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Breast
Special Topics
Artifacts
Artifacts: Mammography and Tomosynthesis
Artifacts: Mammography and Tomosynthesis
Wendie A. Berg, MD, PhD, FACR, FSBI; Michael P. Andre, PhD
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Definitions

          • Artifact: Any physical phenomenon that adds structured noise to image, degrades image quality, mimics pathology, or interferes with image interpretation
          • Full-field digital mammography (FFDM): Electronic device designed to acquire and store images of entire breast
          • Digital breast tomosynthesis (DBT): Digital mammogram acquired by moving tube in arc (ranging from ± 7.5° to ± 20°) with reconstruction of 1-mm slices or planes parallel to detector plane
            • Out-of-plane artifacts: Objects such as calcifications and clips are blurred in direction of tube motion
              • Effect increases with distance from plane of object
            • Blurring: Out-of-plane object appears blurred due to incomplete cancellation of out-of-plane signal
            • Ripple or zipper: Similar to blurring, but object seen discretely multiple times in image; in limiting situation when object is farthest from scan plane, it will appear as frequently as number of projections (e.g., 15 projections = 15 repeated objects)
          • Computed radiography: Digital modality in which latent images are recorded on cassettes with photostimulable phosphor screens
            • Screens are scanned in reader device that uses laser point-by-point, which generates stimulated emissions in proportion to x-ray exposure
          • Review workstation: Soft-copy display device suitable for primary interpretation of digital mammograms
          • Ghosting: Remnant image from prior exposures superimposed on current digital image
            • More common with amorphous selenium (a-Se) detectors than cesium-iodide (Cs-I)
          • Thickness compensation or thickness equalization: Image postprocessing algorithm applied to tissue near skin line to yield approximately uniform background density compensating for breast thickness roll-off
          • Detector saturation: X-ray flux to detector, which exceeds dynamic range of detector, causing registration of maximum possible signal and eliminating contrast between pixels
          • Digital systems required to score at least 4 fibers, 3 speck groups, and 3 masses on American College of Radiology (ACR) phantom, just as for film screen
            • Some digital system manufacturers have set higher requirements
            • Phantom images acquired in 2D typically score higher than DBT
          • Minus density: Lower optical density (lighter)
          • Plus density: Higher optical density (darker)

        IMAGING

        • General Features

          • Radiographic Findings

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                CLINICAL ISSUES

                • Presentation

                  DIAGNOSTIC CHECKLIST

                  • Consider

                    • Image Interpretation Pearls

                      Selected References

                      1. Geiser WR et al: Artifacts in Digital Breast Tomosynthesis. AJR Am J Roentgenol. 211(4):926-932, 2018
                      2. Paap E et al: Mammography in females with an implanted medical device: impact on image quality, pain and anxiety. Br J Radiol. 89(1066):20160142, 2016
                      3. Broeders MJ et al: Comparison of a flexible versus a rigid breast compression paddle: pain experience, projected breast area, radiation dose and technical image quality. Eur Radiol. 25(3):821-9, 2015
                      4. Skaane P et al: Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-field digital mammographic images. Radiology. 271(3):655-63, 2014
                      5. Lu Y et al: A diffusion-based truncated projection artifact reduction method for iterative digital breast tomosynthesis reconstruction. Phys Med Biol. 58(3):569-87, 2013
                      6. Sechopoulos I: A review of breast tomosynthesis. Part I. The image acquisition process. Med Phys. 40(1):014301, 2013
                      7. Geiser WR et al: Challenges in mammography: part 1, artifacts in digital mammography. AJR Am J Roentgenol. 197(6):W1023-30, 2011
                      8. Machida H et al: Optimizing parameters for flat-panel detector digital tomosynthesis. Radiographics. 30(2):549-62, 2010
                      9. Ayyala RS et al: Digital mammographic artifacts on full-field systems: what are they and how do I fix them? Radiographics. 28(7):1999-2008, 2008
                      10. Bloomquist AK et al: Quality control for digital mammography in the ACRIN DMIST trial: part I. Med Phys. 33(3):719-36, 2006
                      11. Yaffe MJ et al: Quality control for digital mammography: part II. Recommendations from the ACRIN DMIST trial. Med Phys. 33(3):737-52, 2006
                      12. Ikeda D et al: Breast Imaging: the Requisites. Philadelphia: Elsevier Mosby. 1-23, 2004
                      13. Lewin JM et al: Digital mammography. Radiol Clin North Am. 42(5):871-84, vi, 2004
                      14. Pisano ED et al: Digital mammography. Philadelphia: Lippincott, Williams & Wilkins, 2004
                      15. Boyle ER et al: Motion artifact seen on slot-scanning direct digital mammography. AJR Am J Roentgenol. 172(3):697-701, 1999
                      16. Hendrick RE et al: ACR Mammography QC Manual. 4th ed. Reston: American College of Radiology, 1999
                      17. Chotas HG et al: Memory artifact related to selenium-based digital radiography systems. Radiology. 203(3):881-3, 1997
                      18. Bick U et al: Density correction of peripheral breast tissue on digital mammograms. Radiographics. 16(6):1403-11, 1996
                      19. IAEA, Quality assurance programme for digital mammography, HHS #17, 2011
                      Related Anatomy
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                      Related Differential Diagnoses
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                      References
                      Tables

