Slide 1
Slide 2
Introduction
Digital Mammography
QA:
Comparing the
Manufacturers
Recommendations
What is QC and why is it important?
Review & compare QC tests
Key take home points
Eric A. Berns, Ph.D.
Northwestern University Medical School
Lynn Sage Comprehensive Breast Center
Chicago, IL
Slide 3
Slide 4
Introduction
ScreenScreen-Film
MQSA
– Mammography Quality Standards Act
ACR
– American College of Radiology
Slide 5
Slide 6
ScreenScreen-Film
Slide 7
ScreenScreen-Film
Slide 8
ScreenScreen-Film
ScreenScreen-Film
Slide 9
Slide 10
ScreenScreen-Film
FFDM
In FFDM, the manufacturer designs and mandates their
own QC program
In FFDM, you must the manufacturers’
manufacturers’ QC program
Slide 11
Slide 12
Quality Control: Why?
Reduce exposure to patients and personnel
Consistent image quality
RWS
Detect and correct for potential problems,
before they impact image quality
Slide 13
Slide 14
Before You Begin QC
What is Quality Control?
Determination of what is “Normal”
Normal”
Golden Rules for Medical Physicist & Tech QC
Detection of what is “Abnormal”
Abnormal”
– Must use manufacturer’
manufacturer’s QC procedures
Understanding of how to return to “Normal”
Normal” from “Abnormal”
Abnormal”
– Manufacturers’
Manufacturers’ QC may refer to Monitor Manufacturers’
Manufacturers’ QC
In particular, in FFDM, how do you know what you are
– Multimodality Workstations have own separate QC
seeing is what it is supposed to be?
Slide 15
– Printers may have their own QC
Slide 16
Before You Begin
ACR Accreditation - www.acr.org
– Physics forms
• http://acr.org/accreditation/mammography/mammo_qc_forms.aspx
• GE Senographe 2000D, DS, and Essential
–
–
–
–
Fischer Senoscan
Lorad Selenia
Siemens Novation
Fuji FCRm
• Note:
Note: if using unit for both screenscreen-film & CR, you must accredit for
both
FDA Accreditation
– www.fda.gov/cdrh/mammography/
– Other vendors when approved
Before You Begin
Slide 17
Slide 18
Before You Begin
Slide 19
Before You Begin
Slide 20
Before You Begin
Before You Begin
Slide 21
Slide 22
Before You Begin
Note:
– For new unit:
unit: Must use most current
version
Vs.
– For renewal unit:
unit: Can use older
version (version used when tested
previously)
Slide 23
Slide 24
Mammo Unit Evaluation
ScreenScreen-Film Mammo
– Ensure locks, detents, angulation indicators, and
mechanical support devices operate properly
Collimation
ScreenScreen-Film Mammo
– Assure XX-ray field aligns with the light field
– Collimator allows full coverage of receptor
– Chest wall edge of compression paddle aligns with chest wall of
receptor
FFDM
– Same
FFDM
– Same
– Multiple targe/filters and/or multiple paddle positions
– Chest Wall Missed Tissue
– Compression Plate Overlap on the Chest Wall Side
Slide 25
Slide 26
Collimation
Fuji FCRm
Fuji FCRm
GE
2000D,
DS,
Essential
Fischer
Senoscan
Lorad
Selenia
Siemens
Novation
Same as ScreenScreen-Film
X
X
X
X
X
Multiple target/filter
combo’
combo’s
X
X
Multiple paddle
positions
Collimation
– Test for routinely used
X
• Collimator, bucky,
X
Chest Wall & Missed
Tissue
Compression Plate
Overlap on Chest
Wall
Slide 27
X
X
X
compression paddle
combo’
combo’s
X
• target materials
X
Slide 28
GE
Collimation
– Mo/Mo
– Rh/Rh
– Different paddle positions
Fischer Senoscan
Collimation
Slide 29
Slide 30
Fischer Senoscan
Lorad Selenia
Collimation
Collimation Assessment
– Use coin techniques as
described in ACR Manual
– 24 x 30 cm
– 18 x 24 cm (left, center,
right – paddle shifts)
Slide 31
Slide 32
Siemens Novation DR
Siemens Novation DR
