Technology Advances in Mammography

Dose Reduction and Image Quality

Fujifilm’s third generation full field digital mammography (FFDM) system, ASPIRE Cristalle, is based
on Fujifilm’s unique and innovative technologies that achieve optimum image quality at very low patient
dose. These outcomes are made possible by a new detector technology that uses a hexagonal close pattern
(HCP) architecture, coupled with analytical and adaptive image processing that automatically adjusts to each
patient’s breast composition. This paper highlights these recent advances in FFDM technology.

ASPIRE Cristalle FFDM System As shown in Figure 2a, due to the right angles
Drawing on over 30 years of digital mammography associated with conventional square pixels, the
detector and image processing expertise, electric field between these pixels demonstrates a
Fujifilm’s ASPIRE Cristalle (Figure 1) incorporates weakness in intensity.
technological advances that can be instrumental This weakness results in a reduction in collection
in the early detection of breast cancer, while at the efficiency as some of the converted x-ray information
same time providing comfortable and low dose (in the form of electrical charges) will not be collected
exams for the patient. by the square pixels, but simply pass between them
(Figure 2b)

Figure 2a: Conventional square pixels with

corresponding electric field intensity

Figure 1: ASPIRE Cristalle

Hexagonal Close Pattern (HCP)

detector
Fujifilm has developed a novel detector that uses
hexagonal shaped pixels. The HCP design provides
a 50 μm output, and yields improved detector
sensitivity when compared to conventional square Figure 2b: Conventional square pixels with
pixel FFDM detectors. reduced collection efficiency.
Technology Advances in Mammography Dose Reduction and Image Quality 2

needed to achieve suitable diagnostic image quality.

Typically, this is accomplished using fixed AEC
sensors that are sampled during a pre-exposure.
However, with this fixed sensor approach, it is
sometimes difficult to determine the breast region
of highest density due to patient positioning or
other considerations (e.g., the existence of breast
implants) which can result in over- or under-exposure
of the breast.
To overcome the limitations associated with
conventional AEC, ASPIRE Cristalle incorporates a
more intelligent approach known as iAEC.
The iAEC algorithm performs a morphological
Figure 2c: Fujifilm’s hexagonal pixels with analysis of the pre-exposure image. Through this
corresponding electric field intensity analysis, iAEC is capable of differentiating between
fibroglandular tissue, adipose tissue, pectoral muscle
and implants, and then isolates the densest region of
the breast. Once isolated, the exposure conditions
are selected to optimize the image quality of the
glandular tissue.
Using this unique analytical method, i-AEC
can provide improved dose stabilization that is
independent of breast composition or positioning.
Figure 2d: Hexagonal pixels with improved Figure 3 demonstrates the results of iAEC’s ability to
collection efficiency localize the fibroglandular regions of various breast
compositions, regardless of the presence of implants
and foreign objects.
To improve the collection efficiency of the
FFDM detector, the Cristalle detector uses the
aforementioned HCP architecture, where, with no
right angles on the hexagon-shaped pixels, the
electric field between them is stronger (Figure 2c).
Using this approach, collection efficiency is increased
as the electrical charges are “steered” to the
hexagonal pixels under the influence of the stronger
electrical field (Figure 2d).
Based on this unique approach to FFDM detector
design, we have successfully reduced dose by
approximately 20% when compared to conventional
detectors that use square pixels.

Intelligent Automatic Exposure

Control (iAEC)
Automatic Exposure Control (AEC) technology
automatically determines the exposure conditions Figure 3: Glandular Tissue localized with iAEC
Technology Advances in Mammography Dose Reduction and Image Quality 3

Patient Dose Reduction

To facilitate patient dose reduction and scale the
exposure dose for individual patient considerations,
ASPIRE Cristalle has three dose modes (H, N, and
L) that can be selected by the technologist (N
mode is typically used). These modes, coupled with
the increased sensitivity of its HCP detector and
improved dose stabilization of its iAEC method,
enable ASPIRE Cristalle to demonstrate reduced
patient dose when compared to a competitive
FFDM system. Figure 4 shows comparative results
of an independent evaluation of Average Glandular
Dose (AGD) across a broad range of thicknesses.

Figure 5: AGD at 50% glandular equivalent,

ASPIRE Cristalle vs. Competitive FFDM

As shown in Figure 5, for a 60mm thick, 50% dense

breast, ASPIRE Cristalle’s N mode acquisition is
almost 2 times lower than that of the competitive
FFDM system, and 3 times lower in L mode.

