1. Quality Assurance, Quality Control & Equipment Bushong Ch. 19 & 20
MAMMOGRAPHY QA
Quality Assurance, Quality Control
& Equipment
Bushong Ch. 19 & 20
PURPOSE OF QC
ASSURES OPTIMUM PATIENT CARE
by avoiding unnecessary repeat exposures due to artifacts, processing problems and equipment failure
Rev. Spring 2009/2010

2. EQUIPMENT DESIGN & OPERATION STANDARDS (DEDICATED UNITS)
MQSA National Statistics
FEDERAL LEGISLATION
OCT. 1, 1994
EQUIPMENT DESIGN & OPERATION STANDARDS (DEDICATED UNITS)
INTENSIVE QUALITY CONTROL PROGRAM
Certification statistics, as of March 1, 2010
  12,623
Certified facilities with FFDM2 units / Accredited FFDM units
5,402 / 7,963
Total annual mammography procedures reported, as of March 1, 20101
38,057,377
Percent of inspections with no violation
80.2%
WHAT DOES MQSA REPRESENT? __________________
1 This number is an aggregate of the total number of procedures performed annually as reported by facilities to

3. MAMMO & Quality Control
Quality control is an equipment and processing evaluation program in diagnostic imaging centers.
QC involves testing, record keeping and evaluation of imaging equipment and processing
QC Team includes Radiographer/Mammographer, Physicists and Radiologist
QA involves people – scheduling, reports, waiting time and follow up exams
“double reads”
See Bushong – CH PG 333

4. Elements of QC pg 333 FREQUENCY TASKS Daily Weekly Monthly/Quarterly
Darkroom Clean
Processor QC – sensitometry/densitometry and DEVELOPER temp
Screen Cleaning
VISUAL CHECK
Phantom Images
Repeat Analysis (should be less than 2% repeat rate - diagnostic rad = 5%)

5. MAMMO QC MONTHLY Checks SEMIANNUALLY DARKROOM FOG SCREEN/FILM CONTACT
COMPRESSION
NOT MORE THAN
40 PSI
(25 PSI
is average)

6. QUALITY CONTROL TOOLS PHANTOM DIGITAL THERMOMETER SCREEN CLEANER
LINT FREE CLOTHS
FIXER RETENTION TESTING KIT
CHARTS

7. Hypo Retention Checks for what?
Fixer left on film – “Archival Properties”

8. WIRE MESH Checks for what
How long should you wait after loading a cassette to use it?
15 min & placed in an upright position

9. Check for leaks/cracks?
Types of Safelights?
Wratten 6b
GBX
Check for leaks/cracks?
How often?
Bulb Wattage?

10. For those still using film… clean crossovers daily
Use “dedicated” processor for only mammo

11. Not calcifications in the breast
VISUAL
CHECKLIST
MONTHLY
FIXER RETENTION
REPEAT
ANALYSIS
DARKROOM
FOG
SEMI-ANNUAL
FILM/SCREEN
CONTACT
COMPRESSION
(25 PSI)
These specks were produced by flakes trapped between the film and the screen –
Not calcifications in the breast

12. PHANTOM IMAGES 4/5 masses 3/4specks 4/6 fibers should be seen
Daily - to assure film density, contrast, uniformity and image quality are optimum – Using the SAME cassette and technical factors each time
4/5 masses
3/4specks
4/6 fibers
should be seen
(see pg 500 review book)

13. REPEAT ANALYSIS Mammography should be less than 2%
Number of repeated film
Repeat Rate = X 100
Total # of films
Diagnostic Radiology = less than 5%
Students = less than 10 %

15. Mammography Equipment Bushong – Ch. 19
FILM SCREEN
& DIGITAL
When the x-ray tube is tilted in its housing, the effective focal spot is small, the x-ray intensity is more uniform, and tissue against the chest is imaged.

16. EQUIPMENT DIFFERENCES
TARGET MATERIAL –
MOLYBDENUM
MO/RHODIUM
SMALLER FOCAL SPOTS
SHORTER SID
KVP RANGES
LOW ~ 24 – – 28 (Bushong)
(type of target used)
MAS
PHOTOCELLS

17. Mammography Imaging System
High frequency generators
TARGET MATERIAL:
Tungsten (W), (z = ____?)
Molybdenum (Mo), (z = ___ ?)
or rhodium (Rh) target (z = ___ ?)
Focal spot sizes 0.3/0.1 mm (Bushong)
with tilted tube
Maximum 600 mAs limit

18. Mammography Imaging System
Inherent filtration 0.1 Al equivalent
Heel effect used to advantage
Compression reduces motion, improves spatial resolution, lowers patient dose
High-transmission cellular grid
Automatic exposure control

19. DEDICATED MAMMOGRAPIC EQUIPMENT
KVP RANGE : 23 – 28 kvp (BUSHONG)
TARGETS: Molybdenum / Rhodium (vs. Tungsten)
FOCAL SPOTS
(can range from 0.1 – 0.6)
SID 60 –70 cm (vs. 100cm)
Compression Paddle
Heel Effect (fat/cat)
GRIDS : 4:1 or 5:1 (vs 8 to16:1)
What does “DEDICATED”
Mean in the above title?

20. Anode Heel Effect –
Which portion should
Be under the cathode
Side of the TUBE?
The heel effect can be used to advantage in mammography by positioning the cathode toward the chest wall to produce

21. DIGITAL MAMMO DIGITAL has a resolution of approximately
5 lp/mm – but also has MORE CONTRAST
CONVENTIONAL FILM/SCREEN: resolution of approximately 12 lp/mm
No need for an additional exposure to the patient

22. MAMMOGRAPHIC IMAGES
The BREAST has a low subject contrast – little differences in density = soft tissue radiography

23. Can affect: kVp & mAs ranges
Compression in mammography has three principal advantages: improved spatial resolution, improved contrast resolution, and lower patient dose.
Can affect:
kVp & mAs ranges

24. but improves contrast significantly p 327
A high-transmission cellular grid designed specifically for mammography.
4:1 or 5:1 grid ratio
40 line/cm frequency
4:1 grid doubles pt dose –
but improves contrast significantly p 327
Correct way to load mammography film and position the cassette.
Spatial resolution improves when the x-ray film is placed closest to the breast and
between the x-ray tube and the radiographic intensifying screen.

26. Position of AEC
over breast tissue

27. Remove all ambient light when possible – for better images

28. Risk Factors for Breast Cancer
Age: the older you are, the higher the risk
Family history: mother, sister with breast cancer
Genetics: presence of BRCA1 or BRCA2 genes
Breast architecture; dense breast tissue
Menstruation: onset before age 12
Menopause: onset after age 55
Prolonged use of estrogen
Late age at birth of first child or no children
Education: risk increases with higher education
Socioeconomics: risk increases with higher status