Physics of Mammography

References
The Essential Physics of Medical Imaging, Second Edition
JT. Bushberg et. al
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 Mammography

Radiographic examination specially designed for

detecting breast pathology and cancer

Low cost, low radiation dose procedure

Has the sensitivity for early detection and

improved treatment

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Mammographic features of breast cancer

1. Masses, particularly with irregular or speculated

(strands of tissue radiating out from an ill-defined
mass, producing a stellate appearance) margins

2. Clusters of micro calcifications (specks of calcium

hydroxyapatite)

3. Architectural distortions of breast structures

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Mammographic Features of Breast Cancer

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Why general plain radiography equipment are not
suitable in mammography?

Why dedicated x-ray machines and x-ray

detectors are required in mammography?

To improve contrast and resolution,

To decrease the radiation dose to the patient

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 Mammography Facts

Breast is composed of fatty tissue, glandular tissue and a

50/50 combination of both
Attenuation differences between normal and cancerous
tissues is small. It is highest at very low x-ray energies (10
– 15 keV) and is poor at higher energies (>35 keV).

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 Mammography Facts

Low x-ray energies provide the best contrast

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 Mammography Challenges

Detection of micro calcifications is important because

high correlation of calcification patterns with disease

Low x-ray energies provide the best differential

attenuation between the tissues (photoelectric effect)

However high absorption results in a high breast dose

and long exposure time

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 Mammography
Detect minute calcifications
Minimize dose
Enhance low contrast detection

Imposes extreme requirements on mammographic

equipment and detectors

Led to the refinement of dedicated x-ray equipment,

specialize x-ray tubes, compression devices, anti
scatter grids, photo timers, and detector systems

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 Improvements in Mammography

Contrast and details are significantly improved

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 Screening Mammography
Craniocaudal (CC) and mediolateral oblique
(MLO) views of each breast are routinely acquired

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 Modern Mammography

Dedicated Mammography
equipment

Specialized x-ray tubes

Breast compression devices

Optimized screen/film
detector systems

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Mammography Equipment

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 X-ray Tube Design

Cathode and Filament Circuit

Dual filaments in a focusing cup
0.3 mm (contact) and 0.1 mm (magnification) focal spot
sizes
Small focal spot minimizes geometric blurring and
maintains spatial resolution
Low operating voltage below 35 kVp

Tube currents
100 mA (± 25 mA) for large focal spot
25 mA (± 10 mA) for small focal spot
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 X-ray Tube Design

Molybdenum (Mo) and Rhodium (Rh) anodes (targets)

are used

Characteristic x-ray production is the major reason for

choosing Molybdenum and Rhodium

For Molybdenum at 17.5 and 19.6 keV

For Rhodium at 20.2 and 22.7 keV

Source to image distance (SID) of 65 cm is used

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 X-ray Tube Design

X-ray tube is tilted to

Minimize the effective focal spot size
Provide adequate field coverage
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 X-ray Tube Design

Heel effect – Lower x-ray intensity on the anode side

of the field due to attenuation through the target
To reduce the above and to get more uniform
exposure cathode-anode axis is placed from the chest
wall to the nipple
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 X-ray Tube Design

This orientation also minimizes equipment bulk near

the patient’s head for easy positioning

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 Tube Port

1 mm thick Beryllium used as the tube port

Beryllium provides both low attenuation and good

structural integrity

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 Beam Quality
Monoenergetic x-rays of 15 to 25 keV are optimal
choice to achieve high subject contrast at lowest
possible radiation dose

Compromises of polychromatic spectra

High energy x-rays in the bremsstrahlung spectrum
diminish subject contrast

Low energy x-rays in the bremsstrahlung spectrum

have inadequate penetration and contribute to patient
dose without providing a useful image

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 Beam Quality

Optimal x-ray energy is achieved by use of specific

target materials and filters to remove the low energy x-
rays

Added tube filters of the same element as the target

reduce the low-energy and high-energy x-rays in the
x-ray spectrum and allow transmission of
characteristic x-ray energies

Common target/filters in mammography Mo/Mo,

Mo/Rh, Rh/Rh
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 Molybdenum Spectra

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 Molybdenum Spectra

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 Mo/Mo Target Filter

Use for thin breasts

Provides 17-20 keV effective energy spectrum

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 Mo/Rh Target Filter

Common for imaging thicker and denser breasts

Produces slightly higher effective energy than
Mo/Mo.
Provides 20-23 keV effective energy leading to
increased penetration for thick and/or dense breasts
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 Rh/Rh Target Filter

