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L N Rothenberg

Publications and source records attributed to L N Rothenberg.

15 recordsLinked to original sources

Physicists in mammography--a historical perspective.

Medical physicists and engineers, working with radiologists and technologists, have made significant contributions in the design of mammographic x-ray units and image receptors, as well as in the development of methods for evaluating mammographic image quality and procedures for quality control. More accurate methods of measuring radiation exposure in the energy range of mammography and more relevant calculations of radiation dose to breast tissue at risk have also been realized. This article will discuss some of the major contributions made by medical physicists for the benefit of mammography. Contributions of radiologists in mammography have been published elsewhere [Bassett, Gold, and Kimme-Smith (1994)]. All contributions cited in this article are based on referenced publications and citations in the following: Medical Physics; Radiology; NCRP Report No. 85; Quality Determinants in Mammography; AAPM Report No. 29; Reduced Dose Mammography, W. W. Logan and E. P. Muntz (editors); RSNA Categorical Course: Technical Aspects of Breast Imaging, A. Haus and M. Yaffe (editors); Film Processing in Medical Imaging, A. G. Haus (editor); Screen-Film Mammography: Imaging Considerations in Medical Physics, G. T. Barnes and G. Donald Frey (editors). The article is divided into six sections: (1) x-ray equipment and receptor development, (2) image quality, (3) radiation dose, (4) phantoms, (5) quality assurance, (6) digital mammography, and (7) reports and committees.

Biophysics

Demographic characteristics of physicists who evaluate mammographic units.

PURPOSE: To determine whether there will be an adequate number of physicists to meet the 1996 American College of Radiology (ACR) Mammography Accreditation Program requirements and assess the qualifications of physicists available to evaluate mammography units as required by the federal Mammography Quality Standards Act of 1992. MATERIALS AND METHODS: A 21-question survey prepared by the ACR was sent to most medical physicists who perform evaluations of mammographic units. Replies were received from 1,011 individuals. RESULTS: Survey results are based on the replies of 824 individuals who indicated a willingness to perform evaluations in the future. In 1996, there will be approximately 510 certified physicists to evaluate an estimated 14,000 mammography units in the United States. CONCLUSION: A sufficient number of certified diagnostic medical physicists will be available to provide required annual performance evaluations of all mammography units in the United States only if the number of units evaluated per physicist increases substantially over current levels.

Data Collection

Recommended specifications for new mammography equipment: report of the ACR-CDC Focus Group on mammography equipment.

The American College of Radiology has published a report that describes desirable features for new mammography x-ray units that will contribute to high-quality imaging. It encompasses all aspects of x-ray equipment performance including mechanical considerations, the x-ray tube focal spot and spectrum, generator performance, collimation, scatter rejection, and the automatic exposure control. The report is intended to provide guidance to equipment manufacturers and to purchasers of mammography systems with regard to basic performance levels that should be expected.

Female

Low-density supradiaphragmatic band artifact on advanced multiple-beam equalization radiography of the chest.

RATIONALE AND OBJECTIVES: A low-density dark band artifact was found above the diaphragm on advanced multiple-beam equalization radiography (AMBER) of the chest and was evaluated. METHODS: Fifty consecutive chest radiographs were evaluated for the presence of the artifact. AMBER radiographs of a phantom were scanned with a microdensitometer. RESULTS AND CONCLUSION: The presence of the artifact is confirmed on the patient chest radiographs (present in 84% on posteroanterior view; 94% on lateral view) and on the phantom images. The artifact was probably caused by a delayed system response to scanning across a sharp boundary.

Artifacts

Mammography instrumentation: recent developments.

Mammography instrumentation has evolved dramatically in recent years. New, more consistent and reliable X-ray generators have been introduced. X-ray tubes with sharper imaging capabilities, higher X-ray outputs, and photon spectra tailored for breasts of different compositions and thicknesses are available. High resolution image receptors which require lower patient dose are in routine use. Scatter reduction mechanisms allow images with higher contrast to be produced. The consistency of mammographic diagnosis has been improved by the introduction of stringent quality control programs which utilize simple phantoms for image evaluation and require that the patient dose be kept low. New developments in breast diagnosis include the use of digital image receptors and stereotactic needle positioning systems. In addition, computer aided diagnostic techniques are being developed. With currently available technology, high resolution, high contrast, and low dose images can be routinely acquired to aid in the early diagnosis of breast disease.

Biopsy

Radiation dose in CT.

The energy deposited in the patient by the rotating x-ray beam in computed tomography produces more uniform absorbed dose values within the section of imaged tissue than those produced in conventional radiologic procedures. The dose values within a specific section are determined by factors such as voltage, current, scan time, scan field, rotation angle, filtration, collimation, and section thickness and spacing. For routine dose determinations, a pencil ionization chamber is usually employed with a plastic phantom. Dose for a specific patient can be determined with thermoluminescent dosimeters placed on the patient. Multiple-scan procedures normally increase the dose in a specific section by less than a factor of two. Typical multiple-scan average doses are in the range of 40-60 mGy for head scans and 10-40 mGy for body scans. Integral dose, however, is directly proportional to the number of sections in an examination. When examination factors are changed to reduce dose, the image noise increases. An optimum protocol is one that results in a balance between dose and image quality.

Humans

AAPM tutorial. Patient dose in mammography.

Patient dose in mammography is important and must be measured for several reasons, especially for evaluation of risk to a patient in a screening program and for assessment and comparison of imaging techniques and equipment. Of the different types of dose that can be measured, mean glandular dose is the best indicator of patient risk. The author reviews factors that affect dose and discusses measurement of dose.

