FFDM Quality Control in Canada - a Vendor Neutral Approach
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1 FFDM Quality Control in Canada - a Vendor Neutral Approach Rasika Rajapakshe, PhD, FCCPM BC Cancer Agency-Center for the Southern Interior Kelowna, BC, Canada 2011 Joint AAPM/COMP Meeting August 4, 2011 Vancouver, BC
2 Outline Background QC Tests Acquisition system Double D SDNR phantom QC Tests Review system Technologist QC Tests Health Canada Draft Safety Code Conclusions
3 Map of Canada ~ 4.5 Million Population estimate (April 2011) : 34,349,236
4 Screening Mammography Program of BC (SMPBC) First organized breast screening program in Canada Established in Sites in total 28 Fixed sites include 3 mobiles 13 Ancillary sites 12 Digital sites ~ 300,000 mammograms/year
5 Digital Transition in SMPBC DR mammography implemented in one center more centers implemented DR mammography Currently ~ 20% of SMP centers are digital Mean Glandular Dose (2007) *: 2.8 mgy (Film/Screen) 1.6 mgy (Digital) * R. Rajapakshe, RSNA (2009), SSE22-02
6 Digital Mammography Process
7 Digital Mammography QC program goals No international standards in place for digital mammography QC ACR Practice Guidelines recommend following vendor QC Various equipment in place with different recommended QC tests Need a standard in place for the program in order to track, troubleshoot and monitor image quality in a consistent fashion
8
9 Where to begin?
10 Where to begin?
11 SMPBC QA Tests for Physicist Acquisition System Unit Evaluation AEC / Tracking Resolution Collimation Ghosting Artifacts Noise and Signal Linearity kvp, HVL, Output Dose Evaluation of Site s QC IHE- Mammo profile Review System Monitor Display Quality Monitor Luminous Response View Conditions Measurement Accuracy IHE- Mammo profile
12 SMPBC QA Tests for Physicist Acquisition System Unit Evaluation AEC / Tracking Resolution Collimation Ghosting Artifacts Noise and Signal Linearity kvp, HVL, Output Dose Evaluation of Site s QC IHE- Mammo profile Review System Monitor Display Quality Monitor Luminous Response View Conditions Measurement Accuracy IHE- Mammo profile
13 Unit Evaluation 1. Temperature in mammography acquisition room within manufacturer specified tolerances. 2. Free standing unit is mechanically stable. 3. All moving parts move smoothly, without obstructions to motion. 4. All locks and detents work properly. 5. Image receptor is free from vibrations during exposure. 6. Compressed breast thickness scale is accurate to +/- 5 mm, reproducible to +/- 2 mm. 7. Automatic decompression override exists (if applicable) and override status displayed. 8. Manual compression release possible with no power to machine. 9. Patient or operator is not exposed to sharp or rough edges or other hazards. 10. Operator protected during exposure by adequate radiation shielding. 11. Operator technique charts are posted. 12. Indicator lights working properly. 13. Maximum Compression pressure applied under power at least 15 dan and less than 20 dan? 14. Maximum Compression pressure applied manually at least 15 dan and less than 30 dan? 15. Back-up timer functioning correctly 16. Annotation on images correct. 17. DICOM header correctly populated.
14 SDNR Test Double D Phantom The phantom is a new test object developed for monitoring digital mammography image performance consistency by monitoring weekly variations in the signal difference noise ratio (SDNR), mas and mean pixel value.
