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Risk of Radiation-Induced Cancer from Screening Mammography

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Risk of Radiation-Induced Cancer from Screening Mammography Risk of Radiation-Induced Cancer from Screening Mammography Raed Mohammed Kadhim M. Ali School of Health Sciences UNIVERSITY OF SALFORD, SALFORD, UK Submitted in Partial Fulfillment of the Requirements of the Degree of Doctor of Philosophy, November 2016 (Medical Physics) Table of Contents List of Figures ....................................................................................................................... VII List of Tables .......................................................................................................................... X List of Publications, Conference Presentations and Seminars ...................................... XIII List of Training Sessions ................................................................................................... XIV Acknowledgements ................................................................................................................ XV Terminology........................................................................................................................ XVI List of Abbreviations ......................................................................................................... XVI Abstract .............................................................................................................................. XVIII Chapter One : Introduction and Thesis Outline ........................................................................ 1 1.1 Introduction ..................................................................................................................... 1 1.2 Rationale, Aim and Objectives........................................................................................ 1 1.3 Thesis Structure ............................................................................................................... 2 Chapter Two : Breast Anatomy, Cancer and Imaging Modalities ............................................ 6 2.1 Chapter Overview ........................................................................................................... 6 2.2 Breast Anatomy ............................................................................................................... 6 2.3 Breast Density ................................................................................................................. 9 2.3.1 Wolf Classification ................................................................................................. 10 2.3.2 Tabar Classification ................................................................................................ 10 2.3.3 BI-RADS Classification ......................................................................................... 10 2.3.4 Boyd Classification................................................................................................. 11 2.3.5 Summary ................................................................................................................. 11 2.4 Breast Cancer ................................................................................................................ 11 2.4.1 Breast Cancer Types ............................................................................................... 11 2.4.2 Breast Cancer Risk Factors ..................................................................................... 12 2.4.2.1 Unchangeable Risk Factors (Gender and Age) ............................................................ 12 2.4.2.2 Relationship of Cancer with Breast Density ................................................................. 12 2.4.2.3 Genetic Factors ............................................................................................................ 13 2.4.2.4 Other Factors ............................................................................................................... 13 2.4.3 Breast Cancer Statistics .......................................................................................... 14 2.5 Breast Imaging Modalities ............................................................................................ 15 I 2.5.1 Mammography........................................................................................................ 15 2.5.2 Breast Computed Tomography (BCT) ................................................................... 16 2.5.3 Breast Ultrasound ................................................................................................... 16 2.5.4 Breast Magnetic Resonance Imaging (MRI) .......................................................... 17 2.6 Breast Cancer Screening ............................................................................................... 18 2.6.1 Breast Self-Examination (BSE) .............................................................................. 18 2.6.2 Clinical Breast Examination (CBE) ....................................................................... 19 2.6.3 Mammography Screening....................................................................................... 19 2.6.4 Magnetic Resonance Imaging (MRI) Screening .................................................... 20 2.6.5 Ultrasound Screening ............................................................................................. 20 2.7 Chapter Summary .......................................................................................................... 20 Chapter Three : Mammography: Development, Physics and Clinical Aspects ...................... 21 3.1 Chapter Overview ......................................................................................................... 21 3.2 The Origins of Mammography Imaging – Equipment and Rudiments of Technique .. 22 3.2.1 Early Developments of Image Receptor ................................................................. 23 3.2.2 Dedicated Mammography Machine Development ................................................. 25 3.2.3 Mammography Developments during the 1980s and 1990s .................................. 26 3.3 Digital Mammography .................................................................................................. 27 3.3.1 Types of Digital Mammography Detectors ............................................................ 28 3.3.1.1 Computed Radiography (CR) ....................................................................................... 28 3.3.1.2 Indirect Digital Mammography .................................................................................... 29 3.3.1.3 Direct Digital Mammography ...................................................................................... 30 3.3.2 FFDM Performance ................................................................................................ 30 3.4 FFDM Physics and Instrumentation .............................................................................. 34 3.4.1 X-ray Tube .............................................................................................................. 34 3.4.2 Breast Compression Device .................................................................................... 37 3.4.3 Grid ......................................................................................................................... 40 3.4.4 Automatic Exposure Control (AEC) ...................................................................... 40 3.4.5 Generator ................................................................................................................ 41 3.4.6 Digital Mammographic Viewing Workstations ..................................................... 41 3.5 Digital Breast Tomosynthesis (DBT) ............................................................................ 42 II 3.5.1 DBT Physics and Instrumentation .......................................................................... 43 3.5.1.1 Image Acquisition ......................................................................................................... 43 3.5.1.2 DBT Image Reconstruction .......................................................................................... 45 3.5.2 Clinical Performance of DBT (for both diagnosis and screening) ......................... 46 3.6 Anatomical Characteristics of the Breast in Mammographic Images ........................... 49 3.6.1 Cranio-caudal (CC) Projection ............................................................................... 50 3.6.2 Medio-lateral Oblique (MLO) Projection ............................................................... 51 3.6.3 Supplementary Mammographic Projections .......................................................... 53 3.7 Screening Mammography ............................................................................................. 53 3.8 Chapter Summary .......................................................................................................... 61 Chapter Four : Mammography Dosimetry .............................................................................. 63 4.1 Chapter Overview ......................................................................................................... 63 4.2 Risk of Low Radiation Dose ......................................................................................... 64 4.3 Mammography Dosimetry ............................................................................................ 69 4.3.1 Mean Glandular Dose (MGD) ................................................................................ 70 4.3.2 Mammography: Dose to Organs Other
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