If you click on Search for MQSA Certified Mammography Facilities in Your Area, you can access a listing by zip code of all mammography facilities in that zip code certified by the Food and Drug Administration (FDA) or Certifying State as meeting baseline quality standards for equipment, personnel and practices under the Mammography Quality Standards Act of 1992 (MQSA) and subsequent Mammography Quality Standards Reauthorization Act (MQSRA) amendments.
The FDA specifies that the new manual may be used only for full-field digital mammography systems and systems with DBT (not for contrast enhancement systems). The new ACR manual will go into effect in November 2018 for facilities that choose to use it for QC.
Download A Mammo
A link to download the new manual at no charge was emailed to the facility and technologist contacts (the persons with the ACR Mammography Accreditation login information) at all ACR-accredited mammography facilities on November 19, 2018, with instructions to share the link with their colleagues at the facilities, including their medical physicists. If you did not receive yours, please contact mamm-accred@acr.org.
The Mammography Accreditation Program provides facilities with peer review and constructive feedback on staff qualifications, equipment, quality control, quality assurance, image quality and radiation dose. The Mammography Quality Standards Act (MQSA) requires all U.S. mammography facilities to be accredited.
In February 2016, the FDA approved an ACR request for an alternative standard that will allow facilities to use the new ACR Digital Mammography Quality Control Manual under MQSA. ACR-accredited mammography facilities, medical physicists associated with ACR-accredited facilities, and those applying for accreditation can download the PDF manual at no charge.
The bottom line is that mammograms are the standard screening tool for breast disease because they can detect problems at the earliest, most treatable stage, usually before a lump can even be felt by your provider or during a breast self-exam. That has helped improve outcomes almost 2 percent a year, according to the Centers for Disease Control and Prevention.
A mammogram is an X-ray of the breasts. A certified technologist takes the images for radiologists specializing in breast disease to examine. All results are then relayed to your provider to share with you.
* 3-D Tomosynthesis mammography and ultrasound are located in the Women's Breast & Imaging Center in the Scheu Family Building, 1100 San Bernardino Road, Second Floor, Upland, CA 91786
The demands on mammography are therefore stringent: both high spatial resolution and excellent low contrast resolution are required to detect microcalcifications and to visualise masses respectively. Additionally, radiation doses must be kept as low as reasonably achievable, a requirement which is absolutely paramount for screening where approximately 99% of the population will be cancer-free at the time of their examination.
Upon arriving in Australia in 2009, I was impressed to find that a group of physicists had already published interim recommendations for digital mammography QA [11]. These physicists, along with the ACPSEM and the Royal Australian and New Zealand College of Radiologists (RANZCR) must be acknowledged for their role in the development and ongoing review of QA guidelines for digital mammography. By necessity, a new image receptor technology requires completely new quality control tests for both physicists and radiographers. Because the major strength of digital detectors is their wide dynamic range, the optimisation process differs from screen-film because the correct exposure is no longer limited purely by contrast, but also by noise. Digital imaging is susceptible to a phenomenon known as dose creep but fortunately, this does not appear to have been an issue in digital mammography, thanks to the rapid development and adoption of new quality control tests, including a measurement of the parameter Signal Difference to Noise Ratio (SDNR) to achieve the optimum balance between dose and image quality [12].
Radiographer QC is an area in which the mammography physicist should also play a key role. At the very least, they should review the QC log during their annual visit. In some respects, radiographers have faced more challenges than physicists, simply due to the number of routine QC standards that exist within Australia. Differences between national guidelines, local guidelines, vendor recommendations and the availability of medical physics support inevitably results in inconsistencies in testing methodologies between sites and a variation in the confidence level of radiographers in performing QC tests, interpreting results and taking appropriate action. Radiographers were faced with tests, tolerance levels and numerous acronyms which were initially unfamiliar to them. For example, measuring optical density on a film was replaced with measuring mean pixel value (MPV) in a region of interest (ROI) drawn on the unprocessed image. Instead of aiming for an optical density of 1.7 OD, regardless of the X-ray system or screen-film combination, most tests now require monitoring the percentage deviation from a baseline MPV. The baseline will be completely different for every equipment vendor so the primary aim of routine QC is to ensure consistency in performance. Equipment performance will, of course, have been confirmed to be optimised during the medical physics acceptance test! Another aim is to detect and remove artefacts, before they become clinically significant. This presented yet another challenge; the cause, appearance and removal of artefacts in digital mammography is quite different to those from screen-film mammography.
