Digital Breast Tomosynthesis QC Requirements
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1 Digital Breast Tomosynthesis QC Requirements AAPM Spring Clinical Meeting March 8, 2015 Michael S Glaser, MS, DABR Alliance Medical Physics, LLC
2 Learning Objectives 1. GE SenoClaire - Physicist & Technologist QC 2. Hologic Selenia Dimensions 3D- Physicist & Technologist QC
3 Disclosures Funding Support- None Conflicts of Interest- None Disclosures- Yes, vendor QC slides Special Thanks for vendor QC slides, courtesy of: Razvan Iordache, PhD of GE Healthcare Nikos Gkanatsios,PhD of Hologic
4 Quality Control for SenoClaire (GE Breast Tomosynthesis)
5 Comment: *Exposure time depends on breast thickness, ; 10 sec for average breast of 4.5cm PMMA. SenoClaire (GE Breast Tomosynthesis) SenoClaire Key Features 9 Projections Stop-and-shoot Sweep angle 25 ( +/- 12.5) Sweep time <10 sec* Detector pixel size 100 um in 2D & 3D 2D/3D-grid for scatter reduction ASIR DBT Iterative Reconstruction No dose increase (3D vs. 2D) BTO DICOM format (Breast Tomosynthesis Object)
6 SenoClaire is an Upgrade for Senographe Essential Motorized Tomosynthesis Device (MTD) Senographe Essential Senographe Essential Upgraded with SenoClaire.....
7 Imaging with the MTD Traditional antiscatter grid - Essential View of system positioned for a left MLO view 2D/3D antiscatter grid SenoClaire s MTD View of system positioned for a left MLO view Both 2D & 3D imaging is performed with the MTD 5
8 SenoClaire QC Manual This quality control (QC) manual adds tests specific to SenoClaire to those listed in the Senographe Essential QC manual 71 pages 6
9 SenoClaire QC Radiologic Technologist 7
10 QC Tests for the Radiologic Technologist Minimum frequency Test Essential SenoClaire (w/ MTD) No 2D No 2D 3D Daily Monitor cleaning Weekly Flat field Weekly Phantom IQ Weekly CNR & MTF Weekly Viewbox & Viewing Monthly AOP Mode & SNR Monthly Visual Checklist Quaterly Repeat Analysis Semianually Compression Force x x Monthly Grid Texture 8
11 QC Tests for the Radiologic Technologist Minimum frequency Test Essential SenoClaire (w/ MTD) No 2D No 2D 3D Daily Monitor cleaning Weekly Flat field Weekly Phantom IQ Weekly CNR & MTF Weekly Viewbox & Viewing Monthly AOP Mode & SNR Monthly Visual Checklist Quaterly Repeat Analysis Semianually Compression Force x x Monthly Grid Texture 9
12 SenoClaire Tests same as Essential Tests Minimum frequency Test Essential SenoClaire (w/ MTD) No 2D No 2D 3D Daily Monitor cleaning Weekly Flat field Weekly Phantom IQ Weekly CNR & MTF Weekly Viewbox & Viewing Monthly AOP Mode & SNR Monthly Visual Checklist Quaterly Repeat Analysis Semianually Compression Force x x Monthly Grid Texture 10
13 SenoClaire Tests specific Visual Checklist Minimum frequency Test Essential SenoClaire (w/ MTD) No 2D No 2D 3D Daily Monitor cleaning Weekly Flat field Weekly Phantom IQ Weekly CNR & MTF Weekly Viewbox & Viewing Monthly AOP Mode & SNR Monthly Visual Checklist Quaterly Repeat Analysis Semianually Compression Force x x Monthly Grid Texture 11
14 Visual Checklist (monthly) Objective To assure that GE Breast Tomosynthesis indicator lights, displays, and mechanical locks and detents are working properly and that the system is mechanically stable. Equipment required Visual checklist Chart 5. Grid texture test, Visual Checklist and Compression Record of Checks (page 36). Procedure Review each item on the visual checklist and indicate its status Action Limit Each of the items listed in the Visual Checklist must pass (ie, receive a check mark) 12
15 SenoClaire Tests New Grid Texture Test Minimum frequency Test Essential SenoClaire (w/ MTD) No 2D No 2D 3D Daily Monitor cleaning Weekly Flat field Weekly Phantom IQ Weekly CNR & MTF Weekly Viewbox & Viewing Monthly AOP Mode & SNR Monthly Visual Checklist Quaterly Repeat Analysis Semianually Compression Force x x Monthly Grid Texture 13
16 Grid Texture Test (monthly) Objective Measures the amount of grid texture in 2D images Equipment required Flat field test object Procedure Automatic acquisition of 10 2D images with increasing mas Record the dispayed test results Action Limit The texture level must not exceed
![Noise [counts] Grid Texture Test (monthly)](/docs-images/40/20839711/images/17-0.jpg "14000 12000 Noise vs dose 10000 8000 y = 0.")