Chest Wall and
Compression Plate Overlap
Missed Tissue
on Chest Wall
– Place coin tangent to
– Mount paddle
chest wall edge of
– Measure overlapping distance
bucky
– Add the missed tissue value
– Measure coin and
for total
subtract from full
– Must be < 6.5 mm
diameter
– Must evaluate for ALL
– Missed tissue must be
< 5 mm
compression paddles
including mag
Slide 33
Slide 34
Limiting Spatial Resolution
Spatial Resolution
ScreenScreen-Film Mammo
Fuji FCRm
– LineLine-pair test tool
GE
2000D,
DS,
Essential
Fischer
Senoscan
Lorad
Selenia
Siemens
Novation
X
X
• Focal spot
FFDM
– LineLine-pair test tool
• Focal spot
• Detector & imaging chain
Slide 35
Same as ScreenScreen-Film
(Focal Spot Eval)
Measure using LP
phantom on top of
acrylic
MTF
X
X
X
X
Slide 36
Fuji FCRm
System Resolution
– Up to 10 lp/mm Test Pattern
– 4 cm acrylic
– Parallel & Perpendicular to tube with 33-5
degree angle
The system limiting spatial resolution must be:
> 8 lp/mm + 2 lp/mm (6 to 10 lp/mm)
Fischer Senoscan
Evaluation of System Resolution
– 3.153.15-16.6 lp/mm Test Pattern
– Modulation in Normal mode @ 7 lp/mm must be > 10%
– Modulation in Hi Res mode at 11.1 lp/mm must be > 5%
Slide 37
Slide 38
GE 2000D, DS, & Essential
GE 2000D
MTF Measurement – Monthly – Raw Image
Focal Spot Evaluation
•Mo/Mo
•Rh/Rh
•Large & Small Spots
(1.5 mag)
MTF (%) = (Std. Dev.) x 222 / (Mean Dark ROI – Mean Light ROI)
MTF (%) @ 2 lp/mm > 58%
Slide 39
MTF (%) @ 4 lp/mm > 25%
Slide 40
GE 2000D
2000D Addendum: SubSub-system MTF
– Optional replacement for MTF & Focal spot
– No need for film
• Use specific bar pattern & 4.5 cm acrylic block
GE DS & Essential
MTF and CNR Measurement - Weekly
– Test consistency of CNR and ensure
contrast is adequate
• IQST Test tool
• Use ROI tools to calculate subsub-system MTF
• Repeat at 1.8 mag
Action Limit:
– MTF @ 2 lp/mm > 58%, MTF @ 4 lp/mm > 25%
– Change in CNR must not exceed 0.2
Slide 41
Slide 42
Lorad & Siemens
AEC Performance
ScreenScreen-Film Mammo
Evaluation of System Resolution
– 5-15 lp/mm Test Pattern
– Measure optical densities
The system limiting spatial resolution must be:
• Different thicknesses using clinical modes
> 7 lp/mm
• Different density settings ((-2, -1, 0, +1, +2, etc.)
FFDM
– Measure resultant techniques
– Measure signal, exposure, & SNR values
Slide 43
Slide 44
AEC
Fuji FCRm
Fuji FCRm
GE
2000D,
DS,
Essential
Fischer
Senoscan
Lorad
Selenia
Siemens
Novation
X
X
Density Control Function
Same as ScreenScreen-Film
– 4 cm acrylic, ACR phantom technique
Density Control
Function
X
ACR Reproducibility
X
Image Mode Tracking
X
CNR
X
SNR
– Repeat at -2, -1, 0, +1, +2 etc. density
X
X
X
X
X
X
– Record mAs
– mAs change should be 5 to 15% per step
Slide 45
Slide 46
Fuji FCRm
Fuji FCRm
Reproducibility & Image Mode Tracking
– 4 cm acrylic with clinical technique
CNR Per Object Thickness
– Position ion chamber in beam
– Record mAs and X
– Repeat 3 times
– CNR using clinical technique for 2 cm
– Repeat in each mode (small, large, mag, no grid)
– Action Limits:
Limits:
– Repeat for 4 and 6 cm
– Action Limits:
Limits:
• Coefficient of variation for Exposure or mAs must not exceed
0.05
• CNR of 2 cm relative to 4 cm must be > 100%
• No significant difference in exposure between small and large
bucky when using similar grids
• CNR of 6 cm relative to 4 cm must be > 75%
Slide 47
Slide 48
GE 2000D
GE DS & Essential
DS specific QC tests
AOP Mode and SNR Check
– Variable thicknesses of acrylic
– Std, Auto
– Evaluate:
• Correct techniques?
• Adequate SNR?