Once again, RANZCR [13] and ACPSEM [14] must be acknowledged for the swift development of routine QC guidelines for digital mammography. Furthermore, ACPSEM, with funding from the Australian Department of Health developed an online, interactive training program for radiographers working in digital mammography which aimed to provide a nationally consistent approach to QC training and processes. The program is known as oMamQA (online mammography QA) [15]. It was published in April 2013 and has been endorsed by the Australian and New Zealand Institutes of Radiographers for CPD points. As of June 2015, there had been 363 enrolments.
Unfortunately, CR has not offered such improvements [29]. Comparisons of cancer detection rates have either shown that CR is comparable to screen-film overall [30, 31], or comparable for invasive cancer only [26], or, worryingly, inferior to screen-film [32]. The difference in results between these studies is, in my view, attributed to differences in the CR performance of different vendors. A review of the UK NHSBSP technical evaluation reports indicates far more variation between CR systems than DR systems [24]. Even if clinical outcomes are comparable, the MGD required to achieve adequate image quality is higher than screen-film for all but one CR vendor [24]. Furthermore, my own testing experience indicates that the sensitivity of CR plates degrades over time and for CR systems greater than 3 years old, the MGD necessary to meet SDNR and image quality requirements is about 20% higher than that for a new system. In 2012, the ACPSEM therefore recommended that only DR technology should be approved for future purchases of equipment for screening mammography in Australia and New Zealand and existing CR systems should be progressively replaced [14].
CEDM employs a dual energy X-ray technique and requires the injection of iodinated contrast agent. With the breast under compression, two images are acquired in quick succession using energies above and below the K-absorption edge of iodine (33.2 keV). Subtracted images show suppression of glandular tissue and enhancement of contrast uptake, based on the principle of tumour angiogenesis, enabling improved detection and characterisation of breast carcinoma [40]. CEDM has demonstrated better sensitivity and specificity than digital mammography, particularly in dense breasts [41, 42]. Compared to MRI, CEDM is faster, cheaper, shares the appearance of digital mammography and offers equivalent sensitivity and improved specificity [43]. CEDM is currently being used as an assessment tool, and it is likely that this will remain the case, due to the requirement for contrast agent, which may be contraindicated in some women. CEDM alone has a similar radiation dose to digital mammography, but as with DBT, the technique is used in conjunction with 2D digital mammography. However, it has been shown that the low-energy mammogram obtained during CEDM may be a suitable alternative to the digital mammography projection image in the context of the assessment clinic [41, 42].
Computed radiography (CR) in mammography was initially based on systems for general radiography. Dedicated mammography CR systems are now available with improved imaging capability, particularly in terms of spatial resolution. The phosphor is carried on a clear backing plate and the reader scans both sides of the phosphor simultaneously.
Image quality data for both types of mammography CR system was obtained using standard test objects. All acquired images were printed onto film using a high-resolution laser printer and were scored under standard viewing conditions. Certain images were also scored as soft copy using a reporting workstation. Breast dose was also assessed. The results were compared to film screen data and to the National Health Service Breast Cancer Screening Programme (NHSBSP) guidelines on the introduction of CR systems for mammography.
Mammograms are one of the most important tools doctors have in breast cancer prevention and early detection. At Providence, our goal is to provide safe and accurate mammograms to help detect breast cancer in its earliest, most curable stage.
Mammography plays an important role in early detection of breast cancer, even before your health care provider can see or feel changes in the breast. The American College of Radiology and Society for Breast Imaging, recommend annual screening mammography starting at age 40. This results in the most lives saved from breast cancer. 2ff7e9595c
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