Technology in Cancer Research & Treatment

ISSN 1533-0346
Volume 1, Number 2, April (2002)
©Adenine Press (2002)

Historical Technical Developments in Mammography Arthur G.Haus

www.tcrt.org Medical Physicist

In mammography it is most important to consistently produce high-contrast, high resolution 112 Tar Heel Drive
images at the lowest radiation dose consistently with high image quality. Today it is possible Delaware,OH 43015
to obtain mammograms with higher image quality that require significantly lower radiation
dose compared to mammograms dating back to the 1970’s and early 1980’s. Some of the
technical developments due to x-ray equipment and image receptors and quality control pro-
grams that have let to todays high quality mammographic images are discussed in this article.

Introduction

In recent years, there have been many significant technological improvements in

mammographic x-ray equipment, image recording systems, and viewing condi-
tions. Some of the major technical development and quality control milestones
in mammographic imaging are shown in Table 1 (1-7). Until the mid 1980’s,
many x-ray units were used that were not dedicated to mammography. These x-
ray units had tungsten target tubes that were designed originally for medical
imaging procedures, such as chest radiography. Some of these units had com-
pression devices that were home made;therefore, breast compression was less
than optimal by today ’s standards. Many of these units had very large focal
spots or short focal spot-to-breast surface distances that could result in signifi-
cant geometric blur (unsharpness). Direct exposure (industrial type) x-ray films
were being used, which often required long exposure times (causing blur by
motion) and which resulted in high radiation exposure. In addition, viewing con-
ditions were inadequate.

Today, mammography is performed with dedicated mammographic x-ray equip-

ment. These units have specially designed tube targets, smaller focal spots, and
significantly improved breast compression devices, among other features.
Cassettes and screen-film combinations are designed specifically for mammog-
raphy. Film processing and viewing conditions also have improved significant-
ly over the years. In 2000, the first digital mammography system was approved
by the Food and Drug Administration (FDA) for clinical use.

The American College of Radiology (ACR) Mammography Accreditation

Program introduced in 1987, the ACR Quality Control Manuals introduced in
1992, and the Mammography Quality Standards Act which was implemented in
1994, have also had a significant impact on the improvement of the technical
quality of mammographic images in the United States.

Today it is possible to obtain mammograms with higher image quality that

Corresponding Author:
require significantly lower radiation doses compared with mammograms dating Arthur G. Haus
back to the 1970’s and early 1980’s, (Figure 1). E-mail: hausag@aol.com

119
120 Haus

Table I
Technical Advances in Mammography
Year Development
Prior to 1969 Conventional tungsten target x-ray tubes with direct exposure industrial type films were used
1969 Dedicated mammographic unit with molybdenum target tube and compression cone introduced (CGR Senographe)
1971 Xeroradiography system introduced for mammography (Xerox)
1972 Screen-film system introduced for mammography (DuPont Lo-dose system)
1976 Rare earth screen-film system and special cassette introduced for mammography (Kodak Min-R system)
1977 Mammography x-ray unit for magnification with microfocal spot introduced (Radiological Sciences Inc.)
1978 Mammography unit with grid introduced (Philips)
1987 American College of Radiology Mammography Accreditation Program (ACR MAP) begins
1992 American College of Radiology Mammography Quality Control Manual for Radiologists, Radiologic
Technologists, and Medical Physicists, introduced
1994 The Food and Drug Administration (FDA) implements the Mammography Quality Standards Act (MQSA)
2000 Digital mammography system approved by the FDA for clinical use (GE Senographe 2000D)

X-ray Equipment aluminum (xeroradiography). The unit also had a compres-

sion cone, a most important feature that identified it as a ded-
Prior to the late 1960’s, there were no commercially available, icated mammographic unit (Figure 2 left). Between 1969
dedicated mammographic x-ray units. X-ray units with tung- and 1973, more than 1000 units were installed. In the early
sten targets which were originally designed for medical imag- 1970’s, dedicated mammographic units became commercial-
ing procedures such as chest radiography were being used. ly available from several companies, including General
Some of these units had compression devices that were home- Electric, Philips, Picker, and Siemens (1, 5, 8).
made;therefore, breast compression was less than optimal by
today ’s standards. Many of these units had very large focal
spots and/or short focal spot-to-breast surface distances which
could result in significant geometric blur (unsharpness).
Direct exposure (industrial type) x-ray films were used which
often required long exposure times (causing blur due to
motion) and which resulted in very high radiation exposures.