Acrylic
Thickness
2.5 cm
TargetFilter
Mo-Mo
Selected
kVp
27 kVp
Selected
mAs
20-60
4.0 cm
Mo-Rh
28 kVp
35-90
6.0 cm
Rh-Rh
32 kVp
35-90
– AOP Mode and SNR Check
• Use builtbuilt-in software for image acquisition
2.5 cm
Acrylic
• AOP: STD/Auto
Exposure Parameters
For AOP STD mode oly
Acrylic Thickness
(mm)
4.0 cm
Acrylic
Each “raw”
raw” image must have a measured SNR of
at least 50
6.0 cm Acrylic
Track/Filter
mAs
25
Mo/Mo
2020-60
26
50
Rh/Rh
4040-90
29
60
Rh/Rh
4545-95
31
SNR must be > 50
kV
Slide 49
Slide 50
Lorad Selenia
Siemens Novation
Automatic Exposure Control
AEC Image Stability and Reproducibility and SNR
– AUTOAUTO-FILTER – 2, 4, 6, 8 cm
– ACR Phantom
– 4 cm ((-5 thru +5)
– Mo/Mo, 28 kV, “H”, sensor 1
– Use ROI to measure mean pixel value
– Record mAs, SNR, Mean, Entrance Exposure (5 times)
inside virtual AEC detector
Action Limits:
Performance Criteria
– Coef. of Var for mAS and X < 5%
– Pixel value should not vary by more
– SNR and Mean shall not vary by + 15% of Mean
than 10% of mean
– Exposure compensation steps shall
meet requirements in pixel value table
Slide 51
Slide 52
Siemens Novation DR
Uniformity of Screen Speed &
Detector Performance
AEC Thickness Tracking
– 2, 4, and 6 cm
– “H” mode
– Max deviation = (Max difference / mean value ) * 100
ScreenScreen-Film Mammo
– Measure if OD’
OD’s are consistent
– Check for artifacts
FFDM
– FlatFlat-field uniformity
– Detector calibration
– Pixel correction test
– CR Reader Scanner Performance
Slide 53
Slide 54
Detector Performance
GE
Fuji FCRm
2000D,
DS,
Essential
Fischer
Senoscan
Lorad
Selenia
Fuji FCRm
Siemens
Novation
Dynamic Range
Same as ScreenScreen-Film
(Screen Uniformity)
FlatFlat-Field Uniformity
X
Detector Calibration
– To confirm the dynamic range of reader and plate
X
X
X
– Use 2 & 4 cm acrylic
X
CR Reader Scanner
Performance
X
– Technique for 6 cm
– View image to determine if 3 regions are visible
Dynamic Range
X
Primary Erasure
X
InterInter-Plate
Consistency
X
Geometric Distortion
and discernable
X
Pixel Correction
Ghosting
X
X
X
Slide 55
Slide 56
Fuji FCRm
CR Reader Scanner Performance
– Establish that IP reader & optics do not exhibit scan or
print jitter
– NonNon-grid exposure
Fuji FCRm
Primary Erasure (Additive & Multiplicative)
– To assess the erasure performance of reader and
plates
– Additive: Shoot phantom, process, wait 1 minute,
– Position rulers in “T” formation
reprocess, change S value to 10X original,
– Expose & process
inspect for visibility of phantom image
– Action Limit: Image must have smooth borders free
from jagged edges or defects
– Multiplicative: Shoot & process phantom, shoot 4
cm acrylic on same cassette, process and inspect
for visibility of phantom image
Slide 57
Slide 58
Fuji FCRm
GE 2000D, DS, & Essential
FlatFlat-field uniformity
– Test to ensure detector performance acceptable
InterInter-Plate Consistency
• Measures detector uniformity (signal & noise)
– To confirm xx-ray absorption & SNR consistency
• Measures bad pixels
– Expose plates using clinical technique with 4cm
– System automatically calculates pass/fail
acrylic
– Record mAS (must be within +10%)
– Calculate SNR (must be within +15%)
QAP
Slide 59
Slide 60
Fischer
Fischer Senoscan
Flat Field and Detector Calibration
– Run daily calibration using software Use 4 cm
Geometric Distortion
acrylic
– Exposure resulting in 1000 ADU’
ADU’s
– No Artifacts at WW > 800
– Compute deviation between corner and center
means
–Use a 40 mesh Cu screen
–Acquire image at low
technique
