Quality assurance and quality control in mammography: a review of available guidance worldwide

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Abstract

Objectives

Review available guidance for quality assurance (QA) in mammography and discuss its contribution to harmonise practices worldwide.

Methods

Literature search was performed on different sources to identify guidance documents for QA in mammography available worldwide in international bodies, healthcare providers, professional/scientific associations. The guidance documents identified were reviewed and a selection was compared for type of guidance (clinical/technical), technology and proposed QA methodologies focusing on dose and image quality (IQ) performance assessment.

Results

Fourteen protocols (targeted at conventional and digital mammography) were reviewed. All included recommendations for testing acquisition, processing and display systems associated with mammographic equipment. All guidance reviewed highlighted the importance of dose assessment and testing the Automatic Exposure Control (AEC) system. Recommended tests for assessment of IQ showed variations in the proposed methodologies. Recommended testing focused on assessment of low-contrast detection, spatial resolution and noise. QC of image display is recommended following the American Association of Physicists in Medicine guidelines.

Conclusions

The existing QA guidance for mammography is derived from key documents (American College of Radiology and European Union guidelines) and proposes similar tests despite the variations in detail and methodologies. Studies reported on QA data should provide detail on experimental technique to allow robust data comparison. Countries aiming to implement a mammography/QA program may select/prioritise the tests depending on available technology and resources.

Main messages

• An effective QA program should be practical to implement in a clinical setting.

• QA should address the various stages of the imaging chain: acquisition, processing and display .

• AEC system QC testing is simple to implement and provides information on equipment performance .

Related collections

Most cited references 24

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Additional factors for the estimation of mean glandular breast dose using the UK mammography dosimetry protocol.

Eila Skinner, D Dance, Edmond W K Young … (2000)

The UK and European protocols for mammographic dosimetry use conversion factors that relate incident air kerma to the mean glandular dose (MGD) within the breast. The conversion factors currently used were obtained by computer simulation of a model breast with a composition of 50% adipose and 50% glandular tissues by weight (50% glandularity). Relative conversion factors have been calculated which allow the extension of the protocols to breasts of varying glandularity and for a wider range of mammographic x-ray spectra. The data have also been extended to breasts of a compressed thickness of 11 cm. To facilitate the calculation of MGD in patient surveys, typical breast glandularities are tabulated for women in the age ranges 40-49 and 50-64 years, and for breasts in the thickness range 2-11 cm. In addition, tables of equivalent thickness of polymethyl methacrylate have been provided to allow the simulation for dosimetric purposes of typical breasts of various thicknesses.

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A review of methods of clinical image quality evaluation in mammography.

Yanpeng Li, Ann Poulos, Donald McLean … (2010)

Consistency in evaluation of mammography images in research and clinical practice is dependent on a standardised clinical image quality evaluation system. Currently two such systems are available-one developed by the American College of Radiology (ACR) and the other by the European Commission (EU guidelines). The purpose of this study was to review mammography clinical evaluation methods in research studies and their adherence to these systems. A total of 23 research articles were reviewed from the period 2000-2006, 11 of these studies used digital images. The focus of the review was the criteria and rating scales used. Only 5 studies used either the ACR (3) or EU guidelines (2). The remainder included aspects of these systems together with a range of other criteria and rating scales. Variation was found in the categories of criteria used, number of criteria, the descriptors of the criteria and the instructions used to evaluate the criteria. Instructions were frequently not specific and open to individual interpretation. Although breast density is an important criterion of image quality and contributes to perception of breast lesions, inclusion of this criterion was not universal, and even when used the area of breast density to be evaluated was not identified, thus enhancing inter-observer variability. Scales that were absolute or relative were used for evaluation, all of which incorporated inconsistent numbers of steps. Low adherence to ACR and EU Guidelines has resulted in considerable variation in the evaluation methods used in research studies. The implications of this variability are considerable both for evaluation of image quality in research outcomes and clinical practice. Crown Copyright (c) 2009. Published by Elsevier Ireland Ltd. All rights reserved.

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Estimation of mean glandular dose for breast tomosynthesis: factors for use with the UK, European and IAEA breast dosimetry protocols.

D Dance, Edmond W K Young, Robrecht van der Wel (2011)

A formalism is proposed for the estimation of mean glandular dose for breast tomosynthesis, which is a simple extension of the UK, European and IAEA protocols for dosimetry in conventional projection mammography. The formalism introduces t-factors for the calculation of breast dose from a single projection and T-factors for a complete exposure series. Monte Carlo calculations of t-factors have been made for an imaging geometry with full-field irradiation of the breast for a wide range of x-ray spectra, breast sizes and glandularities. The t-factors show little dependence on breast glandularity and tables are provided as a function of projection angle and breast thickness, which may be used for all x-ray spectra simulated. The T-factors for this geometry depend upon the choice of projection angles and weights per projection, but various example calculations gave values in the range 0.93-1.00. T-factors are also provided for the Sectra tomosynthesis system, which employs a scanned narrow-beam imaging geometry. In this quite different configuration, the factor (denoted T(S)) shows an important dependence on breast thickness, varying between 0.98 and 0.76 for 20 and 110 mm thick breasts, respectively. Additional data are given to extend the current tabulations of g-, c- and s-factors used for dosimetry of conventional 2D mammography.

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Author and article information

Contributors

: +351-91-8690239 , claudia.reis@estesl.ipl.pt , claudia.reis@fe.lisboa.ucp.pt

: apascoal74@gmail.com

: msakellar@gmail.com

: m.koutalonis@gmail.com

Journal

Journal ID (nlm-ta): Insights Imaging

Journal ID (iso-abbrev): Insights Imaging

Title: Insights into Imaging

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Electronic): 1869-4101

Publication date (Electronic): 4 August 2013

Publication date PMC-release: 4 August 2013

Publication date Collection: October 2013

Volume: 4

Issue: 5

Pages: 539-553

Affiliations

[ ]Department of Science and Technologies of Radiation and Biosignals in Health, Lisbon School of Health Technology-ESTeSL, Lisbon, Portugal

[ ]Faculty of Engineering, Catholic University of Portugal, Lisbon, Portugal

[ ]KITEC-King’s Imaging Technology Evaluation Centre for NICE, King’s College Hospital, London, UK

[ ]Medical Physics Department, Colchester Hospital University NHS Foundation Trust, Colchester, UK

Article

Publisher ID: 269

DOI: 10.1007/s13244-013-0269-1

PMC ID: 3781250

PubMed ID: 23912879

SO-VID: 00ce34dc-f0fb-462a-aa52-f24ddab247b2

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

History

Date received : 18 February 2013

Date revision received : 20 June 2013

Date accepted : 24 June 2013

Custom metadata

ScienceOpen disciplines: Radiology & Imaging

Keywords: mammography,quality control,quality assurance,dose,image quality

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ScienceOpen disciplines: Radiology & Imaging

Keywords: mammography, quality control, quality assurance, dose, image quality

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Quality assurance and quality control in mammography: a review of available guidance worldwide

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Abstract

Objectives

Methods

Results

Conclusions

Main messages

Related collections

Radiology Science

Most cited references 24

Additional factors for the estimation of mean glandular breast dose using the UK mammography dosimetry protocol.

A review of methods of clinical image quality evaluation in mammography.

Estimation of mean glandular dose for breast tomosynthesis: factors for use with the UK, European and IAEA breast dosimetry protocols.

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Cited by 11

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