MAMMOGRAPHY

The X-ray imaging of breast organ is called mammography. It is basically a soft tissue radiography in
which the tissues have similar effective atomic number and similar mass density. However, it will
enhance the differential absorption In soft tissues. It helps to detect breast cancer early and reduces
the mortality rates for women.

BREAST ANATOMY

The breast consists of three tissues, namely, fibrous tissue, glandular tissue, and adipose (fat) tissue.
In premenopausal women, the fibrous and glandular tissues are characterized with ducts, glands and
connective tissues that are surrounded by fat layer

EQUIPMENT

Mammography equipment comprises of high frequency generator molybdenum target, filter, grid,
compression device, and automatic exposure control system . High frequency generator works on
single phase and provides rectified smoothed voltage supply to the tube with ripple factor of about
1%. They are smaller in size with good reproducibility and capable of providing up to 600 mAs. It
employs small focal spots, low kVp technique, low grid ratio, and special screen- films.

TARGET

The X-ray tubes are designed with tungsten (W, Z = 74), molybdenum (Mo, Z = 42), and rhodium (Rh,
Z = 45) targets.

Tungsten target X-ray tube is operated under 30 kVp with 0.5 mm Al filter.

It gives brems- strahlung and 12 keV L-shell characteristic X-rays.

Bremsstrahlung X-ray is useful for mammogram and the characteristic X-ray too low for image
formation and gives only patient dose.

The useful energy range for mammogram is 17-24 keV,

The effective anode angle is about 22-24°, for a source to image distance of 65 cm. This can be
achieved either by o• anode angle and 24° tube tilt or 16° anode tilt and 6° tube

FILAMENT

The filament Is positioned within a focusing cup, which offer two focal spot sizes, namely, 0.4 mm
and 0.1 mm, respectively.

FILTERS

Thin beryllium (Z = 4, 1 mm thick) window or borosilicate glass window is used to reduce inherent
filtration, since It offers low attenuation. This wlll facilitate the inherent filtration in the order of 0.1
mm Al equivalent. In addition, filters are used to remove unwanted high energy bremsstrahlung X-ray
COMPRESSION PEDDLE

Breast compression Is required In all mammography examinations, to get good quality images.
Compression also ensures that tissues near the chest wall are not underexposed and tissues near the
nipple

not over exposed. Breast compression have the following advantages:

(i) it reduces the overlapping of anatomy, spread out the tissue, reduces the thickness of breast and
require only low kVp, thereby improving subject contrast

, (ii) since compressed breast is thinner, scatter radiation is reduced and contrast resolution is
improved,

(iii) compression brings the breast closer to the receptor, minimizes magnification and reduces focal
spot blurring with lesser radiation dose to the breast,

(iv) it also helps to have uniform thickness of breast, to reduce the dynamic range of exposures, and

(v) it also immobilizes the breast, minimizes motion

It is flat and

parallel to the breast support table.

It should match the cassette size

of 18 x 24 cm or 24 x 30 cm. It

can be operated by foot from either

side of the patient. Compression

gives a force of 10-20 newton

GRID

Scattered radiation is an important factor that reduces contrast in mammography. Scatter increases
with breast thickness, breast area and independent of kVp. Scatter can be reduced by grid, or air gap

technique with breast compression. Hence, special grids are made for mammography, and are
placed between the breast and cassette. Generally, moving grids with grid ratio 4:1, focused to the
SID Is used to improve Image contrast
COlllMATION AND HVL

Metal apertures or variable shutters are used to collimate the X-ray beam. It matches the cassette
sizes of 18 x 24 cm or 24 x 30 cm.

The half value layer (HVL) of the mammographic beam ls about 0.3-0.4 mm Al. This depends
upon
the kVp range and type of target/filter used in the tube.

APPLIED VOLTAGE

The operating voltage ranges from 25-30 kVp with tube current of 80-100 mAs. The exposure
times
are about 1-4 s. The tube is operated less than 35 kV, within the space charge effect

AUTOMATIC EXPOSURE CONTROL

Automatic exposure control (AEC) system employs phototimers to measure the X-ray intensity
and
quality. Usually, they are kept closer to the image receptor, to minimize the object to image distance
(010), thereby improving spatial resolution. There are two types of AEC available, namely, (i)
ionization chamber type and (ii) solid state diode type

SCREEN-FILM SYSTEM

Mammography Is used with screen- film and digital detectors today. The cassette, screens and
films
are specially made for mammography. Single emulsion film with single back screen is used to avoid
light cross over

The cassette is made up carbon fiber, to have low attenuation (low Z) and are available in 18 x
24 and
24 x 30 cm sizes. Its back side is made up of low absorbing material when used with AEC

DIGITAL MAMMOGRAPHY
Digital system uses full field of X-rays and hence called full field digital mammography (FFDM).