Figure 2: The first commercially available mammographic x-ray unit, the

CGR Senographe, was produced in 1967. The unit featured a molybde-
num target x-ray tube nd a compression cone (left). The CGR Senographe
unit with long cone technique (right) (Haus et al 13))

In 1977, dedicated unit with microfocal spot for magnifica-

Figure 1: Mammograms of the same patient, same breast, taken in (A)
1977, (B) 1984, (C) 1990 and (D) 1998. (Images courtesy of Wende Logan-
Young, MD)
Tube Target and Filtration
Charles-Marie Gros, a physicist and physician at the
University of Strasbourg, using a phantom, experimented
with crystallographic x-ray tubes having different anode
materials and filters. He showed that molybdenum anode
and molybdenum filter produced improved images (higher
contrast) of the breast. In 1969, the first of series of dedi-
cated mammographic x-ray units – the CGR Senographe unit
contained a molybdenum target tube which filtered the beam
using either 0.03 mm of molybdenum (film) or 0.5 mm of
tion mammography became commercially available from
Radio-logic Sciences Inc., a subsidiary of Pfizer (1). This
unit had a tungsten target with beryllium window and two
focal spot sizes – microfocal spot (0.09mm nominal) for
magnification and a larger (0.45mm) focal spot for conven-
tional mammography. In 1984 (CGR) introduced a higher
current microfocus tube which allowed a longer SID with
less scatter for the same magnification factor (8).
In 1992, double track x-ray source with a molybdenum tar-
get, molybdenum filter, a rhodium target, and a rhodium fil-
ter was introduced by General Electric.
Dedicated molybdenum target x-ray units are widely used,
and settings of less than 28 kVp are generally recommended
with these units (2, 4). The use of low-energy photons, such

