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
Geiser WR et al: Artifacts in Digital Breast Tomosynthesis. AJR Am J Roentgenol. 211(4):926-932, 2018
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
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
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
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
Sechopoulos I: A review of breast tomosynthesis. Part I. The image acquisition process. Med Phys. 40(1):014301, 2013
Geiser WR et al: Challenges in mammography: part 1, artifacts in digital mammography. AJR Am J Roentgenol. 197(6):W1023-30, 2011
Machida H et al: Optimizing parameters for flat-panel detector digital tomosynthesis. Radiographics. 30(2):549-62, 2010
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
Bloomquist AK et al: Quality control for digital mammography in the ACRIN DMIST trial: part I. Med Phys. 33(3):719-36, 2006
Yaffe MJ et al: Quality control for digital mammography: part II. Recommendations from the ACRIN DMIST trial. Med Phys. 33(3):737-52, 2006
Ikeda D et al: Breast Imaging: the Requisites. Philadelphia: Elsevier Mosby. 1-23, 2004
Lewin JM et al: Digital mammography. Radiol Clin North Am. 42(5):871-84, vi, 2004
Pisano ED et al: Digital mammography. Philadelphia: Lippincott, Williams & Wilkins, 2004
Boyle ER et al: Motion artifact seen on slot-scanning direct digital mammography. AJR Am J Roentgenol. 172(3):697-701, 1999
Hendrick RE et al: ACR Mammography QC Manual. 4th ed. Reston: American College of Radiology, 1999
Chotas HG et al: Memory artifact related to selenium-based digital radiography systems. Radiology. 203(3):881-3, 1997
Bick U et al: Density correction of peripheral breast tissue on digital mammograms. Radiographics. 16(6):1403-11, 1996
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
Geiser WR et al: Artifacts in Digital Breast Tomosynthesis. AJR Am J Roentgenol. 211(4):926-932, 2018
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
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
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
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
Sechopoulos I: A review of breast tomosynthesis. Part I. The image acquisition process. Med Phys. 40(1):014301, 2013
Geiser WR et al: Challenges in mammography: part 1, artifacts in digital mammography. AJR Am J Roentgenol. 197(6):W1023-30, 2011
Machida H et al: Optimizing parameters for flat-panel detector digital tomosynthesis. Radiographics. 30(2):549-62, 2010
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
Bloomquist AK et al: Quality control for digital mammography in the ACRIN DMIST trial: part I. Med Phys. 33(3):719-36, 2006
Yaffe MJ et al: Quality control for digital mammography: part II. Recommendations from the ACRIN DMIST trial. Med Phys. 33(3):737-52, 2006
Ikeda D et al: Breast Imaging: the Requisites. Philadelphia: Elsevier Mosby. 1-23, 2004
Lewin JM et al: Digital mammography. Radiol Clin North Am. 42(5):871-84, vi, 2004
Pisano ED et al: Digital mammography. Philadelphia: Lippincott, Williams & Wilkins, 2004
Boyle ER et al: Motion artifact seen on slot-scanning direct digital mammography. AJR Am J Roentgenol. 172(3):697-701, 1999
Hendrick RE et al: ACR Mammography QC Manual. 4th ed. Reston: American College of Radiology, 1999
Chotas HG et al: Memory artifact related to selenium-based digital radiography systems. Radiology. 203(3):881-3, 1997
Bick U et al: Density correction of peripheral breast tissue on digital mammograms. Radiographics. 16(6):1403-11, 1996
IAEA, Quality assurance programme for digital mammography, HHS #17, 2011
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