1

Digita l Mammogra phy Update:Design and Characterist ics of

Current Syst ems

Doug Pfeiffer, MS, DABR

Boulder Community Hospital

Outli ne

� Digital imaging in MAP

� Detector technologies� Manufacturers and their wares

Self -Assessment Module (SAM)

� To assist your efforts toward ABR MOC� Quiz at the end of the talk� SAM

– CAMPEP (Cat 1) activity

– 20 / 10 years (1/year)

– Instructional content

– 5 mult. choice questions– feedback

– no passing requirement

A real SAM!

Thanks to…

� Tony Seibert, PhD

� Eric Berns, PhD� Penny Butler, MS

� John Sandrik, PhD (GE)� Magnus Olofsson (Sectra)

2

FFDM and the ACR

� MAP statistics show a growing adoption ofdigital mammography

US Mammography Facilitiesand Units

7000

8000

9000

10000

11000

12000

13000

14000

2000 2001 2002 2003 2004 2005 2006 2007Year

#

# Facilities # Units

As of July 1, 2007

� 2926 FFDM units– 22% of all mammography units

� 1991 facilities had FFDM units– 23% of all US facilities

� FFDM growing about 6% / month

Uni ts

Facilitie s

Full Field Digital Mammograp hy inthe US

3

0

2000

4000

6000

8000

10000

12000

14000

Oct-03

Jan-04

Apr-04

Jul-04

Oct-04

Jan-05

Apr-05

Jul-05

Oct-05

Jan-06

Apr-06

Jul-06

Oct-06

Jan-07

Apr-07

Jul-07

#U

nits

Screen-Film Units FFDM Units

Screen-Film vs. FFDM Trends in theUS

FFDM Manufacturers and ModelsUndergoing ACR Accreditati on

(1308 units compl eting accr editatio n2/15/03 – 7/12/06)

82, 6%

412, 30%

80, 6%

222, 16%

564, 42%

GE SENOGRAPHE 2000 D

GE SENOGRAPHE DS

FISCHER SENOSCAN

LORAD SELENIA

SIEMENS MAMMOMATNOVATION DR

7.3%92.7%1711FFDM

11.3%88.7%14,574Screen -Film

Deficien tPass

Overall#

Units*

*1st attemp t for bot h initials and ren ewals ; 2/15/03 – 7/12/06

Screen-Film and FFDMAccre ditati on Results

1st Attempt Scree n-FilmDeficiencies(2/15/03 - 7/12/06)

27.7%

72.3%

Phantom Clin ica l

1st Attempt FFDMDeficienc ies(2/15/03 - 7/12/06)

26.0%

74.0%

Phantom Clinica l

Reasons Faci lit ies Do Not PassAccreditat ion

4

Screen-Film ClinicalDefic iencies

56.9%

43.1%

Dense Fatty

FFDM ClinicalDeficiencies

52.4%

47.6%

Dense Fatty

Clini cal Images:Fatty vs. Dense Deficienc ies

128.64.003.854.841711FFDM

(31.4)(0.41)(0.4)(0.48)(SD)

(0.33)

3.60

Specks

(0.54)

4.70

FibersAverage Scores

(0.39)

3.74

Masses

14,574

# UnitsAve Dose*

(mrads)

(38.6)(SD)

168.7Screen -Film

*as measured by TLD

Phantom Images and Dose

Detailed InformationSource Digital Detect or Technologies

� Indirect– Cesium iodide with CCD– Cesium iodide with TFT

� Direct– Amorphous selenium with TFT

� Computed Radiography (CR)� Photon Counting

– Crystalline silicon

1966?

5

Indirect – CsI with CCD

� [Fischer SenoScan]

� (Philips MammoDiagnost FD Eleva = Fischer?)

[ ] = no longer available, ( ) = not FDA approved

Theory: CsI with CCD (slot scan)

Fiber Optic Coupling ofFiber Optic Coupling of CsICsI ScintillatorScintillator totoRectangular CCD ArraysRectangular CCD Arrays

CsICsI ScintillatorScintillator

11--toto--1 Fiber1 FiberOptic CouplerOptic Coupler

CCD ArrayCCD Array

XX--raysrays

Implementati on: CsI with CCD (slotscan)

Cesium IodideCesium IodideScintil latorScintil lator

Fiber OpticFiber OpticPlatePlate

4 CCD4 CCDArraysArrays

1 cmwide slot

Fischer SenoScan Sys tem

6

Fischer SenoScan Details

12 bitsDynamicRange

1 mm-1 – 24%

3 mm -1 – 22%

5 mm -1 – 19%

DQE (Mo/Mo, 28kVp, 8.5 mR=85µGy)