– Must be within + 20% of center ROI
–Visually inspect for
distortions or blurring
Slide 61
Slide 62
Lorad Selenia
Detector Calibration – Every two weeks
Lorad Selenia
Detector Ghosting
– Assure ghosting does not interfere with
image quality
– 4 cm acrylic block – no paddle
– 4 cm acrylic covering half of detector
– Built in Calibration software
– Set AEC clinically
– Follow onon-screen instructions
– 4 cm acrylic covering entire detector
– Make exposure
–
• Review image for artifacts
possible (~ 1 minute after first)
• Repeat until you have 8 images
• End calibration
Calculate Ghost Image Factor =
(MeanR3 – MeanR2 / MeanR1 – MeanR2)
• Calibration is performed automatically
Slide 63
Place 0.1 mm AL on top
– Make 2nd exposure (AEC) as soon as
– Must be within + 0.3
Slide 64
Siemens Novation DR
Detector Uniformity
– Make exposure: 28 kV, 50 mAS,
Mo/Mo
– Select ROI 128 x 128 pixels
– Record measurements in corners
and center
– Pixel value inside each of 5 ROI’
ROI’s
Siemens Novation
Detector Calibration Test
– Objective: to determine if system
was correctly gain calibrated
– Must be done weekly
(technologist)
– Follow onon-screen instructions
– Acquire 8 images
shall not differ by more than 10%
– Images should be free of artifacts
of mean
Slide 65
Slide 66
Siemens Novation DR
Siemens Novation DR
Pixel Correction Test
Ghost Image Evaluation
– Calibration mode
– Setup with 2mm steel bar
– Create new pixel map
– Exp 1:
1: Mo/Mo, 23 kV, 2 mAs – record mean
– Follow onon-screen instructions
– Exp 2:
2: Mo/Mo, 28 kV, 200 mAs - remove steel
– Acquire image
– Wait 180 seconds, place 4 cm Acrylic on top
– Evaluate image is free from
collimator or debris artifacts
– Exp 3:
3: Mo/Mo, 28 kV, 14 mAs
– System compiles new pixel
– Calculate % Ghosting = (PV1 – PV2) / PV1
map
+PV2
– System display results – must
Action Limit:
Limit: % Ghosting < 3%
Slide 67
meet requirements
Slide 68
Artifacts
Artifacts
ScreenScreen-Film Mammo
Fuji FCRm
GE
2000D,
DS,
Essential
Fischer
Senoscan
Lorad
Selenia
Siemens
Novation
X
X
X
X
X
– Evaluate cassettes
Same as ScreenScreen-Film
FFDM
– Evaluate detector
– CR: Imaging Plates
Expose Using Acrylic
Slide 69
Slide 70
Artifacts
Artifacts
Artifact evaluation
Mo/Mo
Slide 71
Artifacts
Slide 72
Artifacts
Mo/Rh
Rh/Rh
Slide 73
Slide 74
Artifacts
Artifacts
Possible cause:
Possible Cause:
Cause:
condensation on
Detector dropout or
detector
mismis-registration
Slide 75
Slide 76
Artifacts
Image Quality
Processing Steps for Digital Images
ScreenScreen-Film Mammo
– ACR Phantom Scores
Image
Detection
Calibration
File
Image
Correction
Raw
Image
Processing
Processed
Image
Display
– Optical Density & Contrast
FFDM
– ACR Phantom Scores
• Pass/fail requirements differ by vendor
– SignalSignal-toto-Noise Ratio (SNR)
– ContrastContrast-toto-Noise Ratio (CNR)
Slide 77
Slide 78
Image Quality
Fuji FCRm
Image Quality
GE
2000D,
DS,
Essential
Fischer
Senoscan
X
X
Lorad
Selenia
ACR Phantom Imaging
Siemens
Novation
GE & Fischer &
Fuji
Lorad &
Siemens
Fibers
4
5
Specks
3
4
Masses
3
4
Same as ScreenScreen-Film
Manual Techniques
Clinical Technique
X
CNR
X
X
Slide 79
X
X
Partial
X
X
Slide 80
GE 2000D
ACR Phantom Imaging
– Manual technique (Mo/Mo, 26
kVp, 125 mAS)
– Score the processed image
GE 2000D
ContrastContrast-toto-Noise Test (CNR)
– To examine consistency of CNR
ratio measured over time
– Use the raw image
– + 20% of baseline
– Acquisition workstation
– Each monitor of the RWS
Background ROI
Mass ROI
– Laser imager
CNR = (Meanbackground - Meanmass)/SDbackground
