TECHNICAL PROFICIENCY CRITERIA

Principle and Basic Instrumentation of

Mammography
 LEARNING OBJECTIVE
 Discuss the principles and basis of mammography

 Describe the components and accessories of a

dedicated mammographic unit

 Emphasis on special designs and characteristics

 MAMMOGRAPHY
Overview:

Technical aspects of mammography

Rationale of breast imaging

Basis of mammography

Unique features of dedicated mammography unit

– generator
– x-ray tube : anode, cathode, filtration, materials and design
– accessories : grids, compression device, cassettes, screens,
film
– resolution
– quality control
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 MAMMOGRAPHY - technical aspects

Radiographic examination of the breast / mammary

gland

Also called soft tissue radiography

Conventional radiography - subject contrast is great /

high because large differences in mass densities and
in effective atomic numbers (of organs examined)

Soft tissue radiography - subject contrast is low

because tissues (muscle and fat) examined have
almost similar mass densities and atomic numbers

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 MAMMOGRAPHY - technical aspects

Substance Effective Atomic No. Density(kg/m3x103)

Muscle 7.4 1.00

Fat 6.3 0.91
Bone 13.8 1.85
Lung 7.4 0.32

Techniques employed in soft tissue radiography:

- must be able to enhance the differential absorption in
tissues
- the resultant image must be able to distinguish
differences in tissues examined

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MAMMOGRAPHY - technical aspects

To attain high contrast and resolution in x-ray images

But using this technique - increased Photoelectric

absorption, increased mAs, high radiation exposure,
increased radiation dose, increased radiation risk
– low kVp, fine grain emulsion film, direct –
exposure

More significantly, radiation exposure to breast can

induce breast cancer as well as detect it

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MAMMOGRAPHY- rationale of examination
Breast cancer:
– leading cause of death in female aged 15 to 54
– 1 out of 8 women will develop breast cancer over a lifetime
– population size at risk for developing breast cancer is
growing every year

Mortality from breast cancer can be reduced

significantly through participation in breast screening
– Most physicians believe that early detection of breast cancer
should result in more effective treatment and fewer deaths

Mammography has proved to be an accurate breast

cancer detection method

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MAMMOGRAPHY - basis of examination
Normal breast consists of 3 principle types of tissues:
– fibrous (muscle),
– glandular (ducts/gland) and
– adipose (fat)
Glandular tissue is most sensitive to induction of cancer
by radiation
Presence of malignancy is seen as distortion of the
normal ductal and connective tissue patterns, and have
associated deposits of microcalcifications
Microcalcifications of less than approximately 0.05mm
are of interest for detection of breast cancer
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MAMMOGRAPHY- basis of examination

Mass density and effective atomic number for soft

tissue components of the breast are so similar,
conventional radiographic technique is useless
– in the 70 to 100 kVp range Compton scattering
predominates with soft tissue, thus differential
absorption among tissues of similar composition is
minimum

Low kvp must be employed to maximise the

photoelectric effect and therefore enhance differential
absorption

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MAMMOGRAPHY- basis of examination

Therefore, mammography requires a low-kVp technique

As kVp is reduced, however, penetrability is reduced,
which in turn requires increase in mAs
If kVp is too low, an extremely high mAs may be
required
This is unacceptable because of increased patient dose
Acceptable radiographic results can rarely be obtained
with conventional x-ray apparatus
Therefore specially designed, dedicated x-ray machines
should be used for mammography

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 DEDICATED
MAMMOGRAPHY UNIT
1 - Control Panel
2 - Foot Control for
Compression Release
3 - Foot Controls for
Automated Compression
4 - AEC Chamber Position
Control
5 - Bucky (Moving grid)
6 - Compression Plate
7 – Collimation Device
8 - Tube housing
9 - Column controls
10 - Column handle
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DEDICATED MAMMOGRAPHY UNIT
The important features are:
- Molybdenum target and filter
material
- Beryilium window
- to optimise contrast
- standard focal spot size ~ 0.3mm
- to optimise the resolution of normal
contact mammography
- small focal spot size ~ 0.1mm
- to optimise the resolution of
magnification mammography