4096 x 5625pixels (34.6 MB)

Image size

54 µm (N)27 µm (HR)

Pixel size

21 x 29 cm (N)10.5 x 14.5(HR)

Detector size(scanner area)

Fischer SenoScan Details

Digitalmagnificationonly

Magnification

<8.5 mmChest wallmissing tissue

NoneGrid

W targetAl filter

X-Ray Tube

Fischer SenoScan Details

10 mm-1fNy

0.13M(fNy)

Automatic,prescan

AutomaticExposureControl

Acquisitiondelay

12-15 secondsDisplay time

Fischer SenoScan Sys tem

7

Indirect – Csi with TFT

� GE Senographe Essential

� GE Senographe DS� [GE Senographe 2000D]

1980

Theory: CsI with TFT

X-ray photons

Cesium Iodi de (CsI)

Digital Data

Light Photons

Amorphous Sil iconPhotodiode/Transi stor Matrix

Electrons

Readout Electroni cs

Theory : CsI wit h TFT

Columns ofColumns of

scintillatorsci ntillator

XX--raysrays

Subst rateSubstr ate

Amorp housAmor phoussiliconsili condetect orsdetectors

cesium iod idecesium iodide

CsI-Needles, 5 - 10µm

Pixel Size (i.e. 100 µm)

Amorphous Silicon Detector

X-ray Photon

5 µµµµm

200-300 µm thick90% absorption

8

Implementati on: Silic on DiodeArray Detector

Scint illat orScintillat or ((CsICsI))

Contact LeadsContact LeadsFor ReadFor Read--OutOutElectronic sElectroni cs

Amor phousAmorph ousSilico n ArraySilicon Array

100 micronpixel size

Conta ct FingersContac t Fing erson 3 Edgeson 3 Edges

Glass Substr ateGlass Substrate

GE Senogra phe Details

100 µm 100 µm

19.2 x 23.0

14 bits14 bitsDynamicRange

0 mm-1 – 60%2 mm -1 – 52%

5 mm -1 – 18%

0 mm-1 – 50%2 mm -1 – 41%

5 mm -1 – 15%

1 mm-1 – 52%3 mm -1 – 49%

5 mm -1 – 30%

DQE (Mo/Mo, 28kVp, 8.5 mR=85µGy) (GE doc.)

2394 x 3062pixels (14 MB)

1914 x 2294pixels (9 MB)

1914 x 2294pixels (9 MB)

Image size

100 µmPixel size

24.0 x 30.719.2 x 23.0Detector size

EssentialDS2000D

GE Senogr aphe Details

1.5X, 1.8X1.5X, 1.8X1.5X, 1.8XMagnification

<5 mm<4 mm<4 mmChest wallmissing tissue

5:1, 36 lp/cm5:1, 31 lp/cm5:1Grid

Mo/Rh target

Mo/Rh filter

Mo/Rh target

Mo/Rh filter

Mo/Rh target

Mo/Rh filter

X-Ray Tube

EssentialDS2000D

GE Senogra phe Details

5 mm-15 mm-15 mm-1fNy

(0.37)(0.37)0.37M(fNy)

AOP (CNT,STD, DOSE),auto dense loc.

AOP (CNT,STD, DOSE),auto dense loc.

AOP (CNT,STD, DOSE),auto dense loc.

AutomaticExposureControl

<25 seconds<18 secondsAcquisitiondelay

16 sec raw

21 secprocessed

<10 sec raw,<15 secprocessed

10 secondsDisplay time

EssentialDS2000D

9

GE Senogr aphe Systems

(2000D nolongeravailable)DS

Essential

Amo rphous Selenium with TFT

� Hologic Selenia

� Siemens Mammomat NovationDR

� (Agfa DM 1000 – NovationDR)

� (IMS Giotto Image MD/SD-SDL)� (Planmed Sophie Nuance)

Theory : Amor phous Selenium wit hTFT Implementation: aSe Detect or

10

Implementati on: aSe Detecto r aSe Unit Detai ls

13 bits

1 mm-1 – 63%

3 mm -1 – 52%

5 mm -1 – 31%

2816 x 3584pixels (16 MB)

85 µm

24.0 x 30.0

Giotto Image

70 µm 85 µm

24.0 x 29.0

16 bits14 bits14 bitsDynamicRange

1 mm-1 – 56% (40%)

3 mm-1 – 44% (30%)

5 mm-1 – 30% (20%)

DQE(Mo/Mo, 28kVp, 8.5mR)

2816 x 3584pixels (20 MB)

3328 x 4096pixels (24 MB)

3328 x 4096pixels (24 MB)

Imagesize

70 µmPixel size

24.0 x 30.0(?)