Slide 81
Slide 82
GE DS
Fischer Senoscan
Phantom Image Acquisition Test and Image Quality
DS specific QC tests
– Select Techniques to give 1000 ADU
– Phantom Image Quality
– Compare background mean, StdDev, and ADU level
difference to baseline values
• Manual technique: Rh/Rh, 29 kVp, 56 mAs
– Score : 4 fibers, 3 speck groups, and 3 masses
– MTF and CNR Measurement
• Use IQST test tool
• Use builtbuilt-in software for image acquisition
• Manual technique: Rh/Rh 30 kVp, 56 mAs
• Results are automatically displayed (pass/fail)
• Same action limits as 2000D
Slide 83
Slide 84
Lorad Selenia
Siemens Novation DR
Phantom Image Quality
– Select clinical exposure mode (i.e. AUTOAUTO-FILTER)
– Print film
– Measure background OD and density difference –
Plot on tech worksheets
• Background must be > 1.20 OD + 0.20
• DD must be > 0.40 + 0.05
Phantom Image Quality
– Position phantom 1 cm
over chest wall edge
– Select: 28 kV, AECAEC-Auto,
Mo/Mo
– Score on RWS or Film
– Score on each Soft Copy Workstation
• 5 fibers
– Fiber > 5
• 4 speck groups
– Specks > 4
• 4 masses
– Masses > 4
Slide 85
Slide 86
Lorad & Siemens
Fuji FCRm
ContrastContrast-toto-Noise Test (CNR)
– To examine consistency of CNR ratio measured over time
– Use 4 cm acrylic & 0.2 mm Al
SNR and CNR Measurements
– Manual technique (Mo/Mo, 26 kVp, 125 mAs)
– Calculate CNR using software
– SNR at least > 40
– + 20% of baseline
– CNR should stay within ±15% of baseline
• Obtained during acceptance testing
Slide 87
Slide 88
kVp
ScreenScreen-Film Mammo
– Assure that actual kVp is
• Accurate (+
(+ 5% of indicated)
• Reproducible (Coeff. Var. < 2%)
FFDM
– Same
HVL
ScreenScreen-Film Mammo
– Assure HVL is adequate to minimize patient
dose
– HVL shall meet FDA’
FDA’s Performance Standards
FFDM
– Same
Note the lead sheet
Slide 89
Slide 90
Dose
Radiation Output
ScreenScreen-Film Mammo
ScreenScreen-Film Mammo
– Dose for single CC view of ACR phantom shall
– System shall be capable of producing a
not exceed 3.0 mGy per exposure
minimum output of 7.0 mGy/sec @ 28 kVp
Mo/Mo over 3.0 second period
FFDM
FFDM
– Same
– Same
– S value confirmation
– Exposure Linearity
Slide 91
Slide 92
Radiation Output
Fuji FCRm
Same as ScreenScreen-Film
X
S Value Confirmation
X
Exposure Linearity
GE
2000D,
DS,
Essential
Fischer
Senoscan
X
Fuji FCRm
Lorad
Selenia
Siemens
Novation
X
X
S Value Confirmation
– Make exposure at 25 kV Mo/Mo to give X
> 20 mR
– Exposure cassette at this technique
X
(wait 10 min. & process)
– Record S value
– Calculate “Corrected S value”
value”
– Action Limit:
Limit: Corrected S value should
not exceed the range of 120 + 20% (96 <
S < 144)
Slide 93
Slide 94
Viewing & Viewing Conditions
Fischer Senoscan
Exposure Linearity and Reproducibility
ScreenScreen-Film Mammo
– Procedure:
– Luminance (>
(> 3000 cd/m2)
• Measure exposure at specified techniques
– Room illuminance (<
(< 50 lux)
• Calculate:
Output = Average exposure reading/mA
– Viewbox cleaning
Linearity = (A(A-B)/(A+B) < 0.08
FFDM
Reproducibility = StdDev/Avg < 0.035 for each
technique
– Same
Slide 95
Slide 96
Assessing Tech QC
ScreenScreen-Film Mammo
Film Processing
ScreenScreen-Film Mammo
– Measure optical densities
– Assess site’
site’s QC program
– Check that QC tests are properly performed
– Independent checks of tech QC tests
• Density difference, midmid-density, base+fog
• Measures consistency
FFDM
– Manufacturers’
Manufacturers’ recommendations
FFDM
– Same
– Some refer to printer manufacturers’
manufacturers’ recommendations