In this, Image can be captured Indirectly or directly. In an Indirect capture, X-rays fall In an scintillator
(Csl:TI), which emits light. This light may be detected by a photodlode (a-SI) or a charged coupled
device (CCD).
In direct capture, the X-rays falls directly on the photo conductor (a-Se), which converts the X-rays
Into digital signal.

I) slot scannln1 with sclntlllattor with CCD arrays,

(II) flat panel scintillator with a-SI diode array, (Ill} flat panel a-Se array,

(Iv) tiled s~ntlllator with fiber-optic tapers and a CCD arrays, and
(v) photostimulable phosphor plates (CR).

Slot Scanning with Scintillator with CCD Arrays

This system consists of a thallium activated Csl with fiberoptic coupling to a CCD. The X-rays are
collimated into a fan beam, matching the detector array. The detector scans laterally across the
breast in synchrony

with X-ray beam and forms the image. The detector Is lm wide In the scanning direction and
consists of 4 CCD

Flat Panel Scintillator with a-Si Diode Array

This system uses a-Si thin film transistor (TFT). The a-Si diode arrays are constructed from a matrix of
a-Si TFT deposited on a glass substrate. Csl crystals are deposited as linear columns on the a-Si
detector array. When light falls on the diode, it liberates charge, which is read out and digitized.

It consists of 1920 x 2304 detector elements on a 19.2 x 23 cm area with each pixel size of 100 µ

Flat Panel a-Se Array

The a-Se digital detector directly converts X-rays into electronic signal. It is a good photoconductor
with high X-ray absorption capability (95%). Its quantum efficiency is higher than that of film-screens
and Csl

Flat Panel a-Se Array

The a-Se digital detector directly converts X-rays into electronic signal. It Is a good photoconductor
with high X-ray absorption capability (95%). Its quantum efficiency is higher than that of film-screens
and Csl
coNE BEAM COMPUTED TOMOGRAPHY

cone Beam Computed Tomography (CBCT) •

. rth d ti d IS a specialized imaging technique used primarily in
denttsit~, ~h ~ on cs, dan some medical fields to produce 30 Images of a patient's anatomy,
espec a Y e ones_ an soft tiS$Ues In the head, neck, and oral regions. It differs from traditional CT
scans In how It acquires and processes the Images

PRINCIPLE

X-ray Source:
. The. system uses a cone-sh aped x-ray beam, as opposed to the fan-shaped beam •in
traditronal CT. This beam rotates around the patient, capturing images from multiple angles.

Detectors: On th e opposite side of the X-ray source, a flat-panel detector captures the X-rays that
pass through the patient.

Data Acquisition: As th e X-ray source and detectors rotate around the patient (usually in a single or
few rotations), they gather data that is used to construct a 30 image.

30 Imaging:

Reconstruction: The data is fed into a computer where specialized software reconstructs it into a 30
image (volumetric data). This provides a highly detailed view of the area being scanned, often with
better spatial resolution than regular CT scans.

Cross-Sectional Views: The 30 data can be viewed in multiple formats (axial, coronal, sagittal), and
you can zoom in on any particular area for greater detail.

ADVANTAGES
High Resolution: CBCT produces high-resolution images, allowing for clear visualization of fine
anatomical details, such as bone structure and teeth.

Lower Radiation Dose: Compared to traditional CT scans, CBCT typically exposes the patient to much
lower doses of radiation.
Speed: CBCT scans are generally faster than conventional CT scans, often taking only a few seconds
to complete.
3D Visualization: The ability to create 30 models provides better Insights, especially for complex
conditions or pre-surgical planning.
Portable: some cecr systems are smaller and more portable than traditional CT machines, making
them more accessible in different healthcare settings.

CLINICAL APPLICATIONS:-
Dentistry and Oral surgery: CBCT is extensively used to evaluate dental Implants, impacted teeth,
root canals, Jaw tumors, and the sinuses. It provides detailed views of the Jaw and teeth, which ts
crucial for planning surgeries.
 orthodontics: For assessing skeletal structure, Jaw alignment, and for treatment planning, CBCT
t
helps orthodontiS s plan braces or other corrective Interventions with greater precision.
nd
ENT (Ear, Nose, a Throat): It's useful for vlsuallzlng structures llke the sinuses, nasal cavity, and ear
bones.

Maxillofaclal Surgery: CBCT Is critical for planning surgeries related to the facial bones, Including
reconstructfve and trauma surgeries.

1mplantology: CBCT helps In precise placement of dental Implants by giving a comprehensive 30 view
of bone volume and the proximity to vital structures llke nerves and sinuses.