“Adaptive” Image Processing

To produce consistent image quality across
the wide range of patients, ASPIRE Cristalle
incorporates image processing algorithms that
automatically “adapt” to patient breast thickness
Figure 4: AGD at 20% glandular equivalent, and composition.
ASPIRE Cristalle vs. Competitive FFDM Using analytical processes similar to those used
with iAEC, these algorithms localize the glandular
As can be seen in Figure 4, e.g., for the acquisition regions in the acquired image, assess their contrast,
of the 60 mm equivalent breast thickness (PMMA, and if needed, make minor adjustments to default
20% glandular equivalent), the Competitive FFDM processing parameters.
system results in an AGD that is 355% higher than Demonstrations of these adaptive algorithms are
ASPIRE Cristalle in L-mode and 210% higher than shown in Figures 6 and 7.
ASPIRE Cristalle in N-mode. The left side of Figure 6, shows a small and dense
As expected, the AGD results between the breast that has been processed with conventional
competitive FFDM system and ASPIRE Cristalle in processing parameters. Because of the fixed
all dose modes remain similar when using BR50/50 nature of these parameters, the contrast within the
(50% glandular equivalent) phantoms when glandular tissue is weak, and the skin line slightly
compared to PMMA. These results are presented exaggerated. But, as shown on the right side of
in Figure 5. the figure, by applying adaptive processing, the
contrast in the glandular region is improved and the
skin line is more naturally presented.
Technology Advances in Mammography Dose Reduction and Image Quality 4

Similarly, for the larger fatty breast shown in Image-based Spectrum Conversion
Figure 7, the conventionally-processed image on (ISC)
the left lacks skin line as well as contrast in the
In general, when compared to a tungsten (W) target,
breast tissue. But, as shown on the right side of
images that are acquired with a molybdenum
the figure, ASPIRE Cristalle’s image processing
(Mo) target produce images of higher contrast.
automatically adapts and corrects for these
This is because the Mo target produces a lower
deficiencies.
energy distribution, and can achieve higher image
contrast. However, these lower energy x-rays
are easily absorbed in the breast, resulting in a
higher patient dose than with the W target (which
produces a higher energy, more penetrating x-ray
beam).
By performing an analysis of the energy distributions
between the two types of target materials, Fujifilm
has developed an image processing algorithm that
takes advantage of the lower dose imaging of a W
target, while at the same time providing the high
contrast images of Mo. ASPIRE Cristalle introduces
this new feature, known as Image-based Spectrum
Conversion (ISC).
Figure 8 presents images acquired with a Mo
Figure 6: Small Dense Breast,
target (left), and with a W target with ISC applied
Conventional vs. Adaptive Processing
(right). The images are of the same quality, but
patient dose of the W target with ISC image was
14% lower than the Mo image.

Figure 7: Large Fatty Breast,

Conventional vs. Adaptive Processing

Figure 8: Mo target image vs. W target with ISC

Technology Advances in Mammography Dose Reduction and Image Quality 5

One-Shot Phantom Quality Control

Program
To facilitate a comprehensive mammography
quality control program, all Fujifilm FFDM systems
include a quality control package consisting of
the One Shot Phantom M Plus (Figure 9) and
corresponding QC software.
Through a single exposure of the One Shot
Phantom M Plus, the QC software will automatically
analyze the acquired phantom image and provide
pass / fail results for the following system-related
tests:
• Missed Tissue at Chest Wall
• Contrast-to-Noise Ratio (CNR)
Figure 9: One Shot Phantom M Plus
• Sensitivity
• Geometric Distortion
• Uniformity
• Dynamic Range
• Spatial Resolution
• Low Contrast Detectability
• Linearity / Beam Quality
In addition to the automated evaluation of the
test objects within the One Shot Phantom M Plus,
the QC software also accumulates all QC results,
supports all medical physicist-related testing,
provides trending graphs for all individual tests, and
can export all QC data to spreadsheet format.

About FUJIFILM Medical Systems U.S.A., Inc.

FUJIFILM Medical Systems U.S.A., Inc. is a leading provider of diagnostic imaging products and medical
informatics solutions to meet the needs of healthcare facilities today and well into the future. From an unrivaled
selection of digital x-ray systems, to the Synapse® brand of PACS, RIS and cardiovascular products, to advanced
women’s health imaging systems, Fujifilm has products that are ideal for any size imaging environment. The
Endoscopy Division of FUJIFILM Medical Systems U.S.A., Inc. supplies high quality, technologically advanced
FUJINON brand endoscopes to the medical market. The TeraMedica Division delivers healthcare informatics,
and is the leading provider of vendor neutral, enterprise-wide solutions for unrestricted medical image
management. FUJIFILM Medical Systems U.S.A., Inc. is headquartered in Stamford, CT. For more information
please visit www.fujifilmhealthcare.com and www.fujifilmendoscopy.com.

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