24.0 x 29.0Detectorsize

PlanmedNuance

SiemensNovation

HologicSelenia

aSe Unit Detai ls

1.8X

Cellular

Mo target

Mo/Rh filter

HologicSelenia

1.5X, 1.8X

≤5 mm

5:1, 31 lp/cm

Mo/W target

Mo/Rh/Al filter

SiemensNovation

1.8X

5:1, 36 lp/cm

Mo target

Mo/Rh filter

Giotto Image

1.6X, 1.8X,2.0X

5:1, 34 lp/cm

Mo target

Mo/Rh filter

PlanmedNuance

Magnifica-tion

Chest wallmissingtissue

Grid

X-RayTube

aSe Unit Detai ls

5.88 mm-17.14 mm-17.14 mm-1fNy

0.460.44M(fNy)

Manual cellselection,auto breastdensitydetection

15-20seconds

HologicSelenia

Manual cellselection, autobreast densitydetection

40-50seconds

SiemensNovation

Manual cellselection

4 seconds

Giotto Image

Auto cellselection, autokVp selection

5-10seconds

PlanmedNuance

AutomaticExposureControl

Acquisitiondelay

Displaytime

11

aSe Units

Giotto ImageSiemens Novation

Planmed Nuance

Casset te-based (CR) Systems

� Fuji ClearView

� (Philips PCR Eleva CosimaX)� (Kodak DirectView CR)

� (Agfa CR MM3.0 Mammo)

1960

Theory : Compute d Radiography

PSPPSP

Base supportBase support

plate exposure:plate exposure:create latent imagecreate latent imag e

xx--ray exposureray expo sure

Theory: Computed Radiography

plate erasure:plate erasure:remove residual signalremove residual signal

light erasurelight erasure

plate readout:plate readout:extract latent imageextract latent image

laser beam scanlaser beam scan

12

Theory : Compute d Radiography

8 eV8 eV

LaserLaserstimulationstimulation

2 eV2 eV

Incident xIncident x--raysrays

F center trapF center trapPSLPSL

3 eV3 eV

� Standard resolution: ~100 µm BaFBr� High resolution: ~50-70 µm BaFBr� Dual-side read; structured phosphor, CsBr

Implemetati on: ComputedRadiogra phy

PMT

Beam deflec tor

LaserSourc e

Light channeling guide

Plate translation:Sub-scan direction

Laser beam:Scan direction

Output Signal

Reference detecto r

B eam splitt er

Cyl indrica l m irr orf-thetal ens

A mplifier

ADC

To imageprocess or

Implemetat ion : Compute dRadiography

Incident Laser BeamIncident Laser Beam

Lig ht guide assemb lyLig ht guide assembl yand PMTand PMT

Protective LayerProte ctive Layer

Phosp hor LayerPhosp hor Layer

Base Supp ortBase Support

LightScattering

Laser Light Spread

Photos timula tedLuminesce nce

"Effective" readout diameter

Implemetati on : Double -SidedReadout

laser beam

mirror

Protect ivelayer

phot odetector

photodetector

opti calgui de

Transparentsupport

Phos phorlayer

emission

opti calgui de

13

CR System Details

10 mm-110 mm-110 mm-110 mm-1fNy

0.37M(fNy)

2816 x 3584pixels (MB)

50 µm

18 x 24

24 x 30

KodakDirectView

50-200 µm 50 µm

18 x 24

24 x 30

12 bits14 bitsDynamicRange

DQE

4760 x 5840pixels (42 MB)

4728 x 5928pixels (xx MB)

3328 x 4096pixels (24 MB)

Imagesize

50 µmPixel size

18 x 24

24 x 30

18 x 24

24 x 30

Detectorsize

Agfa CRMM3.0

Philips PCREleva

Fuji FCRm

Phot on Counti ng

� Sectra MicroDose

1953

Photon Count ing Theory Phot on Counti ng Theory

14

Photon Count ing Theory Phot on Counti ng Theory

� Quoted 90% detection efficiency (edge-on detectors)� Quoted 94% scatter rejection� 2 MHz/pixel maximum count rate� 3.6 eV to create electron-hole pair

– both Compton and PE contribute– ~103 hp per photon

� Custom-designed ASIC (Application Specific Integrated Circuit)contains pre-amplifier, shaper, comparator, digital counter