Sleep Medicine: It's used to evaluate airway space for conditions llke sleep apnea,

LIMITATIONS :_

Soft Tissue Imaging: While CBCT Is excellent for hard tissues (llke bone and teeth), It Is not as
effective for Imaging soft tissues like muscles and nerves. It does not provide the same detalled soft
tissue contrast as tradlttonal CT or MRI.

Artifacts: The quality of Images can sometimes be compromised by artifacts caused by metal dental
work, fllllngs, or other Implants.

Limited Field of View: Some CBCT systems have a limited field of view (FOV), meaning they may not
be able to capture as large an area as a traditional CT scan.

PROCEDURE:

The patient typically stands or sits In front of the CBCT machine, which may have them bite Into a
stablllzer to keep their head stf 11.

The machine rotates around the patient's head (or the area of Interest) while taking the Images.

The scan usually lasts for about 10-30 seconds.

Once the scan rs complete, the Images are processed, and the 30 models are generated.

POST PROCESSING AND INTREPRETATION :_

After the scan Is done, t he Imases are Interpreted by I trained radloloslst, dentist, or orthodontist,
who can review the 30 models, cross-secttons, and volume renderln1s.
'I
I
This lnterpretatfon helps In dla1nosls, treatment plannln1, and follow-up care,

I f I tool for cre1ttn1 hlahly det1lled 3D lm11es of the head,

In 1urnm1ry, Cone 811m CT Is power u advantaaes over tradlt1on1I 20 X-rays or 1t1nd1rd CT
ntck, and dental structures, provldln1 m•n~slon and low radiation exposure are Important.
&cans, 11p1cl1lly In 1pplle1tfon1 where prec
 7

PLICATION
HOUNSFIELD UNIT AND ITS AP
ity used by
asurement of radio dens
a ~elative quantitative me
'fhe Hounsfi~ld uni_t (HU) is ) images. The
int erp retati on of co mputed tomography (CT
diologists in the is used during CT
ua tio n co eff icie nt of radiation within a tissue
:sorption/atten
a grayscale image
reconstruction to produce
the X-ray
is pro po rtiona l to the absorption/attenuation of
ue
The physical density of tiss CT unit, is then calculate
d based on a
als o ref err ed to as the
beam. The Hounsfield unit, X-ray beam, where
the ba se line line ar att enuation coefficient of the
linear transformation of defined to be zero
sta nd ard tem pe rature and pressure) is arbitrarily
distilled water (at for
its can reach up to 1000
an d air de fin ed as -1000 HU. The upper lim
Hounsfield Un its like steel or
s like the coc hle a, and more than 3000 for metals
ne
bones, 2000 for dense bo
silver sal
wing, for example, the na
feren ce be twe en so ft tissues and air is great allo ld value ranges
Density dif ans represent narrow Ho
unsfie
see n. So ft tiss ue s and org
airways to be clearly ent structures, such as
ore mo re dif fic ult to dif ferentiate between adjac
and are theref data.
en fat and mu scl e wh en viewing and segmenting CT
betwe ximately 1000
ys hav e gre ate r HU values. Cortical bone is appro
Things that absorb more x-ra HU; cerebrospinal fluid,
10
ou t 40 HU ; gra y ma tter , 40 HU; white matter, 30
HU; muscle, ab
00
HU; fat, -60; and air, -10
uals and between
l var y som ew hat between healthy individ .
Althoug h val ue s wil on non-contrast CT 10-12
, differ en t tiss ues hav e predicable normal values
manufacturers

air: -1000 HU
bone (cortical): >1000 HU
0 HU
bone (trabecular): 300 to 80
11
brain (grey matter): 40 HU
11
brain (white matter): 30 HU
5 HU 10
subcutaneous fat: -100 to -11
liver: 45-50 HU 10

lungs: ·9SO to -650 HU 12

metal: >3000 HU
muscle: 45 to SO HU 10
10
renal cortex: 25 to 30 HU
spleen: 40 to 45 HU 10
water: oHU (by definition)
APPLICATIONS :-
t tumo rs based on their HU values,
rumor evaluation: Differentiating benign from malignan
re a low HU Indicates a likely benign
particularly In organs like the adrenal glands whe
1denoma.
ion and potential treatablllty of kidney
Kidney stone analysis: Determining the composit
In deciding the best treatment approach.
stones by measuring their density In HU, aiding
density to diagnose osteoporosis and
Bone mineral density assessment: Quantifying bone
monitor treatment effectiveness.
In the liver by comparing the HU of liver
Fatty liver diagnosis: Identifying fatty Infiltration
tissue to surrounding structures.
tissue types like gray matter, white
Neurological Imaging: Differentiating different brain
which can be cruclal In stroke diagnosis.
matter, and blood clots based on their HU values,
ity to Identify conditions like sarcopenla.
Muscle mass evaluation: Assessing muscle dens
ls based on their HU values.
Vascular assessment: Identifying blood clots In vesse