potential in a largely young and asymptomatic population; a baseline is set for further research in optimization of a low-dose approach.Mammography is the most widely used modality in breast imaging. An increasing number of females throughout the world undergo mammography frequently, either in the diagnostic or screening setting. With the growing incidence of breast cancer, and the decreasing age of onset, the demand for mammography, particularly in the younger population, is still rising. Also, a considerable number of high-risk females are identified and advised to have annual mammograms, as part of a multimodality approach, preceding regular screening. With this development, in a relatively young and largely asymptomatic population, every opportunity to lower radiation dose in mammography should be investigated.Standard mammography is gradually being extended to tomosynthesis. When used with synthetic two-dimensional (2D) mammography, the mean radiation dose might be comparable to standard mammography, 1 but lower doses are not to be expected. Moreover, implementation of a new technology, in screening and diagnostic imaging practices, takes both time and money. Therefore, in low-income countries and countries in transition, 2D mammography will continue to play a significant role for many years. Hence, ongoing research in radiation protection i...

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“…Thus, dose reduction must be executed carefully in clinical screening. However, Svahn et al 27 suggested that a dose reduction of 50% would result in nine fewer breast cancer fatalities per 100,000 women undergoing annual screening from the age of 40 to 49 years. They indicated that it may be possible to reduce the dose to the breast by 50% of the level currently used without affecting diagnostic performance for the detection of nodules or masses and microcalcifications.…”

Section: -25mentioning

confidence: 99%

Effect of Dose Reduction on the Ability of Digital Mammography to Detect Simulated Microcalcifications

et al. 2009

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The purpose of this article was to report the relationship between radiation dose and the ability of sentence digital mammography to detect microcalcifications. All images were acquired by computed radiography and an anthropomorphic breast phantom. The tube voltage and anode/filter combination used were 28 kVp and Mo/Mo. Simulated microcalcifications with an approximate diameter of 250-350 μm were positioned on the phantom. Groups of six microcalcifications were arranged in one of two patterns, a line cluster 1 cm long or a hexagonal cluster 4 mm wide. One of the six microcalcifications was removed to create a negative control. Each cluster was placed on 25 different points. Four levels of milliampere-second (mAs) values were applied: 100%, 50%, 25%, and 12.5%. Five staff radiologists participated in an observer performance test. All observers used a workstation with a 3-megapixel monochrome LCD monitor. The areas under the receiveroperating characteristics curves (AUC) were used to compare diagnostic performance among the four doses. The overall AUC scores were 0.97 with 100% mAs, 0.93 (n.s.) with 50%, 0.90 (pG0.05) with 25%, and 0.81 (pG0.01) with 12.5% mAs. Among the negative series, the percentage of images on which observers were able to identify the removed microcalcification point decreased from 88.8% with 100% mAs to 83.6% (n.s.) with 50%, 74.8% (pG0.001) with 25%, and 67.2% (pG0.001) with 12.5% mAs. A certain level of dose reduction in digital mammography may be an option.

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Dose reduction and its influence on diagnostic accuracy and radiation risk in digital mammography: an observer performance study using an anthropomorphic breast phantom

Cited by 21 publications

References 19 publications

Alternative Exposure Parameters and Post Process Noise Reduction Expect Considerable Dose Reduction in Single Mammography Views—Initial Experience on Mastectomy Specimens

Alternative Exposure Parameters and Post Process Noise Reduction Expect Considerable Dose Reduction in Single Mammography Views—Initial Experience on Mastectomy Specimens

The potential use of ultra-low radiation dose images in digital mammography—a clinical proof-of-concept study in craniocaudal views

Effect of Dose Reduction on the Ability of Digital Mammography to Detect Simulated Microcalcifications

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