Guide to Mammography Systems – How to Pick a System
A mammography system is a specific type of X-ray equipment that is used exclusively for breast imaging. With relatively low doses of X-rays they produce images – called mammograms.
Mammography continue to be the leading modality in early detection of breast cancer. They are capable of detecting changes in breast tissues up to two years before it is palpable. Therefore, some countries offer screenings every 2 or 3 years for women from a certain age.
If you are looking for a system this article will be a good preperation for your next purchase, as it covers all the main points above. First up is how to pick a brand and a line of mammography systems.
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How to Pick the Brand and Line of Mammography
The major players on the market of mammography are Fuji, Hologic, GE, and Siemens. Each of these manufacturers produce excellent models that provide high quality imaging.
This also makes them obvious choices for used systems, as the systems maintain a great condition for many years.
However, factors in choosing between the high-end brands are limited. Really, it comes down to whether you have access to service in your region for each brand, and your personal preference.
Learn more about the different brands and their product lines below.
From the main series from Fuji with several popular models.
Fuji is a popular choice among our customers, mainly due to their Amulet series. This series contains several different digital models: The Amulet One, a 2D system, and the Amulet S and Fuji Amulet F.
The differences between these are that the Amulet S is the newer version, replacing the Amulet One. The F is slightly different, as biopsy can be added as an extra option.
An even newer system is the Fuji Amulet Innovality, which is a tomosynthesis (3D) system. However, we rarely see this in the used market as it was introduced in 2014.
Fuji does not have any analog systems available.
Hologic is another strong player in the market. Their main models are Selenia, which is a 2D mammography system, Dimension 2D, and Dimension 3D with tomosynthesis.
The Dimension 2D is the newer model that is replacing the Selenia and is still new on the used market.
Hologic also has biopsy as an option that can be added on both lines.
You can still find their analog models in the used market, for instance the Lorad M-IV, but they are now decreasing in popularity.
GE Senographe Essential
A popular GE mammography system on the used market.
GE, like Hologic, has two main lines that are relevant at the moment.
The Pristina are quite new on the market, therefore, our assessment is that it will be a while before these are available in the used market as well.
All of GEs systems have the capacity for biopsy as well, but it as an extra option and not standard.
Analog GE models on the used market includes the Senographe DMR and DMR Plus, and the Senographe 700 and 800.
Siemens has the Mammomat line, that contains several models, all of which have the capacity to get the biopsy option. The models include the Mammomat Fusion 2D, Mammomat Inspiration, 2D and 3D, Mammomat Inspiration PRIME 2D and 3D.
The Fusion is their entry level system, while Prime is the newest model that came to market in 2013. It uses lower radiation doses than the previous models.
On the used market you will also see analog systems such as the Mammomat Nova 1000 and 3000.
Philips also offer mammography systems, but we rarely have them at our facility. However, on the used market you could find the Sectra Microdose L30 and L50, and the newer MicroDose SI.
As first stated, brand is not the most important factor. In deciding between 2D and 3D models consider that 3D is better for advanced screening and early cancer detection. 2D is generally the choice if you are performing “regular” x-ray of the breasts, for instance, to check palpable masses or to prepare for plastic surgery.
However, we will get back to 2D vs. 3D later – first we will explain the difference of analog and digital mammography.
Analog and Digital Mammography Systems – Advantages and Disadvantages
Digital mammography is now the main choice and, it will be the focus of this section. However, we will still offer a brief overview of the analog systems.
Analog mammography captures the x-ray beams on film cassettes. That creates an image on film that can be examined directly or turned into a digital image with a CR reader.
As opposed to this, a digital mammography captures the x-ray on a digital detector which creates the digital mammogram. This allows the images to be analysed on specialized high-resolution monitors.
This also allows for easy use of digital tools in the analysis. However, they can also be printed if needed.
Digital Mammography Systems
The main pros of digital mammography are listed here:
More efficient workflow as the images are available immediately on the computer
Instant display of images allows for repositioning of patients if necessary and therefore leads to fewer retakes
On average, radiation doses are 30% lower than for analog systems
Good access to both new and used parts, detectors, etc.
However, they are also a bit more expensive than analog systems.
Analog Mammography Systems
As analog systems are slowly declining in the market, we recommend that you choose digital. However, analog systems are cheaper and are still preferred by some of our customers. And as they do not have a digital detector, they can be cheaper to repair as well.
However, the main disadvantages of analog mammography systems are:
Analog images can be less consistent due to the imaging process
As they take images on film, you need a CR reader to convert to digital images
Due to decrease in sales, it might become challenging to find parts for repairs in the coming year
Overall, we do recommend digital mammography systems, but in some cases, analog is also a good choice, mostly in relation to budgetary constraints.
If you want a more in-depth overview of the advantages and disadvantages of each type, we would recommend our dedicated article on the subject.
When Do I Need 3D Mammography
3D mammography or tomosynthesis, as it is also called, is increasing in popularity. In this section we will discuss the main pros and cons of tomosynthesis and in what cases it is worth the investment.
Systems with tomosynthesis obtain 3D images by taking multiple mammograms from different angles, similarly to a CT scanner, which is then reconstructed into a 3D image of the breast. This increases visibility of small changes of the tissues which enhance diagnostic capabilities. In opposition to this, a normal mammogram consists of one 2D image from one angle.