Technology in Cancer Research & Treatment, Volume 1, Number 2, April 2002

Historical Developments in Mammography
as those produced by the 17.9 and 19.5 keV characteristic
lines from the molybdenum target, provide high subject con-
trast for breasts of average thickness. When a 0.03mm
molybdenum filter is used, the spectrum is strongly sup-
pressed at photon energies greater than 20 keV because of the
k-shell absorption edge of molybdenum at that energy (9-11).
This allows more radiation from the characteristic lines to be
used in image formation. Other tube target and filter combi-
nations used in dedicated mammographic units include a (1)
tungsten target with approximately 0.06-mm molybdenum
filter, (2) tungsten target with approximately 0.05-mm rhodi-
um filter, and (3) rhodium target with approximately 0.025-
mm rhodium filter (Figure 3). It has been shown that molyb-
denum target with molybdenum filter combinations are
appropriate for breasts less than 5 cm thick, and molybdenum
target with rhodium filters or rhodium target with rhodium
filters may be appropriate for breasts greater than 5 cm thick
(12). For mammography, kVp settings between 22 and 32
are used depending on breast tissue thickness and composi-
tion and exposure time. It has been shown that increasing
kVp settings between 24 and 32 kVp, at comparable optical
densities causes a slight decrease in lesion detections (8).
Figure 3: Typical x-ray spectra comparing molybdenum target and molyb-
denum filter with rhodium target and rhodium filter (Haus 11).
Geometry and Focal Spots
In 1975, a study showed that, although direct exposure films
have higher spatial resolution than mammographic screen-
film combinations, total resolution can be optimized with
mammographic screen film combinations by using longer
cones (increased focal spot-to-film distances) and/or smaller
focal spots on dedicated mammographic units (Figure 2
right, Figure 4) (13).
The size, shape and intensity distribution of the x-ray tube
focal spot in combination with focal spot-to-object and
Technology in Cancer Research & Treatment, Volume 1, Number 2, April 2002
121
object-to-image receptor distances affect geometric blurring.
To minimize geometric blurring, the focal spot size and
object-to-image receptor distance should be minimized,
whereas focal spot-to-object distance should be maximized.
Focal spot sizes and shapes for the dedicated and conven-
tional x-ray units used for mammography vary considerably
(14, 15). Likewise, the focal spot-to-breast surface distances
for different mammographic units vary.
Several years ago it was common to compress the breast
directly on top of the mammographic cassette. The distance
between the chest wall edge of the breast and the screen-film
combination was very small. Today, many mammographic
procedures re performed with moving Bucky-type-grid.
With the grid in place, a gap of 1 to 2 cm in distance between
the edge of the breast and the screen-film combination may
occur. The size of the focal spot, therefore, needs to be
smaller in terms of limiting geometric resolution for a given
focal spot-to-breast surface distance. The typical nominal
focal spot sizes for todays mammography units are approxi-
mately 0.3mm (non magnification) and 0.10mm (magnifica-
tion technique) (4, 7).
Grids for Mammography
Scattered radiation can significantly reduce image contrast in
mammography (Figure 5) (16). In 1978 Philips introduced
moving grid for mammography.
The use of specifically designed grids for mammography
reduce scattered radiation and improves subject contrast,
which is especially significant when imaging thick, dense
breasts (5, 9, 16, 17, 18). Grids are now included with ded-
icated mammographic x-ray units. The majority of grids
used for mammography consist of lead strips separated by
spacers of radiolucent material such as carbon fiber. Most of
these grids are the moving type, which blur the grid lines.
Moving-type grids are preferred for mammography.
Figure 4: Modulation transfer functions (MTF’s) of geometric unsharp-
ness when the conventional cone and the long cone with improved geome-
try are used at an object-to-recording system distance of 5 cm. MTF’s are
of Kodak RP/M non-screen film and the DuPont Lo-dose screen-film sys-
tem for mammography are also shown (Haus et l. 13).
122
Figure 5: Dependence of the ratio of scattered-to-primary radiation on the
diameter of the radiation field for 3 and 6 cm thickness of a Lucite phantom:
“A at 32 kVp and “B ”at 42 kVp (Barnes and Brezovich 16)
Recently, rhombic cellular structure air grids have been
introduced. These grids offer the potential of improved
image contrast and transmission efficiency compared with
conventional grids (Figure 6).
Figure 6: Contrast improvement factor versus compressed breast thickness
for HTC and linear grid. This is a relative curve. It changes with different
breast composition and film gradient. (Courtesy of Trex Medical
Corporation, Lorad Division, Danbury, CT)
Grids designed for mammography generally require expo-
sure increases of approximately 2 to 2.5 times the exposure
required for nongrid techniques.
Technology in Cancer Research & Treatment, Volume 1, Number 2, April 2002
Haus
Automatic Exposure Control
Automatic exposure control systems, also referred to as pho-
totimers, are designed to automatically provide the radiation
exposure needed to produce a mammogram with an accept-
able (and consistent) optical density. Most dedicated mam-
mographic x-ray units have automatic exposure control
devices. New circuit modifications and developments in
