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Resident Physics Lectures

Mammography X-Ray
System
Prof. J.K Tonui, PhD

School of Medicine,
Department of Radiology & Imaging
Learning Objectives
At the end of this lecture, the student is

expected to:
 Understand why a dedicated x-ray system is

desired for mammography examination.


 Describe the components of mammography

- the C-arm stand, the generator, the AEC,


and the compression devices, the anti-scatter
grid, and the focal point.

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Introduction
Mammography

 Is a radiography procedure optimized for

examination of the breast, and


 The exam is usually called a mammogram, and

 This image aids in the early detection and

diagnosis of breast diseases in women, and


 Recent development include digital

mammography, computer-aided detection (CAD)


and breast tomosynthesis (3D).

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Mammography X-ray Unit
X-rays are attenuated differently by

 Normal breast tissues, and


 Cancerous breast tissues.

However,

 The difference between them is small, hence

 Requires the use of x-ray equipment

specifically designed to optimize breast


cancer detection.

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Mammography X-ray Unit
Mammogram provides information about

 breast morphology,

 normal anatomy, and

 gross pathology.

Mammography x-ray units

 Are designed mechanically and electronically

to meet stringent radiographic and


positioning requirements of breast imaging.

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Mammography X-ray Unit
 Radiological requirements:

 Sufficient spatial resolution

o Details possibly as fine as 50 μm must be adequately visualised

 Adequate contrast in image

o Low-energy X ray spectra

 Broad dynamic range


o Required due to composition of breast and age-dependent

changes in breast

 Lowest absorbed dose compatible with adequate diagnostic

image quality

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Mammography X-ray Unit
Mammographic units differ from convectional

units
 Mainly because of the need to differentiate

between the two tissues of the breast {glandular


(Z=7.4) and adipose (Z=6.5)}, and
 Hence, to maximize subject contrast, it is

necessary to use low tube voltage (kV), which


 Increases PE interaction between the radiation and

the soft tissues, as shown in next slide.

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Mammography X-ray Unit
 Fig.

 Shows relative

contributions from
photoelectric and
Compton events for
mammography, and
 For PE, interaction is

given by:

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Mammography X-ray Unit
Thus, one of the difference between

mammographic and convectional units is:


 The low energy radiation used

o to distinguish between normal and pathologic

soft tissues;
o to produce high-resolution images, and

o to visualize the subtle signs of early breast

cancer with a low radiation dose to the patient.

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X-ray Mammography
Fig.

 Shows attenuation

differences between breast


tissues, where
o It is highest at very low x-

ray energies (10 to 15 keV, )


and
o Poor at higher energies (>35

keV) as shown in Fig. beside.

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X-ray Mammography
Low x-ray energies

 Give the best differential

attenuation between the tissues


as shown in this Fig., hence  Gland  Cancer   100%
Contrast 
Gland
 It results in good subject

contrast with low radiation dose


to pt.

High absorption

 Results in high tissue doses and


 Long exposure time.

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Mammography X-ray Tubes
 Detection of minute calcifications in breast tissues

 Is very important because of the high correlation of

calcification patterns with disease, and


 Hence, detecting micro-calcifications while minimizing dose

and enhancing low-contrast detection impose extreme


requirements on mammographic equipment and detectors,
which
 Has led to the refinement of dedicated x-ray equipment -

specialized x-ray tube, compression devices, anti scatter


grids, phototimers, and detector systems, for
mammography as shown in Fig. in next slide.
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Mammographic X-ray Units
Fig.

 Shows the parts of a

dedicated
mammography unit,
which
 Are typically similar to

those in convectional
unit with few
exceptions.

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Mammographic X-ray Units
 Mammographic x-ray units

 Are designed to achieve the best image quality at

low kV, and also minimum patient dose, and


 This is achieved by optimizing all aspects of

machine design such as:


o Efficient generator supply,

o X-ray tube construction,

o Tissue compression, and

o Automatic dose control.

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Types of Mammogram
Machine
Two types of mammography machines are used:

 Screen-Film Mammography (SFM) units,

o Older systems and have poor sensitivities for denser

breasts.
 Full-Field Digital Mammography (FFDM) units.

o Modern sets and utilise flat panels or digital system

(typically direct conversion), and


o Is sensitive for dense breast tissues, hence expected

to improve mammography examinations.

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Dedicated Mammography
Units
 Specialized components are:

 Target and port/window

 Filter, focal spot

 SID, OID

 Generator, AEC

 Grid and collimators

 Compression devices,

 Processor, and

 Magnifier

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Mammography X-ray Unit
A mammography x-ray unit

 Has a rectangular box that

houses the tube in which x-rays


are produced, and
 Has a C-arm shape stand as

shown in this Fig., and


 Has special accessories that

allow only the breast to be


exposed to the x-rays.
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X-ray Tube Stand
X-ray tube stand

movement
Vertical
 Should have a variable

vertical movement to
accommodate patients
who are both very tall and
those who need to sit, and
Rotation
 There should be at least

180o rotation of the C-arm.

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Source-Image Distance (SID)
Mammography unit

 Has a shorter Source-Image Distance (SID)

distance as compared to convection


radiographic units, which
 Is typically 60-70 cm (24 to 26’’ depending

on the machine) vs. 100 cm for convectional


systems, and
 A SID of 65 cm require effective anode

angle to be at least 20o to avoid field cut-off


for the 24x30 cm field area.

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Source-Image Distance (SID)
Fig.

 Shows two

anode
configuration
s of a
mammograp
hy unit.

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The Generator
A dedicated mammography x-ray generator

 Is similar to a standard x-ray generator in

design and function, but


 With minor differences such as:

o Voltage supplied to the x-ray tube,

o Space charge compensation requirements, and

o Automatic exposure control (AEC) circuitry.