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 DEDICATED MAMMOGRAPHY UNIT
Designed :
– for flexibility in patient positioning with a compression device
– with low-ratio grid technique
– with automatic exposure control
– with microfocus x-ray tubes for magnification radiography
– with high-frequency generators

Must be able to :
– improve contrast
– minimise image unsharpness and increase resolution
– reduce radiation dose

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Specification Mammography Conventional Specification Mammography Conventional

Generator 1Ф high freq. 1 Ф, 3 Ф, Ref.target angle 7.5 - 12 0 7 - 17 0

Capacitor
Anode Mo or Rh Wo
discharge,
falling load Tube port Beryllium Glass
Voltage >10,000 Hz 60 Hz Filter Mo or Rh Al
frequency
HVL (mm Al) 0.3 (30 kVp) 2.3 (80kVp)
Voltage ripple <4 % 4-100%
Grid 4:1 or 5:1 6:1 – 16:1
kVp 25-28 50-130
Screen-film 100 – 320 100 - 1200
mA 20-160 100-1000
speeds
Exp. time (s) 0.4-4.0 0.01-2.0
Resolution 12 – 20 5 - 10
Power rating 3-10kW 50-200kW (lp/mm)
AEC 1 detector 3 detector
Film density (OD) >1.30 1.10

Backup timer 600 grid,300 600 grid

(mAs) non-grid.
Focal spot (mm) 0.1 or 0.3 0.6 or 1.2
SID (cm) 60 – 65 102 -122
X-ray Beam Anode side only Anode &
utilised cathode side
Eff.target angle 22 – 24 0 7 - 17 0 14
 DEDICATED MAMMOGRAPHY UNIT

Knowing your equipment well:

- excellent high contrast

- high resolution images result

- dedicated mammography unit

- dedicated processor

- film-screen combination

- correct viewing condition

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DEDICATED MAMMOGRAPHY UNIT
Discuss:
– Generator characteristics: kVp, exposure time,
mA, mAs
– Automatic Exposure Control
– X-Ray Tube :
Design
Heel-Effect
Cathode
Anode Configuration
Anode Material
Filtration
Magnification
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DEDICATED MAMMOGRAPHY UNIT

Discuss:
– Accessories
Grids
Compression Device
Cassettes
Screens
Film
Screen/film Combination
– Resolution
– Quality Control

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 Generator Characteristics
High-frequency Generator:

– eliminate voltage regulation problem

ripple is low (<4%)

– allows more efficient x-ray production

produces higher effective energy beam
higher x-ray output for a given kVp and mA setting
allows very precise control of kVp, mA and exposure
times
– do not require autotransformer, line compensation circuit or
space-charge compensation circuit:
reduce bulk, cost, space

– operates on single-phase :
easy installation and reduces cost
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 Generator Characteristics

kVp:
– selections range from 22 - 40 kVp in 1 kVp incremental

– clinical range 25 to 28 kVp

– advantage of low kVp:

produces high radiographic contrast

– disadvantage of low kVp:

a high absorption of low-energy x-rays in the breast,
which contributes significantly to patient dose

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 Generator Characteristics
Exposure time, mA, mAs:

– utilise low mA settings (typically 20 to 100 mA):

power rating limitations of small sized anode and small
focal spot sizes

– exposure times of 0.4 to 4 seconds

exposure times short to decrease patient motion but
should not be extremely short - could cause grid
artefacts
exposure times exceeding 1 second used in
magnification technique will result in reciprocity law
failure, therefore, compensation technique are
required to maintain optimal density : AEC 20
 Generator Characteristics
Automatic Exposure Control (AEC) ???