detector arrangements, which take into account changes in
breast tissue thickness and composition, can provide more
consistent film optical density (19).
Image Receptors
In the 1950’s and 1960’s, direct exposure with medical film or
Industrial type films was used for mammography (Figure 7).
In 1971, a xeromammography unit became available (20).
Until then, very little attention was primarily directed to the
use of an image receptor that could provide a mammogram of
adequate contrast, high resolution and low noise.
Figure 7: Characteristic curves for (1) a direct-exposure film, (2) a single-
screen, single–emulsion film used in the 1970’s and early 1980’s and (3) a
single-screen, single–emulsion film combination used for mammography
today. (Haus 11)
In 1972, the first screen-film combination designed for
mammography was introduced by DuPont (21). With this
single-screen, single-emulsion combination, radiation dose
was reduced 10 to 20 times compared to direct exposure
films. DuPont also introduced a vacuum bag system to pro-
vide good screen-film contact. In 1975, Kodak brought to
market mammography screen-film combination which uti-
lized rare earth phosphor screens. This combination pro-
duced sharper images and required one half the radiation
exposure of earlier screen-film combinations. A special low-
absorption cassette was also introduced for mammography.
In 1977, Xonics introduced an electron radiography system
for mammography (22).
Historical Developments in Mammography
The xeroradiography system and the Xonics electronic radi-
ography system are no longer commercially available.
Screen-Film Combinations
Most single-screen, single-emulsion film combinations com-
monly used today have higher film contrast and require sig-
nificantly lower radiation exposure than those used a few
years ago (Figure 7). It is interesting to note that today’s
screen-film combinations require approximately 50 times less
radiation than direct-exposure films. Films currently used in
mammography usually have a single emulsion and are used in
combination with a single back screen. Films are sensitized
to match the spectral emission of the intensifying screen.
The majority of mammographic images are produced with
single intensifying screen used as a back screen in combina-
tion with single-emulsion film (Figure 8). Many mammo-
graphic screens incorporate phosphors containing metals
from the lanthanide series of elements such as terbium-acti-
vated gadolinium oxysulfide (Gd2O2S:Tb). Screens may
incorporate light absorbers in the phosphor that are used to
increase sharpness. Intensifying screens have a protective
overcoat to resist surface abrasion, are edge-sealed to mini-
mize edge wear, and the base includes a backing layer to elim-
inate screen curl. Mammographic screens consisting of ter-
bium-activated gadolinium oxysulfide material emit light in
the visible spectral region from 382 to 622 nm, although the
primary emission peak is in the green spectral region, 545 nm.
For screen-film radiography, light diffusion (spreading of the
light emitted by the intensifying screen before it is recorded
by the film) causes blurring (Figure 8) (11). Factors
involved include (1) phosphor layer thickness in the screen,
Figure 8: Diagrams compare physical configurations for single-emulsion
film in contact with single (back) intensifying screen (as used for mam-
mography) and a double-emulsion film sandwiched between two intensify-
ing screens (used for other radiological procedures. (Haus 11)
Technology in Cancer Research & Treatment, Volume 1, Number 2, April 2002
123
(2) phosphor particle size, (3) light-absorbing dyes and pig-
ments in the screen, and (4) screen-film contact. In recent
years, screen-film combinations for mammography have
used a single high-definition screen in contact with a single-
emulsion film.
The single screen is used as a back screen for mammography
because x-ray absorption (and emission of screen light) is
highest on the side of the screen where the x-rays enter. If the
screen were used s a front screen, x-ray absorption would be
higher in the plane of the screen that is the farthest distance
from the screen-emulsion contact surface. This causes
greater light spread (blur) than when x-ray absorption is high-
est near the screen-emulsion contact surface, as is the case
when it is used as a back screen. Both parallax and crossover
are eliminated in a single-back-screen configuration.
Figure 9 shows modulation transfer function (MTF) curves
for a direct-exposure film and five mammographic screen-
film combinations. Also shown is an MTF curve for a
screen-film combination used for conventional diagnostic
radiology procedures. These curves show that screen-film
combinations used for mammography have much higher
spatial resolution than do those used for conventional diag-
nostic procedures (11)
Figure 9: Modulation transfer function curves are for a direct-exposure
film; three mamographic screen-film combinations; and a two-screen, dou-
ble-emulsion film combination commonly used for conventional radiogra-
phy. (Haus 11)
Film Processing
In the late 1980’s and early 1990’s, the importance of film
processing in mammography became recognized (Figure 10)
(23, 24)
Film processing must be considered as part of system that
includes the automatic film processor, film type, and chemi-
cals (25). Today it is recognized that these components must
be considered together as a system and must be properly
optimized, maintained, and sustained to obtain appropriate
124 Haus