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The Generator
 The X-ray generator

 Modify input ac voltage to provide the x-ray tube with

power necessary to produce the x-ray beam, and


 Due to space charge effects, adequate tube current is

a problem in low kV studies, and


 In mammographic units, longer exposure time is

required to achieve required mAs values, but


 Results in loss of image resolution due to motion

unsharness, and reduce film density.

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The generator
The X-ray generator used in mammographic

system is either:
 High frequency,
frequency i.e. convert the 50- or 60-Hz
input voltage to a frequency as high as 100
kHz, or
 Constant potential,
potential i.e. they supply a
constant, ripple-free voltage to the x-ray tube
regardless of the waveform frequency.
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The Generator
Range of kVp settings

 Vary between 20 to 35 kV to maximise radiographic

contrast, and
 This narrow range accentuates the subtle density

differences in breast tissue, and


 The x-ray generator should be steppable in 1 kV

increments for this range so that the kV can be


adjusted to match the thickness and density of the
patient’s breast.

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Automatic Exposure Control
(AEC)
The AEC is used also in mammography unit:

 Is also called phototimers, and

 Is used to control the value of mAs and

 Also terminate x-ray generation when the

radiation sensor placed behind the film cassette


senses adequate exposure, and
o Typical screen-film exposure is 5 to 10 mR,

o Variable sensor position, and

o Should be under densest tissue.


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The AEC
The AEC

 Employs a radiation sensor (or sensors), an

amplifier, and a voltage comparator, to


control the exposure as shown in Fig.

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The AEC
The AEC circuit

 Uses sophisticated algorithms with input from the

breast thickness (from the compression paddle),


breast density (via a test exposure), density
setting (operator density selector), and exposure
duration (reciprocity law failure issues) to
determine overall exposure time, and
 In fully automatic modes, the kVp, beam filter, and

target are also determined.

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The AEC
Two types of AEC devices are used:

 In one, technician selects kV, and AEC controls

mAs to yield a well-exposed image (OD = least


1.0 in the densest glandular regions in the film
image), and
 In the other, the AEC controls both kV and mAs,

where the kV selection is made through a pre-


exposure or is adjusted during the exposure.

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The AEC
Note that,

 In some systems, the AEC system controls

the anode and filtration as well.

AEC devices automatically compensate

 For patient anatomy, kV variance, and mA,

thereby reducing radiation exposure and


retakes.

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The AEC
In mammographic unit,

 The AEC detector is located underneath the cassette,

unlike most conventional x-ray machines, where it is


located in front of cassette, and
 Sensors used can be a single IC or an array of three or

more semiconductor diodes, and


 The sensor measures residual x-rays after passing thro’

the breast, grid, and image receptor, and


 This arrangement ensure adequate exposure of the film.

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The AEC
AEC should be regularly tested with

phantoms
 Phantoms are objects used to simulate the

absorption and scattering characteristics of the


breast.

This testing is mandatory

 In order to ensure proper calibration of the AEC

device as required by the MQSA.

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The Focal Spot
Because of the heel effect,

 X-ray tube is orientated such that the cathode side is

towards the base of the breast because x-ray


intensity is higher towards cathode than towards anode
(heel effect).
 This orientation helps to expose the
o thicker portion of the breast with energetic x-rays towards the

cathode and
o thinner portion (towards nipple) by lower intensity x-rays

towards the anode.

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The Focal Spot
 Focal spot

 Is located directly above the chest wall

(CW) edge as shown in this Fig., and


 Dual focus tubes are used

o ~0.4 mm for general mammogram

o ~0.1-0.15 mm for magnification views.

 Small focal spot

 Minimizes geometrical blurring and improves

spatial resolution needed to detect micro-


calcification.

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The Focal Spot
Due to small focal spot,

 Tube current is limited to ~100

mA to avoid melting the anode,


anode
and
 Exposures as short as 0.01 s and

as long as 6 s are used.

The breast

 Is positioned on the support

platform as shown in this Fig.


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The Focal Spot
System geometry for

image acquisition
showing:
 correct alignment and

 missed tissue

associated with
incorrect alignment.

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Compression Device
Mammography x-ray unit,

 Has a device called

compression pad attached to


it, and
 Is used to hold, and compress

the breast during imaging and


 Also position the breast so

that images can be obtained at


different angles.

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Compression Device
Compression is applied to;

 Hold the breast still during exposure

(exposure times can be quite long due to low


mA), hence reduce motion unsharpness;
 Reduce the thickness of tissue so lower

exposure factors can be used (lower dose);


 Spread the anatomy out to minimise

overlaying structures (improve contrast)

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Compression Device
Compression is applied to;

 Equalise thickness to ensure homogenous

density on radiograph, and


 Bring the structures closer to the detector to

reduce geometric unshaprness.

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Anti-Scatter Grid
Uses two kinds of moving grids to remove

scatter:
 Linear grids, and

 High Transmission Cellular (HTC) Grids

Note that

 Grid moves during exposure to blur the image of

the grid septa on the image, and


 Motion must be uniform and of sufficient amplitude

to avoid non-uniformities in the image.


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Anti-Scatter Grid
Linear grids

 Grid ratio is  4.1 to 5.1, with 30-40 lines/cm vs.

convectional grid of 8.1 to 12.2, with 43 lines/cm;


 Breast dose is increased by use of grids (Bucky

Factor) by a factor of 2 to 3 (justified by improvement


in image quality), with 40% improvement in contrast.
 Laminae are focused to the focal spot to prevent grid

cut off.
 Grid septa generally perpendicular to chest wall.

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Anti-Scatter Grid
High Transmission Cellular (HTC) Grids:

 Are 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.

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Anti-Scatter Grid

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