Provides the highest effective energy beam (2 to 3

keV higher)

Useful for the thickest and densest breasts

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 Collimation
Fixed size metal apertures or variable field size
shutters are used to collimate the x-ray beam

Field size matches the 18×24 cm or 24×30 cm film

cassette sizes

Collimator light and mirror define the x-ray field

Useful x-ray field must extend to the chest wall

edge without field cutoff

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 X-ray Generator
Design and function are similar to a standard X-
ray generator
High frequency generators are the standard for
mammography

Differences
Lower power rating (3 kW)
Lower kVp (22 – 40 kVp)
Automatic Exposure Control (AEC) circuit

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 Automatic Exposure Control (AEC)
Called also as a photo timer
AEC sensor is located underneath the cassette in
mammography unlike conventional radiography

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 Automatic Exposure Control (AEC)

If the transmission of photons is insufficient to

trigger the AEC switch after an extended exposure
time, a backup timer is there to terminate the
exposure

For a retake, a higher kVp must be selected for

greater beam penetrability

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 Breast Compression

Breast compression is necessary

Reduces overlapping anatomy and decreases the
breast thickness
Less scatter, more contrast, less geometric
blurring of the anatomic structures, less motion
and lower radiation dose to the tissues
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 Breast Compression

Breast is compressed using a low attenuating

lexan paddle attached to a compression device

Flat, 90° paddle provides uniform density image

Principal drawback of compression is patient

discomfort 32
 Spot Compression

Spot compression uses small paddles

Can get better compression over a small area

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 Scatter Radiation
Degrades subject contrast

d
Amount of scatter increases
with breast thickness and
breast area and is relatively
constant with kVp (25-35
kVp)

Without scatter rejection,

only 50 to 70% of the
inherent subject contrast will
be detected
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 Antiscatter Grid

Used to reject scatter

Placed between the breast and the image receptor

Linear grids with a grid ratio 4:1 to 5:1 are typical.

Some manufacturers use cellular grids

Higher grid ratios provide greater x-ray scatter

removal but also give higher dose
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 Anti-Scatter Grids
Aluminum and carbon fiber are typical interspace
materials.

Carbon fiber is preferred (lower Z) because

Aluminum attenuates too many of the low energy
x-rays used in mammography

Grid frequencies range from 30 to 50 lines/cm for

moving grids and up to 80 lines/cm for stationary
grids

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 Anti-Scatter Grids

Bucky factor is the ratio of exposure with the grid

compared to the exposure without the grid for the
same film optical density

For mammography, Bucky factor is about 2 to 3,

so breast dose is doubled or tripled, but image
contrast improves by 40%

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 Air Gaps
Use of an air gap between the
patient and the screen-film d
reduces the amount of scatter
detection

Grids not used in

magnification, air gap used

Reduction of the breast dose is

offset by the shorter focal spot
to skin distance

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 Magnification
Small focal spot is used
d
1.5× to 2.0× magnification is
used

Advantages
Reduction of scatter

Increased resolution of the

image by the magnification
factor
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Mammography Screen Film Systems

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 Mammography Screen Film System
Cassettes are made of low attenuation carbon fiber

Have a single high definition phosphor screen

Used with a single emulsion film

Terbium activated gadolinium oxysulfide

(Gd2O2S:Tb) is the most commonly used screen
phosphor

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 Mammography Screen Film System

Screen is positioned in the back of the cassette

X-rays pass through the cassette cover and film

before interacting with the phosphor

Because of exponential attenuation, x-rays are more

likely to interact near the phosphor surface closer to
the film emulsion 42
 Mammography Screen Film System

Reduces distance traveled by light

Minimizes the light spreading and preserve spatial

resolution

X-ray absorption at depth in the screen produces

broader light distribution and reduces resolution
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 Mammography Screen Film System
For 100 speed mammography screen film, limiting spatial
resolution is about 15 – 20 lp/mm.

Occasionally, extended time processing is used

– (reduces dose and increases contrast)

Screen and film are designed to be matched for optimal

image quality

Mixing of screens and films is not recommended because of

potential variations in speed and other characteristics

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 Thank You
Next lesson will be on equipment accessories used in
mammography examination

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