Several companies are providing viewbox systems designed

for reading mammograms with appropriate luminance levels
(Table 2) (27). The ACR Mammography Quality Control
Manual indicates that the mammographic viewboxes should
be capable of producing a luminance of at least 3000 nit
(candelas per meter square) (7, 27).
Table II
Mammography View Box Measurements from Five Institutions (27)
Number
Average Minimum Maximum
of Panels
2
Luminance (cd/m ) 23 2,920 1,620 3,630
Illuminance (lux) 23 40 6 97
Color temperature (0K) 23 8,400 4,950 10,900

The illuminator surface should provide diffused light of uni-

form brightness, and variations in surface luminance should
Figure 10: Gradient versus optical density curves for Kodak ortho M film
in standard nd extended processing. (Tabar and Haus 24)
be gradual. The luminance level must be sufficient to illu-
minate areas of interest in the mammogram. Ideally, all
image quality in terms of film contrast of the processed radi- viewboxes should have the same color.
ograph (7, 25). The resulting film speed affects radiation
dose to the patient. Automatic film processor variables The contrast sensitivity of the eye (the ability to distinguish
include (1) processing cycle time, (2) temperature, (3) chem- small luminance differences) is greatest when surroundings
icals, (4) replenishment, (5) agitation, and (6) drying. are of about the same brightness as the area of interest.
Therefore, to see detail in a mammogram, it is important to
Digital Mammography reduce glare to a minimum, to avoid surface reflections, and
to reduce ambient light level to approximately that reaching
Digital image receptors for mammography have been under- the eye through the mammogram. Glare and reflections can
going development in recent years (28, 29). Small area dig- be reduced by locating illuminators away from bright sur-
ital detectors have been available for a few years on two dif- roundings such as windows, by turning off surrounding
ferent commercially available stereotactic breast localization viewboxes when not in use, and by using masks to cover
units (30). Most recent efforts for obtaining digital mammo-
grams include units which “stitch together ”several small
area images, scanning slot digital detectors, and large area
multi-detector arrays. In 2000 the first digital mammogra-
phy unit was approved for clinical use by the FDA and
became commercially available. Today several companies
have received FDA approval for digital mammography sys-
tems which are commercially available.

A main advantage of digital mammography compared to

screen-film mammography is that the image acquisition,
image display, and storage are decoupled (Figure 11) (31).
Clinical studies are underway to evaluate the clinical per-
formance of digital mammography systems (32).

Viewing Conditions

Much of the information contained in the mammographic

image cannot be visualized if proper consideration is not
given to viewing conditions. Mammograms should be inter-
preted under conditions that provide good visibility, comfort,
Figure 11: Characteristic curves for a digital mammography system. The
and minimal fatigue (26).
acquisition and display have two separate curves. The acquisition system
has a linear response to x-ray intensity whereas the display curve can be
adjusted by the viewer. (Haus and Yaffe 31)

Technology in Cancer Research & Treatment, Volume 1, Number 2, April 2002

Historical Developments in Mammography 125

low-density areas in the mammogram being examined.
Subdued lighting is preferred in the viewing room. It is also
important to have a variable high output light source (with
appropriate masks) to view high-density areas on mammo-
grams, and to make sure mammograms are properly
exposed.
Quality Control
On October 1, 1994, the Mammography Quality Standards
Act (MQSA) went into effect. To operate lawfully under
MQSA, mammography facility must be certified by the
Food and Drug Administration (FDA). In order to be certi-
fied, a facility must be accredited by a federally approved,
private non-profit or state accreditation body. The FDA has
approved the ACR, the states of Iowa, California, Arkansas
and Texas as accreditation bodies.