– Typically identical to ACR SFM Manual
Slide 97
Slide 98
Film Processor QC
Follow Printer
Manufacturers QC
If Not, Use Theirs
Fuji FCRm
GE
2000D,
DS,
Essential
Fischer
Senoscan
X
X
X
X
X
X
Film Processing
Lorad
Selenia
Base + Fog
Siemens
Novation
Wet Processing
Follow FFDMs’
FFDMs’ QC
X
Laser Printer
Northwestern Memorial Hospital - Processor ID: Kodak 8900 - Oct
2006
Base + Fog
Northwestern Memorial Hospital - Processor ID: 2 - MAR 2006
Base + Fog
X
0.35
0.40
0.30
0.35
0.30
0.25
0.25
0.20
0.20
0.15
0.15
Base + Fog Action Limit = 0.22
Base + Fog Action Limit = 0.23
0.10
Base + Fog Daily Value
0.10
Base + Fog Daily Value
Base + Fog - Operating Level = 0.19
Base + Fog - Operating Level = 0.2
0.05
0.05
0.00
O
ct
ob
er
2,
O
20
ct
ob
06
er
3,
O
c to
200
be
6
r
4,
O
ct
20
ob
06
er
5,
O
20
ct
ob
06
er
6,
O
c to
200
ber
6
O
9,
cto
20
ber
06
10
O
ct
,2
ob
00
er
6
1 1,
O
cto
200
ber
6
12
O
cto
, 20
be
06
r
13
O
ct
,2
ob
00
er
6
1 6,
O
ct
200
ob
er
6
17
O
cto
, 20
be
06
r
18
O
ct
,2
ob
00
er
6
1 9,
O
cto
20
ber
06
20
O
cto
,2
0 06
be
r2
O
3,
ct
200
ob
er
6
2 4,
O
cto
20
ber
06
25
O
cto
, 20
be
06
r2
O
6,
ct
200
ob
er
6
2 7,
O
cto
20
ber
06
30
,2
0 06
06
06
a r-
a r-
6
06
a r06
-M
ar
-0
6
M
ar
-0
6
14M
ar
s er
-0
6
vic
e
3/
15- 14
M
a r06
16
-M
a r06
17
-M
a r06
20
-M
a r06
21
-M
ar
-0
6
22M
ar
-0
6
23M
ar
-0
6
24M
ar
-0
6
27M
a r28- 06
M
a r06
29
-M
a r06
30
-M
a r06
31
-M
a r06
9 -M
8 -M
13-
10
a r-
a r-
a r-
ar
-0
06
7 -M
6 -M
3M
2M
1M
06
0.00
Date
Slide 99
Date
Slide 100
Film Processing
Film Processing
MidMid-Density
Density Difference
Wet Processing
Laser Printer
Northwestern Memorial Hospital - Processor ID: 2 - MAR 2006
Mid-Density
Northwestern Memorial Hospital - Processor ID: Kodak 8900 - Oct 2006
Mid-Density
Wet Processing
Laser Printer
Northwestern Memorial Hospital - Processor ID: 2 - MAR 2006
Density Difference
Northwestern Memorial Hospital - Processor ID: Kodak 8900 - Oct 2006
Density Difference
2.60
2.30
1.70
2.50
1.60
2.40
1.50
2.30
1.40
2.20
1.90
1.30
2.10
1.80
1.20
1.70
1.10
HD Step=13
2.00
LD Step=10
MD Step=12
2.20
1.90
2.10
1.80
2.00
1.70
1.60
1.50
2.00
Mid-Density Upper Control Limit = 1.48
1.40
1.90
Mid-Density Daily Value
1.00
Mid-Density Daily Value Operating Level = 1.33
Mid-Density Daily Value
1.70
Mid-Density Lower Control Limit = 1.76
Density Difference Daily Value
1.20
Density Difference Daily Value
1.60
1.10
Density Difference Lower Control Limit = 1.95
Date
06
, 20
6,
cto
be
r
O
O
ct
200
ob
6
er
O
9,
cto
20
be
06
r1
O
0,
cto
20
be
06
r1
O
1,
cto
20
be
06
r1
O
2,
cto
20
be
06
r
13
O
, 20
ct
ob
06
er
16,
O
cto
200
ber
6
17,
O
cto
200
be
6
r1
O
8,
cto
20
be
06
r1
O
9,
cto
20
be
06
r2
O
0,
cto
20
be
06
r
23
O
, 20
ct
ob
06
er
24,
O
cto
200
ber
6
25,
O
cto
200
ber
6
26,
O
cto
20
be
06
r2
O
7,
cto
20
be
06
r3
0,
20
06
06
20
20
, 20
3,
2,
be
r5
be
r4
ber
cto
cto
ct
ob
er
cto
O
O
6
6
6
06
Date
O
1-M
ar
-0
6
2M
ar0
3-M 6
ar
-0
6
6M
ar06
7-M
ar
-0
6
8M
ar0
9-M 6
ar06
10
-M
ar06
13
-M
ar06
14
-M
arse
06
rv
ic
e
3/
14
15
-M
ar
-0
166
M
ar06
17
-M
ar
-0
206
M
ar06
21
-M
ar
-0
226
M
ar06
23
-M
ar
-0
246
M
ar06
27
-M
ar06
28
-M
ar06
29
-M
ar06
30
-M
ar06
31
-M
ar06
ob
O
ct
ob
6
20
06
er
11,
20
ob
06
er
12,
O
ct
20
ob
06
er
13,
O
ct
20
ob
06
er
16,
O
ct
20
ob
06
er
17,
O
ct
20
ob
06
er
18,
O
ct
20
ob
06
er
19,
O
ct
20
ob
06
er
20,
O
ct
20
ob
06
er
23,
O
ct
20
ob
06
er
24,
O
ct
20
ob
06
er
25,
O
ct
20
ob
06
er
26,
O
c to
20
ber
06
27
O
c to
,2
00
ber
6
30
,2
00
6
2 00
er
10,
O
ct
6
6
2 00
2 00
2 00
9,
er
ob
ct
O
ct
O
2 00
2 00
6,
ob
er
5,
3,
2,