15 AEC / Tracking
16 Resolution - MTF West Edge East Edge North Edge South Edge Effective Frequency (lp/mm)
17 Ghosting ACR phantom
18 SMPBC QA Tests for Physicist IHE Mammo Acquisition System Must conform to IHE Mammography Image Integration Profile as an Acquisition Modality Actor
19 IHE Mammo - Acquisition Modality Actor
20 SMPBC QA Tests for Physicist Acquisition System Unit Evaluation AEC / Tracking Resolution Collimation Ghosting Artifacts Noise and Signal Linearity kvp, HVL, Output Dose Evaluation of Site s QC IHE- Mammo profile Review System Monitor Display Quality Monitor Luminous Response View Conditions Measurement Accuracy IHE- Mammo profile
21 Monitor QC Measures two main criteria: Spatial Resolution Luminous Response
22 Monitor Resolution AAPM TG-18 QC image
23 Luminous Response AAPM TG-18 NL images Compliance with DICOM GSDF Luminance Response - Left Monitor dl/l for a JND Normalized Contrast Left Norm. Exp. Contrast Left lower limit Left upper limit Left Average JND
24 Measurement Accuracy
25 SMPBC QA Tests for Physicist IHE Mammo Review System Must conform to IHE Mammography Image Integration Profile as an Image Display Actor
26 IHE Mammo Image Display Actor
27 IHE Mammo Image Display Actor Image Display Size Same Size True Size 1 : 1 (View actual pixels)
28 IHE Mammo Image Display Actor Same Size
29 IHE Mammo Image Display Actor True Size
30 IHE Mammo Image Display Actor 1 : 1 (100%) Display 3 MegaPixel 1536 x MegaPixel 2048 x 2560
31 SMPBC QA Tests for Technologist SDNR Test Weekly Artefact Test Weekly Display Monitor QC Weekly RMI Phantom Image Quality Monthly Mechanical Inspection Monthly Compression Test Semi Annual Laser Printer Sensitometry Weekly Laser Printer Artefacts Monthly CR Plate Artefacts Monthly Printed Image Quality Test Monthly Detector Uniformity Test - Monthly
32 SDNR Test Double D Phantom The phantom is a new test object developed for monitoring digital mammography image performance consistency by monitoring weekly variations in the signal difference noise ratio (SDNR), mas and mean pixel value. Technologists SDNR test is performed on the FOR PRESENTATION images.
33 Digital Mammography Process
34 Challenges in image processing Algorithms may differ based on the type of procedure chosen Contact Vs magnification view Therefore proper selection of the procedures is critical for optimal image quality
35 Challenges in image processing IPPGname=Standard_OV2_hc IPPGparameters=OpView2:_AM(1/1.5 8)_NI(1)_GaL(31)_H(127/0.00)_E(15/ 0.00/0)_AE(3/-0.30)_I(0/ /- 30)_WM(2/130/2.20)_VM(0)_GL((2/4. 00/2048/230))_SB(1)_SEG(1513/0)_S T(0/1513/1.58)_ROI(0/0/0/0)
36 Changes in image processing
37 Why FOR PRESENTATION (Processed) images? kv mas Image Pro Signal Bk Std SDNR Processed off Processed low Processed med Processed high Raw off Raw low Raw med Raw high
38 mqc Software Automatic SDNR Analysis
39 mqc Software Reporting for Accreditation
40 Health Canada Safety Code Current National Consultation: New Safety Code on Mammography You are invited to participate: Consultation - Safety Code Mammography Consumer and Clinical Radiation Protection Bureau Health Canada 775 Brookfield Road, PL 6301A Ottawa, ON K1A 1C1 Tel: Fax: CCRPB-PCRPCC@HC-SC.GC.CA, Consultation ends October 31, 2011
41 Health Canada Draft Safety Code - Mammography
42 Conclusions A unified system of vendor neutral quality control tests have been developed and adopted for digital mammography systems in the provinces of British Columbia and Ontario We are planning on adopting this methodology throughout Canada
43 Acknowledgements Martin Yaffe Gordon Mawdsley Aili Bloomquist Sam Chen (OBSP)
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Quick reference guide Manufactured by: Esaote Europe B.V. Philipsweg 1 6227 AJ Maastricht The Netherlands Tel. +31 (43) 382 4600 Fax +31 (43) 382 4601 Internet: www.esaote.com Email: international.sales@esaote.com