– to provide consistent film density for various

thickness and density compositions of breast tissues
and the range of kVp used

– small variations in film density will affect the contrast

required to visualise the subtle breast tissue and to
diagnose cancer , i.e minimal exposure latitude

– AEC is crucial because of the wide range of breast

thickness and density compositions, i.e impossible
for radiographer to determine exact density
composition of breast tissue,therefore, the exact
exposure time required

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 Generator Characteristics
Automatic Exposure Control (AEC):

– single radiation-sensitive detector 2

1
located behind the cassette 3

– detector capable of moving toward

nipple, from primary position at
chest wall
1- the chamber
2- distance from chest wall
– calibrated for 2 different
3- selection device to position
screen/film system, non-grid,
grid and magnification options
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 X-Ray Tube

Design:

– design and components must be capable of

achieving high resolution and high contrast at
moderate radiation exposure levels

– engineered to provide visualisation of

microcalcifications and the subtle parenchymal
structures of the breast

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 X-Ray Tube
Heel Effect:

– Cathode side of x-ray beam has

a significantly greater intensity
of x-rays compared to the anode
side

– X-ray tube is aligned with

cathode placed directly over
chest wall area and anode
outward towards the nipple end

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Carlton, Adler p575
 X-Ray Tube

Heel Effect (cont’d):

– used to max. advantage :

a more uniform-density
breast image can be
produced because the more
intense x-rays are at chest
wall where there is greater
tissue thickness

– prominent due to short SID and

narrow target angle

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 X-Ray Tube

Cathode:

– Standard helical-shaped tungsten filaments in a focusing

cup

– typically, a single filament wire for both large and small

focal spot utilising bias focusing

– 0.3 mm large focal spot

– 0.1 mm small focal spot for magnification images

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Carlton, Adler p575-577, fig 40-10, 40-11
 X-Ray Tube
Cathode:

– 2 dilemmas of effective focal spot size variations over

breast images : geometric properties of focal spot

– reduce resolution over chest wall where many lesions

are found – this is unacceptable

– Solutions:
off-center placement of glass x-ray tube within
housing to eliminate entire cathode side of x-ray beam
anode and vertical ray directly over chest wall

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Carlton, Adler p575-577, fig 40-10, 40-11
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 X-Ray Tube
Cathode:
– angled central ray is termed reference axis
– physical size of focal spot (0.1mm & 0.3mm) is measured at reference
axis
– therefore effective focal spot size will be at least 2 x larger

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Carlton, Adler p575-577, fig 40-10, 40-11
 X-Ray Tube
Anode Configuration:
– Rotating anode
– Effective target angle 22 to 24 degrees (greater)
– necessary to cover 24 x 30 cm cassette at 60 - 65 SID
– However reference axis target angle is smaller varying from 7.5 to
12 degrees

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Carlton, Adler p578-79, fig 40-12/13
 X-Ray Tube
Anode Configuration:
– To utilise narrower effective target angle for greater anode heat
capacity, x-ray rube must be tilted or anode stem in vertical position
(x-ray tube steeply tilted)

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Carlton, Adler p578-79, fig 40-12/13
 X-Ray Tube
Anode Material:

– made of molybdenum: high melting point , conducts heat

well
– solid or with graphite backing
– doped with 3% vanadium : to prevent anode surface
roughness or pitting

Manufacturers design:

– Biangular anode : two tracks for each focal spot, one for
Mo, one for Rh
– Dual track anode : Mo and Wo (with rhodium filter)
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Carlton, Adler p579-80, fig 40-14/15
 X-Ray Tube
Anode Material:
 Molybdenum:
Advantages:

Increased number of low-energy photons are produced

– At 26 kVp : prominent characteristic photons at 17 and
20 keV in the preferred energy range(17 to 20keV) for
mammography

High radiographic contrast is achieved in the image

– large number of low-energy x-ray photons (17keV) is
photoelectrically absorb which is needed to produced
high contrast that will improve visibility of the details

Production of specific x-ray energies required for breast

imaging
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Carlton, Adler p579-80, fig 40-14/15
 X-Ray Tube
Anode Material:

 Molybdenum:
 Disadvantages:

Increased dose to the patient

– large number of photoelectric absorption
interactions occur

Increased mAs required to maintain film density

Less x-ray photon output due to lower atomic

number - 42

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Carlton, Adler p579-80, fig 40-14/15
 X-Ray Tube
Anode Material