4,
er
er
er
er
ob
ob
ob
ob
ct
O
ct
ct
ct
ct
O
O
O
O
9M
ar
1 0 -0 6
-M
ar06
13
-M
ar
-0
14
6
-M
ar06
rv
ic
e
3
1 5- /1 4
M
ar
-0
16
6
-M
ar1 7- 06
M
ar
-0
20
6
-M
ar06
21
-M
ar
-0
22
6
-M
ar06
23
-M
ar2 4- 06
M
ar
-0
27
6
-M
ar2 8- 06
M
ar
-0
29
6
-M
ar06
30
-M
ar3 1- 06
M
ar
-0
6
se
6
6
06
6
ar-
8 -M
06
ar
-0
ar0
ar
-0
ar-
ar-
M
7-
M
M
6 -M
3-
2-
1 -M
06
Date
1.50
06
1.00
0.70
1.30
Density Difference Daily Value Operating Level = 1.62
Density Difference Lower Control Limit = 1.47
Density Difference Daily Value Operating Level = 2.1
0.80
1.40
Density Difference Upper Control Limit = 1.77
1.30
Density Difference Upper Control Limit = 2.25
Mid-Density Lower Control Limit = 1.18
0.90
Mid-Density Daily Value Operating Level = 1.91
1.50
1.80
O
Mid-Density Upper Control Limit = 2.06
1.60
Date
Slide 101
Slide 102
Film Processing
Lorad
Dmax
Laser Printer QC - Daily
Laser Printer
Northwestern Memorial Hospital - Processor ID: Kodak 8900 - Oct
Dmax
2006
40%
•
SMPTE pattern from
AWS
•
Measure OD
4.00
3.90
3.80
3.70
3.60
3.50
•
10%, 40% and 90%
•
Plot midmid-density
(40%), density
difference (40(40-10%),
lower density (90%)
•
+ 15 from baseline
3.40
3.30
3.20
3.10
3.00
Dmax Daily Value
2.90
2.80
90%
10%
Dmax - Operating Level = 3.44
Dmax Action Limit = 3.19
2.70
cto
cto
O
O
O
cto
be
r2
,2
00
be
6
r3
,2
00
be
6
r4
O
,2
cto
00
be
6
r5
O
,2
cto
00
be
6
r6
O
,2
cto
00
be
6
r
O
9,
cto
20
be
06
r1
O
0,
cto
20
be
06
r
O
11
cto
,2
00
be
6
r1
O
2,
cto
20
be
06
r
O
13
cto
,2
00
be
6
r1
O
6,
cto
20
be
06
r
O
17
cto
,2
00
be
6
r1
O
8,
cto
20
be
06
r
19
O
cto
,2
00
be
6
r2
O
0,
cto
2
be
00
6
r2
O
3,
cto
20
be
06
r2
O
4,
cto
20
be
06
r2
O
5,
cto
20
be
06
r2
O
6,
cto
20
be
06
r2
O
7,
cto
20
be
06
r3
O
0,
cto
20
be
06
r3
1,
20
06
2.60
Date
Slide 103
Slide 104
RWS QC
Follow monitor
manufacturers QC
If Not, Use FFDM’
FFDM’s
Multimodality Workstations
Fuji FCRm
GE
2000D,
DS,
Essential
X
X
X
X
X
X
Fischer
Senoscan
Lorad
Selenia
Siemens
Novation
FDA Approved Multimodality Workstations
– AGFA IMPAX MA3000
– Sectra IDS5/mx
– Kodak DirectView PACS System 5
– McKesson’
McKesson’s PACS Mammo Station
– iCad Second Look 500M
Use FFDM
manufacturers’
manufacturers’s QC
X
X
– Cedera II-ReadMammo
– Fuji Synapse
– GE Seno Advantage & Centricity
– Fischer Senoview Plus (Cedera)
– Hologic SecureView DX
– Siemens MammoReportPlus
Slide 105
Slide 106
AGFA IMPAX MA3000
–
–
–
–
–
–
–
Barco
Clean monitor surface
Measure display white & black
Measure quality level
Measure uniformity
Calibrate displays
View SMPTE pattern
Viewing conditions
–
–
–
–
Eizo
GE Seno Advantage
–
–
–
–
I-Guard Check
Quality Level
Display White
Calibration Settings Check
–
–
–
–
Viewing conditions check and setting
Monitor calibration
Image quality – SMPTE pattern
Analysis of screen uniformity
Pattern Check
Luminance Check
Grayscale Check
Uniformity Check
Siemens MammoReport Plus
–
–
–
–
–
–
–
Geometric distortion
Reflection
Luminance Response
Luminance Uniformity
Resolution
Noise
Overall Evaluation
Slide 107
Planar
–
–
–
–
–
Monitor Cleaning
Viewing Conditions Check
Monitor Calibration Check
Image Quality – SMPTE
Visual Inspection for Display
Defects
Slide 108
Suggestions
Troubleshooting QC
Keep a good file system for naming & numbering the
different QC tests
Archive all digital QC images on a CD
Keep QC test tools in a safe place
Repeat test
– Clean plexiglass & move slightly
Questions to ask yourself:
Perform flatflat-field imaging before phantom imaging tests
– Are you using the correct image? Raw vs. Processed?