17 Noise [counts] Grid Texture Test (monthly) Noise vs dose y = x x Detector dose [ngy] 15
18 SenoClaire Tests 3D Extensions Minimum frequency Test Essential SenoClaire (w/ MTD) No 2D No 2D 3D Daily Monitor cleaning Weekly Flat field Weekly Phantom IQ Weekly CNR & MTF Weekly Viewbox & Viewing Monthly AOP Mode & SNR Monthly Visual Checklist Quaterly Repeat Analysis Semianually Compression Force x x Monthly Grid Texture 16
19 Flat field 3D Test (Weekly) Objective Ensure flatness and homogeneity when reconstructing planes through a flat field phantom Equipment required Flat field test object Procedure Automatic 3D acquisitiion Record the displayed test results Action Limit Both Brightness non-uniformity* and SNR non-uniformity* tests must pass * Calculated in the plane at 10 mm height 17
20 Phantom IQ 3D Test (Weekly) Objective Ensure adequate and consistent IQ of 3D images Equipment required ACR mammography accreditation phantom Procedure 3D acquisitiion with Rh/Rh track/filter, 29 kv, 56 mas Review the volumes; score the phantom Scroll through the volume to find the best in-focus plane for each structure! Action Limit The score must be: Fibers > 4, Speck groups > 3, Masses > 3 Same technique & action limit as for the 2D test 18
21 AOP 3D Check (Monthly) Objective Check that the correct parameters are selected in AOP 3D mode Equipment required Set of acrylic plates (same as for the AOP 2D Check) Procedure 3D AOP acquisition on 25mm, 50mm, and 60 mm of acyrlic Record the exposure parameters Action Limit Acrylic Thickness (mm) Exposure parameters Track/Filter mas kv 25 Mo/Mo or Mo/Rh Rh/Rh Rh/Rh or 31 19
22 AOP 3D Check (Monthly) Displayed results 20
23 SenoClaire QC Tests for the Technologist 2D Tests: - Section 3: Phantom IQ Test with MTD - Checks for consistency of image quality. - Section 4: CNR and MTF Measurement with MTD - Checks for consistent production of good contrast images. - Section 8: AOP 2D and SNR Check with MTD - Checks for correct operation of AOP mode with MTD. MTD Test: Section 7: Grid Texture Test - Checks for consistency of image quality regarding grid texture. 3D Tests: - Section 5: Flat-field 3D Test - Checks for consistency of image quality. - Section 6: Phantom IQ 3D Test - Checks for consistency of image quality. - Section 9: AOP 3D Test - Checks for correct operation of AOP mode in 3D. Section 10: Visual Checklist (page 27). Section 11: Compression Force Test - Checks for the correct level of compression force. Section 12: Test Results Forms - Provides charts for use in recording test results. It is recommended that you copy these chart pages to record test results. For record keeping and further analysis, data generated on the Acquisition Workstation (AWS) for Flat-field, CNR, MTF, AOP and SNR tests can be exported as text files to a CD-R. 21
24 SenoClaire QC Medical Physicist 22
25 QC Tests for the Medical Physicist Test Essential SenoClaire (w/ MTD) no 2D no 2D 3D Flat field Phantom IQ CNR & MTF AOP Mode & SNR Artifact Eval & Flat field Unif Collimation (2 alternatives) Sub-system MTF or Focal Spot Perf Breast Entrance Expose, AGD, Reproducibility Flexible paddle deflection kvp Accuracy and Reproducibility HVL Mammo Unit Assembly Eval Grid Texture Compression paddle border to chestwall alignment Volume Coverage 23