Main Advantages of Mammography with Tomosynthesis
Better image quality
Earlier detection of changes in the breast tissue and better accuracy
Overcomes some limitations of 2D mammograms such as tissue overlap and hereby decreases false positive scans
Additionally, they can detect microcalcifications in the breast tissue, which can be a precursor for cancer.
So, are there really any disadvantages of the 3D mammography?
It is limited. However, 3D images require higher doses of radiation than a standard 2D image. This is of course still minimal and well within doses that FDA approved for mammograms.
Furthermore, both acquisition and maintenance costs are higher for systems with tomosynthesis.
To put it very simply – You need 3D mammography when you are doing cancer screening and early detection of cancer.
So, this section will focus on maybe the most frequently asked question we get.
“What is the price?”
And the short answer is – it depends. On year of manufacture (YOM), model, condition, and specifications.
However, there are some general price brackets that we would like to share. The prices cover used systems, as that is what we have nearly 20 years of experience with.
Below you can see an overview, based on the three categories: Analog, digital, and digital with tomosyntheses. All of which you can learn more about in the previous sections.
In the table, prices are in euros and are for the systems only. This means that workstations and other accessories are not included. Furthermore, you need to top off the numbers with costs for crating, shipping, warranty, installation, etc.
And remember, if you buy an analog model, you also need a CR if you want to convert to digital images.
A short note for the digital ones. An important part is their digital detector, which happens to be quite expensive. Therefore, the condition of the detector usually has a big impact on the price of the overall system.
So as first stated, it depends. When you have a specific model and accessories in mind, we can narrow assist and narrow it down further.
So next up – Accessories.
A mammography can require different accessories, depending on your facility.
For instance workstations. The workstation is the computer that allows you to analyse the mammograms independently of the system and the operative console.
It is doable to analyse images on the operating console. We have customers who do so. However, only customers that are not actively performing cancer screening.
So overall, we recommend that you acquire a workstation.
As the workstations work on DICOM, the brand of the workstations does not have to match the brand of the system.
Same goes for printers –they can be any brand. The most important is that they need to print in excellent quality, to not lose precision of the images. Not all printers can do proper mammogram printing in adequate resolution, so make sure you get the right one.
As mammograms need to be of very high quality to detect the small changes in the tissue, it is also necessary to have monitors with excellent definition. Furthermore, you need dual monitors, as a standard examination can provide up to 6 images. A monitor is usually 5 mega pixel (mp). Some of our customers are fine using 3 mp, but we do recommend 5 mp or more, to meet the standard of 50 micron per pixel.
Other accessories are stereotactic, for biopsies, and the tomosynthesis options as described earlier.
Maintenance and Installation – Do’s and Don’ts
If you want to install and take care of your mammography system yourself, once you have made a purchase, there are some very general tips we would like to share.
It is a good idea to:
Detach and ship the detector in a thermo box. The detector is very sensitive to low temperatures, rapid temperature changes, and transport shocks.
Keep a service backup from before deinstallation or before/after any system configuration.
Keep the software CDs and especially the detector CD. You may need the detector CD for a full calibration process in case a software issue happens.
Use a trained technician to install or deinstall your system. Small mistakes might turn into issues.
We also recommend that you do not:
Do not touch or push the detector surface, as it may cause unrecoverable damage.
Do not change the IP of the mammography components without checking with a trained technician. Normally, there is a second LAN port in acquisition workstation which can be configured for hospital connection as you wish.
Do not use detergents to clean the carbon cover, grid and detector surfaces. Consult with the service manual for the proper way of cleaning these parts.
Do not use the mammography system if you have unstable power and no UPS.
These are very general – but each model is different. We recommend that you check the service the manuals for model specific information.
So, after all this information, are you on top of the main factors that help you decide on a mammography system that is just right?
Let us repeat the main points.
Which brand is better?
The major OEMs is what we know of, and we know them for excellent quality.
In choosing between Fuji, Hologic, Siemens, and GE, your main indicator is which service provider you have access to in your specific area.
Should I buy analog or digital?
The analogs were very stable systems that can be cheaper in maintenance costs.
However, the digital systems are taking over the market and are the future of mammography. If you have the budget for it, we recommend digital.
Should I get a 3D mammography system or not?
Tomosynthesis gives you the option of capturing your images in 3D rather than 2D.
This can improve visibility of even small abnormalities and is particularly relevant if you are doing early cancer detection and screening.
How much does a mammography system cost?
Generally, the analog ones are slightly cheaper and can be found for around 11.000 euros.
Digital mammography systems are more expensive and are typically found in the range of 20 – 50.000 euros. And if you want a system with tomosynthesis as well, you will most likely need to go well above 50.000 euros.
What accessories do I need for my mammography machine?
Often, our customers require a workstation and sometimes a printer. Useful for respectively increasing patient throughput and if you prefer to analyse or store the images in paper.
Should I buy used, refurbished or new?
This depends on your practice.
For some, only the newest most cutting-edge options will do. Those should pick a new system.
However, most can have their needs covered with either a used or refurbished, which is also much cheaper than new. The refurbished mammos come in a better condition than used and can be offered with warranty as well. This again depends on your own preference and budget.
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