In addition to the technical development advancements in With the implementation of MQSA, all mammography facil-
mammography, quality control programs have also had ities must apply to a federally-approved accreditation body,
major impact on the improvement in image quality of mam- undergo periodic review of its clinical images, have an annu-
mograms. The American College of Radiology (ACR) al survey by a medical physicist, and meet federally-devel-
Mammography Accreditation Program which began in late oped quality standards for personnel qualifications, quality
1987 has had a significant impact on improved and consis- assurance programs, and record keeping and reporting. The
tent image quality in mammography (7). The program facility must also undergo an annual inspection conducted by
requires (1.) questionnaire to be completed which includes federal or state personnel.
information such as credentials of staff, type of x-ray equip- Table IV
ment, image receptors, processing and quality control proce- Medical Physicist Tests (Annually) (7)
dures used, (2.) mammograms of two patients (one with fatty
breasts, the other with dense breasts), for evaluation by panel 1. Mammographic unit assembly evaluation
2. Collimation assessment
of radiologists, (3.) a breast phantom image for evaluation of 3. Evaluation of system resolution
medical physicists, (4.) radiation dose evaluation, and film 4. AEC system performance
processor control data. 5. Uniformity of screen speed
6. Artifact evaluation
7. Image quality evaluation
The ACR also developed quality control manuals with rec- 8. kVp accuracy and reproducibility
ommendations on quality control procedures and tests to be 9. Beam quality assessment
10. Breast exposure and AEC reproducibility
done on a routine basis (7). The manuals define the respon- 11. Average glandular dose
sibilities of the radiologist, medical physicist, and technolo- 12. Radiation output rate
gist for mammography quality control. There are separate 13. Measurement of viewbox luminance and
recommendations on quality control tests and frequency of room illuminance
tests to be performed by the medical physicist and technolo-
gist (Tables 3 &4) (7). Conclusion

Table III Today, due to technical advancements in x-ray equipment,

Technologists Tests (7)
image receptors (screen-film and digital), film processing
and viewing conditions together with implementation of
Daily
1. Darkroom cleanliness required quality control, it is possible to consistently produce
2. Processor quality control mammograms of high image quality.
3. Mobile unit quality control

Weekly
Acknowledgements
1. Screen cleanliness
2. View boxes and viewing conditions The author thanks Wende Logan-Young, MD, Breast Clinic
3. Phantom images of Rochester, New York, for providing the clinical mammo-
Monthly gram comparisons; Joel E. Gray, PhD, Trex Medical
1. Visual check list Corporation, Lorad Division, for the figure on the HTC grid.
Quarterly References &Footnotes
1. Repeat analysis
2. Analysis of fixer retention in film 1. Haus, A.G.: Physical principles and radiation dose in mammogra-
phy. Breast Carcinoma Current Diagnosis and Treatment, Masson
Semi-Annually Publishing pp 99-114. Eds. S. A. Feig and R. McLelland. NY (1983).
1. Darkroom fog 2. NCRP Report 85 Mammography-A users’s guide. National Council
2. Screen-film contact of Radiation Protection and Measurements. Bethesda, MD (1986).
3. Compression 3. Rothenberg, L. N., Haus, A. G.: Physicists in mammography-A his-
torical perspective. Medical Physics 22 (11) pp 1923-1934,
November(1995).