26 QC Tests for the Medical Physicist Test Essential SenoClaire (w/ MTD) no 2D no 2D 3D Flat field Phantom IQ CNR & MTF AOP Mode & SNR Artifact Eval & Flat field Unif Collimation (2 alternatives) Sub-system MTF or Focal Spot Perf Breast Entrance Expose, AGD, Reproducibility Flexible paddle deflection kvp Accuracy and Reproducibility HVL Mammo Unit Assembly Eval Grid Texture Compression paddle border to chestwall alignment Volume Coverage 24
27 Test Intervals all at acceptance and at least annually 7 tests from radiologic technologist s section 5 additional only for medical physicists
28 SenoClaire Tests same as Essential Tests Test Essential SenoClaire (w/ MTD) no 2D no 2D 3D Flat field Phantom IQ CNR & MTF AOP Mode & SNR Artifact Eval & Flat field Unif Collimation (2 alternatives) Sub-system MTF or Focal Spot Perf Breast Entrance Expose, AGD, Reproducibility Flexible paddle deflection kvp Accuracy and Reproducibility HVL Mammo Unit Assembly Eval Grid Texture Compression paddle border to chestwall alignment Volume Coverage 26
29 Compression paddle to MTD chest wall alignment test Objective Assure that the paddle chest wall side border aligns with the chest wall side of the MTD Same test as Compression Paddle Chest Wall Test from the Collimation Assessment tests for Essential ( EN) - Job Card VF-P01A - Collimation Assessment with -Ray Cassette, OR - Job Card VF-P01B - Collimation Assessment with Radiation Sensitive Strips 27
30 SenoClaire Tests New Grid Texture Test Test Essential SenoClaire (w/ MTD) no 2D no 2D 3D Flat field Phantom IQ CNR & MTF AOP Mode & SNR Artifact Eval & Flat field Unif Collimation (2 alternatives) Sub-system MTF or Focal Spot Perf Breast Entrance Expose, AGD, Reproducibility Flexible paddle deflection kvp Accuracy and Reproducibility HVL Mammo Unit Assembly Eval Grid Texture Compression paddle border to chestwall alignment Volume Coverage 28
31 SenoClaire Tests 3D Extensions Test Essential SenoClaire (w/ MTD) no 2D no 2D 3D Flat field Phantom IQ CNR & MTF AOP Mode & SNR Artifact Eval & Flat field Unif Collimation (2 alternatives) Sub-system MTF or Focal Spot Perf Breast Entrance Expose, AGD, Reproducibility Flexible paddle deflection kvp Accuracy and Reproducibility HVL Mammo Unit Assembly Eval Grid Texture Compression paddle border to chestwall alignment Volume Coverage 29
32 3D Breast Entrance Exposure and AGD Objective Measure the typical entrance exposure in 3D mode on a standard breast (42-mm 50% fibroglandular); calculate the delivered AGD Equipment required Dosimeter & ACR Mammography accreditation phantom Procedure 3D stationary* acquisition in manual mode acquisition technique should be as close as possible to technique clinically used on a standard breast From the measured Entrance exposure compute the AGD Action Limit The AGD for a standard breast must not exceed 3 mgy per 3D acquisition Same procedure as for the 2D test but entrance dose measured over a sequence of 9 low-dose acquisitions * 3D acquisitions with the tube non-moving (at zero degree) 30
33 SenoClaire Tests New 3D Specific Test Test Essential SenoClaire (w/ MTD) no 2D no 2D 3D Flat field Phantom IQ CNR & MTF AOP Mode & SNR Artifact Eval & Flat field Unif Collimation (2 alternatives) Sub-system MTF or Focal Spot Perf Breast Entrance Expose, AGD, Reproducibility Flexible paddle deflection kvp Accuracy and Reproducibility HVL Mammo Unit Assembly Eval Grid Texture Compression paddle border to chestwall alignment Volume Coverage 31
