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Screen-film mammography

Introduction

Mammography, be it screen-film or digital mammography, is one of the most demanding examinations in medical imaging requiring fine detail, high contrast, low patient motion, low noise images, and appropriate viewing conditions.  In addition, with screen-film mammography the photographic processing is extremely critical to the quality of the final image.

First and foremost, mammography must be carried out using dedicated mammographic imaging equipment with low energy output (molybdenum x-ray tube anode, or a tungsten anode at low kilovoltage, e.g., 30 kVp or less) imaging capability.  It is not appropriate to do mammographic examinations with other than a dedicated mammography system.

Important Principles

There are several manuals available regarding mammographic imaging.  These emphasize the importance and proper use of technology, but also stress the importance of correct patient positioning and breast compression.  Although the medical physicists do not directly play a role in positioning and compression, they must understand the need and assure that the equipment is functioning appropriately.

Image quality is extremely important in mammography and it is essential to assure that the entire mammographic imaging system is functioning optimally.  This includes the screens and film, the mammographic x-ray system, the photographic processor, and the viewing area and view boxes or digital displays.  There is a section in the ACR Mammography Quality Control Manual entitled “Important Points” which discusses many of these areas.

Introduction to References

The essential references include information on both screen-film and digital mammography since much of the information regarding screen-film mammography is also applicable to digital mammography. The IAEA documents cover all aspects of a mammography quality assurance programme.

  Click here for more details on the IAEA text, including supplementary  interactive material    

Well established national and regional QA programmes in mammography include the American College of Radiology Mammography Accreditation Program and European documents.  The ACR Mammography Accreditation Requirements provides a concise list of the requirements for dedicated mammography equipment in the Equipment section and for quality control in the Quality Control Section.

The NCRP report covers the history of mammography, looks at patient dose and risk, and provides guidance for the overall mammography screening programme and quality control.