Technology in Cancer Research & Treatment, Volume 1, Number 2, April 2002

126
4. Recommended Specifications for New Mammography Equipment:
Screen-Film X-ray Systems, Image Receptors, and Film Processors.
American College of Radiology, Reston, VA (1995).
5. Barnes, G. T.: Mammography imaging physics: x-ray equipment
considerations. Syllabus, Categorical Course in Diagnostic
Radiology Physics: Physicial Aspects of Breast Imaging-Current
and Future Considerations, Radiological Society of North America
pp 41-57, Eds. A. G. Haus and M. J. Yaffe, Oak Brook, IL (1999).
6. Haus, A. G.: Mammography imaging physics: screen-film process-
ing and viewing condition considerations. In ref 5 pp 59-77.
7. American College of Radiology (ACR) Mammography Quality
Control Manual for Radiologists, Medical Physicists, and Techno-
logists, American College of Radiology, Reston VA (1999).
8. Gabbay, E.: Mammography x-ray source, Syllabus, A Categorical in
Physics: Technical Aspects of Breast Imaging, Radiological Society
of North America pp 47-62, Eds. A. G. Haus and M. J. Yaffe, Oak
Brook, IL (1994).
9. Haus, A. G., Metz, C. E., Chiles, J. T., Rossman, K.: The effects of
x-ray spectra from molybdenum and tungsten target tubes on image
quality in mammography. Radiology pp 705-709 (1976).
10. Fewell T. R., Shupping, R. E.: Handbook of Mammographic X-ray
Spectra. HEW Publication (FDA) (1979).
11 Haus, A. G.: Dedicated mammographic x-ray equipment, screen-
film processing systems and viewing conditions in mammography.
Seminars in Breast Disease Vol 2 No 1, pp 30-54 March (1999).
12. Hendrick, R. E., Burns, E. A.: Optimizing mammographic tech-
niques. In ref 5 pp79-89
13. Haus, A. G., Doi, K.,Chiles, J. T., Rossmann, K., Mintzer, R. A: The
Effect of geometric and recording system unshapness in mammog-
raphy, Invest Radiology 10 No 1 , pp 43-52 (1975).
14. Haus, A. G., Cowart R. W., Dodd, G. D., Bencomo, J.: A method of
evaluation and minimizing geometric unsharpness for mammo-
graphic x-ray units. Radiology 128 pp 775-778 (1978).
15. Kimme-Smith, C, Bassett, L. W., Gold, R. H.: Focal spot measure-
ments with pin hold and slit for microfocus mammography units.
Medical Physics 15 pp 293-298 (1988).
16. Barnes, G. T., Brezovich, I. A.: The intensify of scattered radiation
in mammography. Radiology 126 pp 243-247 (1978).
17. Chan, H. P., Frank, P. H., Doi, K.et al: Development of ultra-high
strip density (UHSD) grids: A new anti-scatter technique for mam-
mography. Radiology 154 pp 807-815 (1985).
Date Received: January 15, 2002
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18. Sickles, E. A., Weber,. N.: High-contrast mammography with mov-
ing grid: Assessment of clinical utility Am. J. Roentgenol 146 pp
1137-1139, (1986).
19. LaFrance, R. L., Gelskey, D. E., Barnes, G. T: A circuit modification
that improves mammographic phototimer performance. Radiology
166 pp 773-776, (1988).
20. Thourson, T. L., Xeroradiography: SPIE 56 pp225-235 (1975).
21. Wayrynen, R. E.: Fundamental aspects of mammographic receptors
film process. Reduced Dose Mammography, Masson Publishing pp
521-528, Eds. W. W. Logan, E. P. Muntz, New York, NY, (1979).
22. Muntz, E. P, Welkowsky, M., Kaegi, E., Morsell, L, Wilkinson, E.,
Jacobson, G.: Optimization of electrostatic imaging systems for min-
imum patient dose or minimum exposure in mammography.
Radiology 127 pp 517 (1978).
23. Kimme-Smith, C., Rothchild, P. A., Bassett, L. W., Gold, R. H.,
Moler, C.: Mammographic film processor temperature, development
time, and chemistry: Effect on dose, contrast and noise. Am. J.
Roentgenol 152 pp 34-40 (1989).
24. Tabar, L., Haus, A. G.: Processing mammographic films: Technical
and clinical considerations. Radiology 173 pp 65-69 (1989).
25. Haus, A. G., Jaskulski, S, M.: The Basics of Film Processing
Medical Imaging. Medical Physics Publishing, Madison, WI (1997).
26. Kimme-Smith, C., Haus, A. G., DeBruhl, N., Bassett, L. W.,: Effects
of ambient light and viewbox luminance on the detection of calcifi-
cations in mammography. Am. J. Roentgenol 168 pp 775-778
(1997).
27. Haus, A. G., Gray, J. E., Daly, T. R.: Evaluation of mammographic
viewbox luminance, illuminance, and color. Medical Physics 20 pp
819-821 (1993)
28. Karellas, A, Harris, L. J., D’Orsi, C. J.: Small field digital
Mammography with a 2048 x 2048 pixel charge coupled device.
Radiology 177 pp 288 (1990)
29. Yaffe, M. J.: Digital mammography. In Ref 5 pp 229-238
30. Hendrick, R. E., Parker, S. H.: Stereotactic imaging. In Ref 8 pp 263-
274
31. Haus, A. G., Yaffe, M. J.: Screen-film and digital mammography-
image quality and radiation dose considerations.: Radiologic Clinics
of North America Vol 38 No 4 pp 871-898 (2000)
32. Pisano, E. P.: Current clinical status of full-field digital
Mammography. In Ref 5 pp 239-247