 Rhodium:
– Atomic number 45 (Mo = 42 ) creates slightly higher energy x-ray
photons

 Advantages:
energies of characteristic x-rays 2-3 keV higher(20 and
23keV) than Mo
provides better penetration for very dense breasts
reduction in exposure time of approx. 25%
with appropriate filter ,decrease exposure by 50%

 Disadvantage:
Not appropriate for small or less dense breasts
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Carlton, Adler p579-80, fig 40-14/15
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 X-Ray Tube
Filtration:

Port of x-ray tube is made of Beryllium (Z=4) to allow the

low-energy x-rays to exit

Glass cannot be used because it attenuates most low-

energy x-rays needed to produce breast images

Filtration used at tube port to attenuate the very low-energy

x-rays not needed in mammography

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Carlton, Adler p581
 X-Ray Tube
Filtration:

Without filtration:
– 5-10 keV will exit the tube, would be absorbed by breast,
drastically increase dose
– 20-30 keV will also exit tube, would degrade image quality by
reducing contrast

Specific function of filter in mammography is to decrease

most of the low-energy and some of the high-energy x-rays

To accomplish this, filters are made of the same element as

the anode material
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 X-Ray Tube
Filtration:

0.03mm Mo, 0.025mm Rh

HVL (half-value-layer) indirect measurement of total

filtration in x-ray beam path; include attenuation
properties of beryllium window, Mo filter, mirror, and
plastic compression

Should not exceed 0.40mm Al at 30kVp and should not

be less than 0.25mm Al at 25kVp

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 X-Ray Tube
Magnification:

Requested:
- visibility of detail in very small
breast structures
- microcalcifications need to be
enhanced
- when breast structures lie close
together and overlap – need to
separate them

Magnification factors: 1.5X to 1.8X

(as high as 2.0X)

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Carlton, Adler p582
X-Ray Tube

Magnification:

Provides:
– Increased resolution due to the small focal spot used (0.1mm) and
reduced quantum mottle ( more x-rays per unit volume to produce
image)
– Reduction in scatter radiation reaching the film due to air gap
between cassette and breast
– Improved visibility of detail due to the larger field of view

Should not be used routinely because:

– Normal mammogram are adequate
– Entire breast may not be completely imaged
– Patient dose may be doubled
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 Accessories
Grids:

Mammography grids are linear type with low ratio of 4:1 or

5:1

Grid frequency will range from 30 – 50 lines/cm

Grid strips made of lead, wood or carbon fibre used as

inner space materials instead of aluminium

Grids are moving type – moving in one direction only and

do not reciprocate

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Carlton, Adler p583
 Accessories
Grids:

Scatter increases significantly for larger and more dense

breasts and with higher kVp settings

Use of grid reduces scatter and maintained high contrast in

images

But use of grid will increase radiation exposure to patient by

factor of 2-3X

Grids are capable of producing artefacts

Can also contain inherent artefacts

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 Accessories
Compression device:

Made of plastic that allows transmission

of low-energy x-rays

Should have a straight chest wall edge - allow compression

to grasp the breast tissues close to chest wall edge

Compression controlled by radiographer

Capable of applying 25-45 lbs. of force

Have smaller ‘spot’ device used to compress localised

areas
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Carlton, Adler p584
 Accessories
Compression device:

Vigorous compression should always be

employed in mammography

Appropriately applied compression is one

of the critical components in production
of high quality mammogram

Overall function of compression:

- to decrease the thickness of the breast
- bring the breast structures as close to
the film as possible
Carlton, Adler p583
- increase radiographic contrast 46
 Accessories
Compression device:

 Advantages:

– Reduced magnification lessens

geometric unsharpness and increases resolution

– Reduced tissue thickness requires less kVp prompting a

reduction in scattered radiation and an increase in
radiographic contrast

– Reduced radiation exposure because less exposure time

is required due to the decrease tissue thickness
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Carlton, Adler p583-84,fig 40-18/19
Accessories
Compression device:

 Advantages:

– Reduced motion unsharpness occurs because

the breast is completely immmobilised

– Improved visualisation of breast structures

because the structures are spread out over a
larger area and also less superimposition of
overlying structures

– More uniform film density occurs due to the

flattening effect of compression permitting
optimal exposure of the entire breast
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Accessories
Cassettes:

Designed specifically to image

the breast

Contain single emulsion

screen used with single
emulsion film

Made of plastic or low-

attenuation carbon-fiber

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Carlton, Adler p585,fig40-20
 Accessories
Cassettes:

Screen mounted on foam

pressure pad and placed
behind film for greater
resolution and less image
noise

X-rays exit breast enter top of

cassette, go through film
before reaching screen
phosphor

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Carlton, Adler p585,fig40-20
 Accessories
Screens:

Green emitting gadolinium oxysulphide screen phosphor

material

Slower than conventional radiography

Slow screen offers reduced noise and increased resolution

Using screen in mammography instead of direct exposure:

– Major reduction in radiation exposure to patient
– Dramatic increase in radiographic contrast

Disadvantage is:
– decrease in resolution and increased image noise
51
Carlton, Adler p585,fig40-20
 Accessories
Image receptors:

Direct exposure film : high pt.dose, no longer employed

Screen film

Xerox : no longer used

52
Carlton, Adler p585,fig40-20
 Accessories
Screen films:

Designed to be very high in contrast and resolution

Highest in diagnostic radiology

Single emulsion, slow speed (low image noise, high

resolution)

Green sensitive to match green emitting screen

Antihalation coating on non-emulsion side

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 Accessories
Screen/film (SF) combination:

Relative speed of mammography SF combination should not be

associated directly with conventional SF system

100-speed mammo system will typically be 50 to 75% slower than 100-

speed conventional system

Typical range: 100 to 320 speed

Dual screen, dual emulsion by Kodak

Advantage: speed doubled, shorter exposure time, reduce dose

Disadvantage: increased noise, decreasing resolution

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Carlton, Adler p585,fig40-20
 Limitations of screen-film
The nature of breast parenchyma: very dense tissue (fatty)
may obscure masses.

Positioning: must include as much tissue as possible, x-ray

beam pass through breast tangentially to the thorax, no
obscure any breast part, ? Mass located in breast portion
that is difficult to include.

The nature of breast carcinoma: some Ca seen as well-

defined, rounded mass, or tiny bright calcifications.
? Poorly defined, irregular, no radiographic signs.

Limitations in Ca detection cannot be overemphasized

Additional imaging, short-term close clinical follow-up, or

biopsy.
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 Resolution

Conventional radiography :
- 2 lp/mm (fluoroscopy)
- 5 lp/mm (300-speed s/f sys.)
- 10 lp/mm (100-speed extremity sys.)

Mammography :
- must provide a minimum of 11 to 13 lp/mm (available now
as high as 22 lp/mm)

Magnifying glass often required to view small structures and

to actually see the high resolution in mammography

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Carlton, Adler p585,fig40-20
 Quality Control

Mammography has own QA and QC manual, tests and

compliance/acceptance limits according to regulatory
bodies

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Carlton, Adler p585,fig40-20
 Other imaging modalities
Ultrasonography:

- indications: detected mass, palpable mass, guidance

for intervention.

- Limitation: very operator dependent, image of small part

at one moment, not overall survey – lesions missed.

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 Other imaging modalities

Ultrasonography:

- Appearance:

Normal: skin, premammary, retromammary, fasciae,

trabeculae, walls of ducts and vessels, pectoral fasciae –
well seen as linear structures. Glandular and fat lobules
are oval, varying sizes, hypoechoic relative to
surrounding connective tissue.

Abnormal: simple cyst – anechoic, thin smooth walls,

most solid mass – hypoechoic.

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 Other imaging modalities

MRI

Ductography

Image-Guided Needle Aspiration and Biopsy

Image-Guided Needle Localization

Biopsy Specimen Radiography

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THANK YOU FOR YOUR KIND
ATTENTION!!

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