34 Volume Coverage Objective Ensure that the entire imaged object is reconstructed on the Z-axis (perpendicular to the detector) Equipment required Set of acrylic plates; 2 1-mm Al sheets Procedure Sandwich 25 mm of acrylic plates in between the 2 Al sheets as showed in the picture Manual 3D exposure, clinically used compression force Search for the focal planes for the 2 Al sheets Repeat with 60 mm acrylic Action Limit The focal planes for the 2 Al planes must be in the reconstructed volume 32
35 Volume Coverage 33
36 SenoClaire Quality Control Forms 34
37 Conclusion Additional QC Tests for SenoClaire (with MTD installed) Technologist Tests 1. Phantom IQ 2D Test with MTD 2. CNR and MTF Measurement with MTD 3. Flat-field 3D Test 4. Phantom IQ 3D Test 5. MTD Grid Texture Test 6. AOP 2D and SNR Check with MTD 7. AOP 3D Check 8. Visual Checklist 9. Compression Force Test Weekly Monthly Medical Physicist Tests (in addition to repeating those above) 1. Compression paddle to chest wall alignment with MTD 2. Breast Entrance Exposure and AGD in 2D with MTD 3. Breast Entrance Exposure and AGD in 3D Mode 4. Artifact Evaluation and Flat-field Uniformity with MTD 5. Volume Coverage of DBT Semi-annually Annually 35
38 DBT QUALITY CONTROL PROCEDURES Quality Control Procedures: Digital Breast Tomosynthesis Selenia Dimensions Digital Breast Tomosynthesis Systems
39 S Y S T EDBT M DQUALITY E S C R I P TCONTROL I O A N D PROCEDURES U S E R I N T E R F A C E System Description
40 DBT QUALITY CONTROL PROCEDURES Image Acquisition Modes Conventional Acquires 2D images, only Tomo Acquires tomosynthesis images, only TomoHD Acquires tomosynthesis images, only Produces C-View images Combo Acquires 2D images Acquires tomosynthesis images ComboHD Acquires 2D images Acquires tomosynthesis images Produces C-View images
41 DBT QUALITY CONTROL PROCEDURES QC Modes Quality control procedures test Conventional Tomo Combo iview The following modes do not require separate QC testing TomoHD ComboHD
42 DBT QUALITY CONTROL PROCEDURES AWS Configurations With AWS-8000 (premium version) With AWS-5000 (standard version)
43 DBT QUALITY CONTROL PROCEDURES -Ray Generation -Ray Tube Tungsten (W) Anode LFS: 0.3 mm; SFS: 0.1 mm -Ray Filtration Conv: 50 μm Rh; 50 μm Ag Tomo: 0.7 mm Al -Ray Generator 200 ma max for LFS 50 ma max for SFS Max ma varies with kvp ma adjusts to target time range
44 DBT QUALITY CONTROL PROCEDURES Selenia Dimensions: Techniques Conventional 2D Imaging a-se detector, cm area 70 μm pixel size Rh and Ag filters HTC grid in contact mode; HTC (High Trans. Cellular) kvp Tomosynthesis Imaging a-se detector, cm area 140 μm pixel size Al filter No anti-scatter grid Moving tube, 15 sweep Moving detector 15 projections ~4 seconds acquisition Reconstruction ~100 μm pixel size 1 mm slice spacing kvp
45 S Y S T EDBT M DQUALITY E S C R I P TCONTROL I O A N D PROCEDURES U S E R I N T E R F A C E DBT Quality Control
46 DBT QUALITY CONTROL PROCEDURES Selenia Dimensions QC Manual 3d-breast-tomosynthesis-dimensions-2d-fullfield-digital-mammography The QC manual covers: - Selenia Dimensions 2D FFDM system - Selenia Dimensions DBT system - Current revisions: - MAN R008, Jul MAN R002, Aug 2014