– 100 nS pulse– 2 MHz count rate– ~200 electron rms noise– no Swank noise

� Operates close to quantum limit

Sectra Micr oDose Details

12 bitsDynamicRange

1 mm-1 – 60%

3 mm -1 – 40%5 mm -1 – 18%

DQE (Mo/Mo, 28kVp, 8.5 mR=85µGy)

4800 x 5200pixels (37 MB)

Image size

50 µmPixel size

24 x 26 cmDetector size(scanned area)

Monnin, et al

Sectra MicroDose Details

Digitalmagnificationonly

Magnification

<5 mmChest wallmissing tissue

NoneGrid

W targetAl filter

X-Ray Tube

15

Sectra Micr oDose Details

Automatic,prescan

AutomaticExposureControl

Acquisitiondelay

<20 secondsDisplay time

Sectra MicroDose System

MTF Comparison DQE Comparison

Monnin, et al

16

DQE Comparison

Lazzari, et. al.

131 µGy

Dose Comparison (AGD)

[0.5 mGy]SectraMicroDose

1.8 mGy(2.1 mGy)

HologicSelenia

1.3 mGy(1.5 mGy)

FischerSenoScan

1.9 mGyFuji

1.5 mGyGE 2000D

(1.0 mGy)GE DSDosesfrom:

Bloomquistet al

or

(measuredclinically)

or

[manufacturer]

Future Developme nts

� Tomosynthesis (Lorad, GE, Planmed)

� Dual energy� Contrast enhancement

� CAD integration� ??

SAM questi ons

� Follow on the next slides

� Use response system

17

Of the foll ow ing sys tems, whichinco rporate CsI in the detector?

6%

3%

89%

0%

3% 1. Lorad Selenia2. Sectra Microdose3. GE Essential4. Siemens Mammomat Novation5. Fuji FCRm

Of the followi ng systems, whichincorporat e CsI in the detector?

1. Lorad Selenia2. Sectra Microdose3. GE Essential4. Siemens Mammomat Novation5. Fuji FCRm

Of the foll ow ing sys tems, whichinco rporate CsI in the detector?

1. Lorad Selenia – amorphous selenium2. Sectra Microdose – crystalline silicon3. GE Essential - CsI4. Siemens Mammomat Novation – a-Se5. Fuji FCRm – CsBr

Which of the follow ing systemsdoes not uti lize a grid?

7%

0%

2%

82%

9% 1. Lorad Selenia2. Sectra Microdose3. GE DS4. Siemens Mammomat Novation5. Fuji FCRm

18

Which of the follo wing systemsdoes not util ize a gr id?

1. Lorad Selenia2. Sectra Microdose3. GE DS4. Siemens Mammomat Novation5. Fuji FCRm

Which of the follow ing systemsdoes not uti lize a grid?

� Explanation– The Sectra MicroDose uses a pre- and

post- collimated slot scan system, inherentlyreducing the S/P to a level obviating use ofa grid.

Which of the follo wing yields theoveral l lowest DQE?

20%

68%

0%

9%

2% 1. Lorad Selenia2. Sectra Microdose3. GE Essential4. Fischer Senoscan5. Fuji FCRm

Which of the follow ing yields theoverall lowest DQE?

1. Lorad Selenia2. Sectra Microdose3. GE Essential4. Fischer Senoscan5. Fuji FCRm

19

Which of the follo wing yields theoveral l lowest DQE?

1. Lorad Selenia2. Sectra Microdose3. GE Essential4. Fischer Senoscan

5. Fuji FCRm

References

� Blo omquist , A et al, Quality con trol for di gital mammograp hyin the ACRIN DMIS trial: Part I, Med. Phys. 33 (3), March 206,p. 719-36.

� Lawinsk i C, et al, Comparative Specifi cations of Full FieldDig ital Mammogra phy Systems , Medicine and HealthcareProduct s Regul atory Ag ency, Repor t 05037, CrownPublish ing, July 2005

� Lazzari , B et al, Physica l charac ter isti cs of five clinicalsys tems for dig ital mammograph y, Med. Phys. 34 (7), July2007, p. 2730-2743.

� Monnin , P et al, A compari son of the perform ance of digita lmammography systems , Med. Phys. 34 (3), March 2007, p.906-914.

� Manuf acturer -specific docu ments: Operator ’s Manuals , QCManuals, whit e papers, marke ting bl urbs

� RadioG raphi cs, Vol 10, 1111-1131, 1990