In achieving the goals of mammography, quality control standards should be adopted during the technical, training and clinical trial of the breast cancer. However, the range of activities included in the process should have a wide implication on the mammography imaging process. In such a consideration, a systematic approach to assessing improved performance is realized through the implementation of the quality assurance (QA) program. Besides, the QA programs provide a framework for increased performance by enhancing the feedback mechanism to allow for the identification of deviations from the optimal performance of the mammographic equipment, training requirements, and suboptimal clinical practice (LI et al., 2001). Furthermore, for an effective QA program, the clinical settings should be enacted to improve the practice. As well, adequate test equipment should be instituted to arrive at a standard method of obtaining the desired outcomes along with the quality of the subjective metrics. Such a consideration should ensure that the costs incurred are small to make the process affordable. Nevertheless, equipment testing should address critical imaging stages and be implemented in a multidisciplinary team approach that includes, the radiologists, medical physicist, radiographer. In other words, the national and international guidelines on the quality of mammography are based on the technical aspects as well as clinical aspects such as epidemiology, pathology, surgery, and interventions (Klabunde et al., 2001). Such a scenario has been enhanced through the development of digital mammography to increase the efficiency of the QA programs while encouraging the new tests and procedures in QC.
Similarly, based on QA and QC measures in mammography, three main stages of testing have been adopted for breast dose assessment, that is, image acquisition, processing, and display. In testing image acquisition, the x-ray production system is recommended for the alignment of x-ray fields, the accuracy of output resource, and the automatic exposure control versus thickness of the breast in addition to the arrangement of the compression plate. Furthermore, the mean glandular dose is essential in mammography for assessing the risk of radiation in the developing breast cancer (Marshall, 2011). However, different protocols are used in measuring the required mean glandular dose. Besides, the image receptor testing in digital mammography includes the response function of the mammography system, image noise, uniformity of the signals, and image artifacts. More so, in assessing the quality of the acquired image, technical and clinical image quality criteria are employed using phantoms and test objects (Tsai et al., 2010). Meanwhile, the analysis of artifacts focuses on the chemical processing and screen-film detector degradation, which helps in the investigation of image acquisition problems in the CR systems.
Consequently, the QA testing of the mammographic systems and breast dosage assessment depends on the image detection and acquisition system used in the procedures since they have direct implications for the outcomes. The methods involved in assessing breast dose vary due to the recommended breast phantoms and test objects. However, the use of a standard methodology for dose assessment allows for the comparison of different techniques of mammography and investigation of the technical setting of the breast dose. Therefore, mammography is set to be beneficial if the QC tests can be acquired from the clinical and technical aspects, which calls for collaboration and teamwork in the promotion of success of QA programs.
Klabunde C, Bouchard F, Taplin S, Scharpantgen A, Ballard-Barbash R. Quality assurance for screening mammography: an international comparison. J Epidemiol Community Health. 2001;55(3):204–212. doi: 10.1136/jech.55.3.204
Li Y, Poulos A, Mclean D, Rickard M. A review of methods of clinical image quality evaluation in mammography.Eur J Radiol. 2010;74:122–131. doi: 10.1016/j.ejrad.2009.04.069.
Marshall NW, Mackenzie AHI.Quality control measurements for digital x-ray detectors.Phys Med Biol. 2011;56:979–999. doi: 10.1088/0031-9155/56/4/007
Tsai HY, Chong NS, Ho YJ, Tyan YS.Evaluation of depth dose and glandular dose for digital mammography.Radiat Meas. 2010;45(3–6):726–728. doi: 10.1016/j.radmeas.2010.02.005
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