47 DBT QUALITY CONTROL PROCEDURES Medical Physics QC Tests 12 tests to be performed by the medical physicist 7 of them have DBT components/requirements
48 DBT QUALITY CONTROL PROCEDURES Tomosynthesis Option Tomosynthesis specific tests are marked with an icon Icon indicates that a special action is required under tomosynthesis NOTE: When testing FFDM only, these instructions are ignored
49 S Y S T EDBT M DQUALITY E S C R I P TCONTROL I O A N D PROCEDURES U S E R I N T E R F A C E Quality Control Tests
50 MP Tests for Dimensions 2D 10
51 MP Tests with Tomosynthesis Option 11
52 Technologist Tests Dimensions 2D 12
53 Technologist Tests Tomosynthesis Option 13
54 DBT QUALITY CONTROL PROCEDURES Follow the 1999 ACR Mammography Quality Control Manual 1. MAMMOGRAPHIC UNIT ASSEMBLY EVALUATION
55 DBT QUALITY CONTROL PROCEDURES Follow the Hologic Selenia Dimensions Quality Control Manual 2. COLLIMATOR ASSESSMENT
56 DBT QUALITY CONTROL PROCEDURES 2a. -Ray Field to Light Field ONLY use the 24x29 cm compression paddle Cover the image receptor if repeated, high exposures are required (i.e. self-developing film)
57 DBT QUALITY CONTROL PROCEDURES 2b. -Ray Field to Image Receptor Test with the 24x29 cm compression paddle Test left, center and right x-ray fields with the 18x24 cm compression paddle Use the Zero-Degree Tomo view to test under tomosynthesis Follow the directions in the QC manual
58 DBT QUALITY CONTROL PROCEDURES 2c. Compression Paddle to Image Receptor Compression paddles Manufactured as single pieces Do not have adjusting parts Designed to comply with the regulations Design assumes mild compression (~10lb) to remove play
59 DBT QUALITY CONTROL PROCEDURES Follow the Hologic Selenia Dimensions Quality Control Manual 3. ARTIFACT EVALUATION
60 DBT QUALITY CONTROL PROCEDURES Procedure Highlights DICOM printer Send an artificial flat field image to the printer FFDM testing Test all focus/filter combinations (LFS/Rh; LFS/Ag; SFS/Rh; SFS/Ag) Preview image in full resolution DBT testing Test using middle projection Preview image in full resolution
61 DBT QUALITY CONTROL PROCEDURES Follow the 1999 ACR Mammography Quality Control Manual 4. KVP ACCURACY AND REPRODUCIBILITY
62 DBT QUALITY CONTROL PROCEDURES Procedure Highlights Cover the image receptor to protect it from radiation exposure FFDM extends to 39 kvp; DBT extends to 49 kvp Use the Zero-Degree Tomo mode to test beyond 39 kvp, if needed Non-invasive meters must be calibrated to the specific filters and energy range used Hologic Service can assist with equipment
63 DBT QUALITY CONTROL PROCEDURES Follow the 1999 ACR Mammography Quality Control Manual 5. BEAM QUALITY ASSESSMENT HVL MEASUREMENT
64 DBT QUALITY CONTROL PROCEDURES Procedure Highlights Cover the image receptor to protect it from radiation exposure Use the Zero-Degree Tomo mode to measure HVL under DBT (Al filter) NOTE: compression thickness should be <24cm for the system to allow exposure Non-invasive meters must be calibrated to the specific filters and energy range used [HVL > (kvp/100) ] in mm Al
65 DBT QUALITY CONTROL PROCEDURES Follow the Hologic Selenia Dimensions Quality Control Manual 6. EVALUATION OF SYSTEM RESOLUTION
66 DBT QUALITY CONTROL PROCEDURES Procedure Highlights Place the line pair phantom on top of the 4 cm acrylic c Rotate the line pair phantom 45 Apply lb of compression to avoid vibration during DBT Use the Flat Field view (no image processing) Resolution guidelines: FFDM: > 7 45 DBT: > 3 45