                      Tables

                      KEY FACTS

                      • Terminology

                        • Imaging

                          • Diagnostic Checklist

                            TERMINOLOGY

                            • Definitions

                              • Artifact: Any physical phenomenon that adds structured noise to image, degrades image quality, mimics pathology, or interferes with image interpretation
                              • Full-field digital mammography (FFDM): Electronic device designed to acquire and store images of entire breast
                              • Digital breast tomosynthesis (DBT): Digital mammogram acquired by moving tube in arc (ranging from ± 7.5° to ± 20°) with reconstruction of 1-mm slices or planes parallel to detector plane
                                • Out-of-plane artifacts: Objects such as calcifications and clips are blurred in direction of tube motion
                                  • Effect increases with distance from plane of object
                                • Blurring: Out-of-plane object appears blurred due to incomplete cancellation of out-of-plane signal
                                • Ripple or zipper: Similar to blurring, but object seen discretely multiple times in image; in limiting situation when object is farthest from scan plane, it will appear as frequently as number of projections (e.g., 15 projections = 15 repeated objects)
                              • Computed radiography: Digital modality in which latent images are recorded on cassettes with photostimulable phosphor screens
                                • Screens are scanned in reader device that uses laser point-by-point, which generates stimulated emissions in proportion to x-ray exposure
                              • Review workstation: Soft-copy display device suitable for primary interpretation of digital mammograms
                              • Ghosting: Remnant image from prior exposures superimposed on current digital image
                                • More common with amorphous selenium (a-Se) detectors than cesium-iodide (Cs-I)
                              • Thickness compensation or thickness equalization: Image postprocessing algorithm applied to tissue near skin line to yield approximately uniform background density compensating for breast thickness roll-off
                              • Detector saturation: X-ray flux to detector, which exceeds dynamic range of detector, causing registration of maximum possible signal and eliminating contrast between pixels
                              • Digital systems required to score at least 4 fibers, 3 speck groups, and 3 masses on American College of Radiology (ACR) phantom, just as for film screen
                                • Some digital system manufacturers have set higher requirements
                                • Phantom images acquired in 2D typically score higher than DBT
                              • Minus density: Lower optical density (lighter)
                              • Plus density: Higher optical density (darker)

                            IMAGING

                            • General Features

                              • Radiographic Findings

                                • Imaging Recommendations

                                  DIFFERENTIAL DIAGNOSIS

                                    CLINICAL ISSUES

                                    • Presentation

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Geiser WR et al: Artifacts in Digital Breast Tomosynthesis. AJR Am J Roentgenol. 211(4):926-932, 2018
                                          2. Paap E et al: Mammography in females with an implanted medical device: impact on image quality, pain and anxiety. Br J Radiol. 89(1066):20160142, 2016
                                          3. Broeders MJ et al: Comparison of a flexible versus a rigid breast compression paddle: pain experience, projected breast area, radiation dose and technical image quality. Eur Radiol. 25(3):821-9, 2015
                                          4. Skaane P et al: Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-field digital mammographic images. Radiology. 271(3):655-63, 2014
                                          5. Lu Y et al: A diffusion-based truncated projection artifact reduction method for iterative digital breast tomosynthesis reconstruction. Phys Med Biol. 58(3):569-87, 2013
                                          6. Sechopoulos I: A review of breast tomosynthesis. Part I. The image acquisition process. Med Phys. 40(1):014301, 2013
                                          7. Geiser WR et al: Challenges in mammography: part 1, artifacts in digital mammography. AJR Am J Roentgenol. 197(6):W1023-30, 2011
                                          8. Machida H et al: Optimizing parameters for flat-panel detector digital tomosynthesis. Radiographics. 30(2):549-62, 2010
                                          9. Ayyala RS et al: Digital mammographic artifacts on full-field systems: what are they and how do I fix them? Radiographics. 28(7):1999-2008, 2008
                                          10. Bloomquist AK et al: Quality control for digital mammography in the ACRIN DMIST trial: part I. Med Phys. 33(3):719-36, 2006
                                          11. Yaffe MJ et al: Quality control for digital mammography: part II. Recommendations from the ACRIN DMIST trial. Med Phys. 33(3):737-52, 2006
                                          12. Ikeda D et al: Breast Imaging: the Requisites. Philadelphia: Elsevier Mosby. 1-23, 2004
                                          13. Lewin JM et al: Digital mammography. Radiol Clin North Am. 42(5):871-84, vi, 2004
                                          14. Pisano ED et al: Digital mammography. Philadelphia: Lippincott, Williams & Wilkins, 2004
                                          15. Boyle ER et al: Motion artifact seen on slot-scanning direct digital mammography. AJR Am J Roentgenol. 172(3):697-701, 1999
                                          16. Hendrick RE et al: ACR Mammography QC Manual. 4th ed. Reston: American College of Radiology, 1999
                                          17. Chotas HG et al: Memory artifact related to selenium-based digital radiography systems. Radiology. 203(3):881-3, 1997
                                          18. Bick U et al: Density correction of peripheral breast tissue on digital mammograms. Radiographics. 16(6):1403-11, 1996
                                          19. IAEA, Quality assurance programme for digital mammography, HHS #17, 2011