Perform testing in the morning
– Are the ROI’
ROI’s in the correct location?
Have a system for monitoring the “Auto Print/Auto Push”
Push”
functions
ReRe-boot system
Call service
– ReRe-calibration solves most image quality problems
Slide 109
Slide 110
Key Take Home Points
Key Take Home Points
Obtain proper handshands-on training
Review workstation monitors – look at the clinical
Must perform manufacturer specific QC tests
images!
Artifacts – most problems can be seen here
– Do they match?
ReRe-booting and/or rere-calibrating fixes most
– Appropriate dark and light levels
problems
Be aware of separate QC for review workstations
Laser Printer
– Dmax at least 3.5 OD
Know, and be involved with, your site QC program
– MidMid-density about 1.5 OD
Slide 111
Slide 112
Thank You
SAM Questions
Digital Mammography Quality
Assurance: Comparing the
Manufacturers Recommendations
Slide 113
4%
16%
62%
0%
18%
Slide 114
In digital mammography, who
mandates the pass/fail criteria for site
QC?
1. The American College of Radiology
2. The FDA
3. The FFDM unit manufacturer
4. NEMA
5. MQSA
Slide 115
Answer: 3 - The FFDM unit
manufacturer
References
MQSA Regulations 900.12(e)(6)
http://www.fda.gov/CDRH/MAMMOGRA
PHY/frmamcom2.html#s90012
Slide 116
How do you accredit a Fuji CR
Mammography system which uses
both CR and screenscreen-film on the same
x-ray system?
Answer 3: The FFDM unit
manufacturer
Explanation
“the quality assurance program shall be
substantially the same as the quality
assurance program recommended by the
image receptor manufacturer, except that
the minimum allowable dose for screenscreenfilm systems in this section”
section”
As 1 mammography unit?
As 2 mammography units?
3. You cannot use CR and film on the
same unit.
4. CR is exempt from accreditation
4%
1.
92%
2.
4%
0%
Slide 117
Slide 118
Answer: 2 – As 2 mammography
units
References
http://www.acr.org/accreditation/mammography/
mammo_faq/mammo_faq_mamac.aspx#8.0.1
Slide 119
Answer: 2 - As 2 mammography
units
Explanation
As of November 15, 2006 facilities using
both screenscreen-film and CR on the same
mammography units must accredit these
2 systems as 2 separate units.
Slide 120
What are the minimum passing ACR
phantom scores for the Lorad Selenia for
weekly QC?
4%
1.
11%
2.
80%
3.
0%
4.
4%
5.
5 Fibers, 4 Speck Groups, 3 Masses
4 Fibers, 3 Speck Groups, 3 Masses
5 Fibers, 4 Speck Groups, 4 Masses
4 Fibers, 4 Speck Groups, 3 Masses
4 Fibers, 4 Speck Groups, 4 Masses
Answer 3: 5 Fibers, 4 Speck Groups, 4
Masses
References
Hologic. Lorad Selenia Quality Control
Manual MANMAN-00093, Revision 003,
Bedford (MA): Hologic, 2005
Slide 121
Answer 3: 5 Fibers, 4 Speck Groups, 4
Masses
Explanation
The Lorad Selenia QC manual states that the ACR
Phantom minimum passing scores are as
follows:
5 Fibers
4 Speck Groups
4 Masses