QUITE apart from the academic consideration that vital and medical statistics now form an obligatory part of the education of students seeking the University of London's diploma in public health, the demand for information about the methods of vital and medical statistics is increasing. The most casual reader of the newspapers is now aware that population problems are of serious practical importance and that the publications of the General Register Office cannot be ignored. It is scarcely an exaggeration to say that the recently issued preliminary report on the census of 1931 is one of the most sensational documents which has appeared for years, and that he who reads it intelligently will understand what is meant by saying that civilisation is in the melting pot. An Introduction to Medical Statistics. By Hilda M. Woods William T. Russell. Pp. x + 125. (London: P. S. King and Son, Ltd., 1931.) 7s. 6d.

/pdf/an-introduction-to-medical-statistics-58gm2cuxfv.pdf

An Introduction to Medical Statistics

OBJECTIVES
To record the radiation doses involved in UK breast screening and to identify any changes since previous publications related to technical factors and the population screened.


METHODS
Mammographic exposure factors for 68,998 women imaged using 411 X-ray sets spread across the UK were compiled. Local output and half value layer measurements for each X-ray set were used to estimate mean glandular dose (MGD) using the standard UK method.


RESULTS
Mean MGDs in digital mammography have increased by 11% since 2010-12 for both medio-lateral oblique (MLO) and cranio-caudal (CC) views. The mean compressed breast thickness (CBT) has increased (4.8% CC, 5.2% MLO) over the same period. The mean MLO CBT value of 62.4 ± 0.1 mm is outside the 50 to 60 mm range used for diagnostic reference levels. The increase in MGD is consistent with the CBT changes. The mean MGD in the 50 to 60 mm CBT range is 1.44 ± 0.03 mGy for MLO views. CBT varies with age and peaks at 51.


CONCLUSIONS
Mean CBT has increased with time, and this has increased mean MGDs for digital mammography. CBT also varies with age.


ADVANCES IN KNOWLEDGE
Updated average MGDs in the UK are provided. There is evidence that breast size is increasing in the UK and that mean CBT is affected by age related changes in the breast.

Radiation doses in the united Kingdom breast screening programmes 2016-2019.

Commissioning and Routine Testing of Mammographic X-Ray Systems. Report No. 59 of the Institute of Physical Sciences in Medicine, England, 1989, by M. Fitzgerald, D. R. Dance, K. Fisher, C. P. Lawinski, and M. L. Ramsdale

In radiography, much valuable associated data (metadata) is generated during image acquisition. The current setup of picture archive and communication systems (PACS) can make extraction of this metadata difficult, especially as it is typically stored with the image. The aim of this work is to examine the current challenges in extracting image metadata and to discuss the potential benefits of using this rich information. This work focuses on breast screening, though the conclusions are applicable to other modalities.The data stored in PACS contain information, currently underutilised, and is of great benefit for auditing and improving imaging and radiographic practice. From the literature, we present examples of the potential clinical benefit such as audits of dose, and radiographic practice, as well as more advanced research highlighting the effects of radiographic practice, e.g. cancer detection rates affected by imaging technology.This review considers the challenges in extracting data, namely,• The search tools for data on most PACS are inadequate being both time-consuming and limited in elements that can be searched.• Security and information governance considerations• Anonymisation of data if required• Data curationThe review describes some solutions that have been successfully implemented.• Retrospective extraction: direct query on PACS• Extracting data prospectively• Use of structured reports• Use of trusted research environmentsUltimately, the data access process will be made easier by inclusion during PACS procurement. Auditing data from PACS can be used to improve quality of imaging and workflow, all of which will be a clinical benefit to patients.

Successes and challenges in extracting information from DICOM image databases for audit and research.

This study aims to establish Lebanese national diagnostic reference levels (NDRLs) for full field digital mammography (FFDM) and digital breast tomosynthesis (DBT). Data were collected from 34% of the total number of health facilities with FFDM and/or DBT units in Lebanon. NDRLs were set as the third quartile of mammography units’ median value of average glandular dose (AGD). NDRLs for different compressed breast thickness (CBT) and age groups were also proposed. Statistical analysis were performed to test the difference of AGD between cranio caudal (CC) and medio lateral oblique (MLO) views, FFDM and DBT, and AGD across health facilities, CBT and age groups. Data from 2803 women with a total of 10462 images were included in the study. For FFDM and DBT, NDRLs for CC and MLO views were equal to 1.85 and 2.24 mGy, and 2.65 and 3.04 mGy, respectively. Lebanese NDRLs were higher than most published DRLs while remaining below the European Commission’s maximum acceptable dose level (2.5 mGy) for FFDM. AGD increased significantly (p &lt; 0.05) with the increase in CBT for both views and techniques. This first set of mammography DRLs reveals the need for optimizing the radiation exposure in Lebanon and will serve as a national/international benchmark. 

Establishment of National Diagnostic Reference Levels for Full Field Digital Mammography and Digital Breast Tomosynthesis in Lebanon

Optimisation must be carried out on all medical radiological units to ensure doses are as low as reasonably practicable, consistent with the intended purpose. To achieve this, population doses must be estimated and diagnostic reference levels (DRLs) set. For mammography examinations, mean glandular doses (MGDs) are calculated for this purpose. The average MGD per unit is compared to the national mammography DRL, which is applicable to compressed breast thicknesses (CBTs) of 50-60 mm for oblique (OB) views only and set using data from screening units. It is the purpose of this work to assess planar MGDs across Scotland and set DRLs based on data collected from all screening and symptomatic units across Scotland, considering craniocaudal (CC) and OB views and a wider range of CBTs. Data from the most recent dose audit (spanning 2015-2017) for 67 mammography x-ray units were collated and analysed (26 195 images). No large differences between MGD of CC and OB views were found when considering specific CBT ranges (median difference 2.6%). There was, however, a significant difference between screening and symptomatic data (19%). As expected, MGD increased with CBT and there were significant differences in MGD between manufacturers. From the data analysed, Scottish DRLs were set based on 95th percentile values for digital mammography units for three CBT ranges (30-49, 50-60 and 61-80 mm): 1.3, 1.8 and 2.6 mGy respectively. These values consider OB and CC views collectively. Fifth percentile values are quoted to highlight units at greater risk of insufficient image quality. These MGD values, together with image quality assessments, will facilitate optimisation across Scotland. Results show that use of different CBT ranges and inclusion of CC views increases the number of images included in dose audit data analysis from approximately 12%-92%, which is substantially more representative of the population.

Setting Scottish diagnostic reference levels for mammography incorporating both craniocaudal and oblique projections between 30 and 80 mm.

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Setting Scottish diagnostic reference levels for mammography incorporating both craniocaudal and oblique projections between 30 and 80 mm.