Evolution of mammographic image quality in the state of Rio de Janeiro

Villar, Vanessa Cristina Felippe Lopes; De Seta, Marismary Horsth; Andrade, Carla Lourenço Tavares de; Delamarque, Elizabete Vianna; Azevedo, Ana Cecília Pedrosa de

doi:10.1590/0100-3984.2014.0047

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ORIGINAL ARTICLES • Radiol Bras 48 (2) • Mar-Apr 2015 • https://doi.org/10.1590/0100-3984.2014.0047 copy

Evolution of mammographic image quality in the state of Rio de Janeiro^* * Study developed at Escola Nacional de Saúde Pública Sergio Arouca/Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To evaluate the evolution of mammographic image quality in the state of Rio de Janeiro on the basis of parameters measured and analyzed during health surveillance inspections in the period from 2006 to 2011.

Materials and Methods:

Descriptive study analyzing parameters connected with imaging quality of 52 mammography apparatuses inspected at least twice with a one-year interval.

Results:

Amongst the 16 analyzed parameters, 7 presented more than 70% of conformity, namely: compression paddle pressure intensity (85.1%), films development (72.7%), film response (72.7%), low contrast fine detail (92.2%), tumor mass visualization (76.5%), absence of image artifacts (94.1%), mammography-specific developers availability (88.2%). On the other hand, relevant parameters were below 50% conformity, namely: monthly image quality control testing (28.8%) and high contrast details with respect to microcalcifications visualization (47.1%).

Conclusion:

The analysis revealed critical situations in terms of compliance with the health surveillance standards. Priority should be given to those mammography apparatuses that remained non-compliant at the second inspection performed within the one-year interval.

Mammography; Breast neoplasms; Quality assurance; Health care; Quality control; Public health surveillance

Parameters	Standards
Monthly image quality testing	The facility performs monthly imaging quality testing and the results remain at the health surveillance disposal
Collimation evaluation	The x-rays must cover the whole film surface, without exceeding the compression paddle borders
Automatic exposure control	Variations should not be > 20% for breasts between 2 and 5 cm in thickness. It is desirable that the variation does not exceed 10%
Compression paddle force	The compression paddle force should be between 11 and 18 kg
Compression paddle alignment	The maximum acceptable deformation is 5 mm
Surface entrance dose in the phantom	The dose should be < 10 mGy
Films processing	Films processing must comply with the physical quality standards
Films response	The films must comply with minimum specifications for appropriate images generation
High-contrast details (microcalcifications)	Small-sized objects should be visualized up to sets with 0.25 mm in diameter
Low-contrast circular details (disks)	Low-contrast objects, polyester disks with 2 mm in diameter and thickness between 0.5 and 3.0 mm should be visualized up to the 7th disk
Low-contrast linear details (fibers)	Low-contrast linear objects of different diameters mimic fibrotic tissue into fat tissue and should be visualized up to 0.75 mm fiber
Visualization of tumor masses	Nylon spherical caps mimic tumor masses and should be visualized up to the 4th cap of 4.0 mm in diameter and 2.0 mm thickness
Background optical density (OD)	Measurement at a spot on the phantom image located at 6 cm from the chest wall and laterally centered on the film. Threshold between 1.10 and 1.80
Contrast index	The image contrast affects the visualization of structures. Represented by optical density points on the film of the evaluated facility. Values between 0.55 and 0.67
Absence of imaging artifacts	Imaging artifacts are defects in the image processing which may result either in loss or marking of information. They should not be present
Availability of mammography-specific film processor	The availability of mammography-specific film processor ensures the maintenance of proper adjustment tothe thickness of the mammographic film

Status	Description
Compliance stability	The compliance observed at the first inspection remained unchanged at the second inspection
Compliance rate decrease	The compliance observed at the first inspection was no longer observed at the second inspection
Compliance rate increase	The non-compliance observed at the first inspection evolved to a compliance situation at the second inspection
Stationary	The non-compliance observed at the first inspection remained unchanged at the second inspection

	Compliance (%)
Parameters	First inspection	Second inspection
Monthly image quality testing	26.9	28.8
Collimation evaluation	64.6	62.5
Automatic exposure control	68	58
Compression paddle force	72.3	85.1
Compression paddle alignment	52.9	52.9
Entrance dose on the phantom surface	73.1	51.9
Films processing	54.5	72.7
Facility film response	47.7	72.7
High-contrast details (microcalcifications)	80.4	47.1
Low-contrast circular details (disks)	47.1	45.1
Low-contrast linear details (fibers)	96.1	92.2
Tumor masses visualization	60.8	76.5
Background optical density	68.6	62.7
Contrast index	66.0	64.0
Absence of imaging artifacts	64.7	94.1
Availability of mammography-specific film processors	88.5	88.2

	Status
	Stability		Compliance rate decrease		Compliance rate increase		Stationary		Total
Parameters	n	%	n	%	n	%	n	%	n	%
Collimation evaluation	17	32.7	13	25	12	23.1	6	11.5	48	92.3^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Automatic exposure control	25	48.1	9	17.3	4	7.7	12	23.1	50	96.2^* * Study developed at Escola Nacional de Saúde Pública Sergio Arouca/Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
Compression paddle force	29	55.8	5	9.6	8	15.4	5	9.6	47	90.4^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Compression paddle alignment	18	34.6	9	17.3	9	17.3	15	28.8	51	98.1^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Entrance dose on the phantom surface	20	38.5	18	34.6	7	13.5	7	13.5	52	100
Films processing	14	26.9	8	15.4	17	32.7	5	9.6	44	84.6^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Facility film response	13	25	5	9.6	19	36.5	7	13.5	44	84.6^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Mammography-specific film processors	36	69.2	3	5.8	3	5.8	3	5.8	52	100

	Status
	Stability		Compliance rate decrease		Compliance rate increase		Stationary		Total
Parameters	n	%	n	%	n	%	n	%	n	%
Monthly imaging quality testing	8	15.4	5	10.0	7	13.5	29	56	49	94.2^* * The difference for 100% corresponds to the absence of data in the inspection reports.
High-contrast details (microcalcifications)	22	42.3	18	34.6	2	3.8	9	17.3	51	98.1^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Low-contrast circular details (disks)	12	23.1	12	23.1	11	21.2	16	30.8	51	98.1^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Low-contrast linear details (fibers)	47	90.4	1	1.9	0	0	3	5.8	51	98.1^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Tumor masses visualization	28	53.8	3	5.8	12	23.1	8	15.4	51	98.1^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Background optical density	23	44.2	11	21.2	9	17.3	8	15.4	51	98.1^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Contrast index	22	42.3	11	21.2	10	19.2	7	13.5	50	96.2^* * The difference for 100% corresponds to the absence of data in the inspection reports.
Absence of imaging artifacts	31	59.6	2	3.8	16	30.8	2	3.8	51	98.1^* * The difference for 100% corresponds to the absence of data in the inspection reports.

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[1] Mailing Address: Vanessa Cristina Felippe Lopes Villar. Avenida Brasil, 4365, Manguinhos. Rio de Janeiro, RJ, Brazil, 21040-360. E-mail: vanessalopesvillar@ gmail.com.

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Evolution of mammographic image quality in the state of Rio de Janeiro* * Study developed at Escola Nacional de Saúde Pública Sergio Arouca/Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.

Objective:

Materials and Methods:

Results:

Conclusion:

Evolution of mammographic image quality in the state of Rio de Janeiro^* * Study developed at Escola Nacional de Saúde Pública Sergio Arouca/Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.