Breast

Digital angiography in the pediatric patient with congenital heart disease: comparison with standard methods.

Digital subtraction angiography (DSA) permits high-resolution cardiac imaging with relatively low doses of contrast medium and reduced radiation exposure. These are potential advantages in children with congenital heart disease. Computer-based DSA (30 frames/sec) and conventional cutfilm angiography (6 frames/sec) or cineangiography (60 frames/sec) were compared in 42 patients, ages 2 months to 18 years (mean 7.8 years) and weighing 3.4 to 78.5 kg (mean 28.2 kg). There were 29 diagnoses that included valvular regurgitant lesions, obstructive lesions, various shunt abnormalities, and a group of miscellaneous anomalies. For injections made at a site distant from the lesion and on the right side of the circulation, the mean dose of contrast medium was 60% to 100% of the conventional dose given during standard angiography. With injections made close to the lesion and on the left side of the circulation, the mean dose of contrast medium was 27.5% to 42% of the conventional dose. Radiation exposure for each technique was markedly reduced in all age groups. A total of 92 digital subtraction angiograms were performed. Five studies were suboptimal because too little contrast medium was injected; in the remaining 87 injections, DSA and conventional studies resulted in identical diagnoses in 81 instances (p less than .001 vs chance). The remaining six injections made during DSA failed to confirm diagnoses made angiographically by standard cutfilm angiography or cineangiography. We conclude that DSA usually provides diagnostic information equivalent to that available from cutfilm angiography and cineangiography, but DSA requires considerably lower doses of contrast medium and less radiation exposure than standard conventional methods.

Adolescent

Radiation dosimetry survey of computed tomography systems from ten manufacturers.

Profiles of the absorbed dose delivered throughout cylindrical and anthropomorphic phantoms during single scans by computed tomography systems from ten manufacturers were measured using LiF thermoluminescent dosemeters (TLD) and X-ray therapy verification film. The dose profiles demonstrate that a significant portion of the dose is delivered outside the imaged volume of a single scan. The doses measured in cylindrical Plexiglas phantoms were similar to those measured in anthropomorphic cross sections of tissue substitute materials except near the centre of the thorax section. The film results, obtained using a single calibration curve, agreed with the TLD results to within 25% for most systems.

Absorption

An evaluation of CT systems from ten manufactures.

During the past three years, 23 computerized tomography (CT) machines from ten different manufacturers located in Europe and the USA have been evaluated. Using the same set of phantoms and measurement techniques, performance data have been derived including noise, uniformity of CT numbers, low contrast detectability, spatial resolution, modulation transfer function, effective photon energy and linearity of CT numbers. Thermoluminescent and film dosimetry were used to determine single-slice dose profiles at the periphery and centre of specialized anthropomorphic phantoms. The results of this study are presented in tabular and graphical form together with some general conclusions on their implications.

Brain

Patient exposures from film and xeroradiographic mammographic techniques.

Radiation exposures of several mammographic imaging systems, including (a) industrial film, xeroradiographic plates, the Du Pont Lo-Dose vacuum-cassette screen-film combination exposed with a molybdenum target tube and (b) xeroradiographic plates exposed with a tungsten target, were investigated with a thin-window ionization chamber and a range of exposures for different breast sizes was determined for each technique. The Lo-Dose system was found to provide high-quality diagnostic images with minimal patient exposure.

Health Physics

A patient-equivalent attenuation phantom for estimating patient exposures from automatic exposure controlled x-ray examinations of the abdomen and lumbo-sacral spine.

The Joint Commission on Accreditation of Healthcare Organizations requires diagnostic radiology facilities to known the approximate amount of radiation received by an average patient during radiographic examinations at the facility. Automatic exposure controlled (AEC) techniques are used for many of these exams, and a standard patient-equivalent phantom is necessary when estimating patient exposure on such systems. This is of particular importance if exposures are to be compared among AEC systems with different entrance x-ray spectra. We have developed a phantom, LucA1 Abdomen, to facilitate determining the average patient exposure from AEC anteroposterior (AP) abdomen and lumbo-sacral (LS) spine radiography. The phantom is relatively lightweight, transportable, sturdy, and made of readily available inexpensive materials (Lucite and aluminum). It accurately simulates the primary and scatter transmission through the soft tissue and L-4 spinal regions of a patient-equivalent anthropomorphic phantom for x-ray spectra typically used in abdomen/LS spine radiography. A clinical evaluation to verify the patient-equivalence of three commercial anthropomorphic phantoms (Humanoid, Rando, 3-M) and two acrylic/aluminum phantoms (ANSI and LucA1 Abdomen) has been conducted. The design and development of the LucA1 Abdomen phantom and the evaluation of all phantoms is described.

Humans

Recommendations on performance characteristics of diagnostic exposure meters: report of AAPM Diagnostic X-Ray Imaging Task Group No. 6.

Task Group 6 of the Diagnostic X-Ray Imaging Committee of the American Association of Physicists in Medicine (AAPM) was appointed to develop performance standards for diagnostic x-ray exposure meters. The recommendations as approved by the Diagnostic X-Ray Imaging Committee and the Science Council of the AAPM are delineated in this report and provide specifications on meter precision, calibration accuracy, calibration reference points, linearity, energy dependence, exposure rate dependence, leakage, amplification gain settings, directional dependence, the stem effect, constancy checks, and calibration intervals. The report summarizes recommendations for meters used in mammography, general purpose radiography including special procedures, computed tomography, and radiation safety surveys for x-ray radiography.

Child