67 DBT QUALITY CONTROL PROCEDURES Procedure Highlights
68 DBT QUALITY CONTROL PROCEDURES Follow the Hologic Selenia Dimensions Quality Control Manual 7. AEC FUNCTION PERFORMANCE
69 DBT QUALITY CONTROL PROCEDURES AEC Function Description AEC modes Auto-Filter Auto-kV Auto-Time AEC positions Auto AEC: 2, 1cm 2 floating sensors at 5x14cm 2 area One of seven manual positions (marked on compression paddle) AEC function kvp and filter parameters are determined by compression thickness and AEC technique tables Starting mas is determined from short pre-exposure targeting a specific exposure index (EI) Final mas is adjusted by CNR correction factor
70 DBT QUALITY CONTROL PROCEDURES Procedure Highlights Compression thickness must be set using the compression display FFDM testing Range of phantom thickness Different operating modes (i.e. mag) Exposure compensation steps DBT testing Range of phantom thickness
71 DBT QUALITY CONTROL PROCEDURES Exposure Index (EI) EI is defined as the digital value of a detector element Raw EI values need to be corrected by Subtracting the DC offset (value of 50) Pixel Value = Normalizing by the CNR correction factor (given in Appendix D of the Hologic QC Manual) ROI mean DC Offset CNR Correction Factor
72 DBT QUALITY CONTROL PROCEDURES CNR Correction Factors, FFDM LFS
73 DBT QUALITY CONTROL PROCEDURES CNR Correction Factors, FFDM SFS
74 DBT QUALITY CONTROL PROCEDURES CNR Correction Factors, FFDM LFS
75 DBT QUALITY CONTROL PROCEDURES Calculation Example
76 DBT QUALITY CONTROL PROCEDURES Follow the Hologic Selenia Dimensions Quality Control Manual 8. BREAST ENTRANCE EPOSURE, AEC REPRODUCIBILITY AND AGD
77 DBT QUALITY CONTROL PROCEDURES Procedure Highlights Wait until the image receptor goes from Warming to Ready status Use ACR Phantom view to overwrite compression thickness to 4.2 cm
78 DBT QUALITY CONTROL PROCEDURES Procedure Highlights Test AGD in all three modes FFDM DBT Combo Hologic AGD recommended dose for ACR phantom FFDM: 1.2 mgy DBT: 1.45 mgy Performance criteria AGD < 3 mgy
79 DBT QUALITY CONTROL PROCEDURES Follow the Hologic Selenia Dimensions Quality Control Manual 10. PHANTOM IMAGE QUALITY EVALUATION
80 DBT QUALITY CONTROL PROCEDURES Procedure Highlights Wait until the image receptor goes from Warming to Ready status Use ACR Phantom view to overwrite compression thickness to 4.2 cm
81 DBT QUALITY CONTROL PROCEDURES Phantom Scoring Score phantom on AWS display Review image in full resolution FFDM scoring 5 fibers, 4 specs, 4 masses Due to phantom variations a score of 4.5/4.0/3.5 is acceptable providing SNR and high contrast resolution tests pass DBT scoring Scroll to the slice that puts the different elements in focus 4 fibers, 3 specs, 3 masses
82 DBT QUALITY CONTROL PROCEDURES Follow the Hologic Selenia Dimensions Quality Control Manual 11. SNR AND CNR MEASUREMENTS
83 DBT QUALITY CONTROL PROCEDURES Procedure Highlights Wait until the image receptor goes from Warming to Ready status Use ACR Phantom view to overwrite compression thickness to 4.2 cm ACR Phantom view allows automatic SNR/CNR calculations Test is performed under FFDM mode only
84 DBT QUALITY CONTROL PROCEDURES Automatic Computation
85 Geometry Calibration
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