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Program Information

Breast Imaging QA

W Geiser

D Reeve

W Geiser*, D Reeve*, UT MD Anderson Cancer Center, Houston, TX

TH-A-134-1 Thursday 8:00AM - 9:55AM Room: 134

A. Implementation of a New Breast Tomosynthesis Program: A Clinical Medical Physicist’s Experience

Digital breast tomosynthesis (DBT) was approved by the FDA as a screening tool for breast cancer in February 2011. Many systems were preinstalled as 2D systems and are now being upgraded for DBT and there is evidence that DBT is helping reduce recall rates while increasing cancer detection rates. As of February 2013 there were approximately 500 systems certified by the FDA for DBT and it is expected that there will be more than 700 certified systems by the third quarter of 2013. Facilities implementing a breast tomosynthesis program need to be aware that there are many hurdles to be overcome before tomosynthesis studies can be performed.

The purpose of this lecture is to provide medical physicists assisting facilities that are upgrading 2D systems or installing new DBT systems, the knowledge to assist with facility design, image storage requirements, choice of PACS, and optimization of diagnostic review. New educational requirements for medical physicists to qualify to perform acceptance testing and continued annual testing of DBT systems will also be reviewed.

Learning Objectives:
1. Be able to assist with implementation of breast tomosynthesis at their facility.
2. Know the process for accreditation and certification of DBT systems.
3. Understand additional shielding requirements and facility design for a facility installing digital breast tomosynthesis.

B. Breast MR Imaging and Quality Control

MR imaging of the breast is an important adjunct to mammography and ultrasound for the detection of breast cancer and for breast biopsy guidance. Diagnostic breast MRI protocols typically include T2-weighted fat saturated images and 3D T1-weighted dynamic contrast enhanced (DCE) multiphase images using a Gadolinium-based contrast agent. The DCE images are used to determine the kinetic signature of enhancing tissues in order to differentiate between benign and malignant lesions. MR spectroscopy and diffusion weighted images (DWI) may also be acquired in order to provide additional diagnostic information.

The diagnostic value of breast MRI scans can be improved by choosing acquisition parameters that optimize image quality parameters such as SNR, contrast and spatial resolution. As with any MRI protocol, achieving the desired image quality must balance the need for acceptable scan times. The timing and temporal resolution of the DCE series are important considerations.

Breast radiofrequency (RF) coils are phased array coils capable of simultaneous bilateral imaging. A comprehensive breast MRI quality control program is important to assess the performance of the MRI system as well as the breast RF coils.

Learning Objectives:
1. Provide an overview of breast MR imaging and MR-guided biopsy procedures.
2. Describe breast MR image quality criteria and protocol optimization.
3. Discuss the components of a breast MRI quality control program.

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