Comprehensive Medical Physics Assessment of Digital Mammography Equipment: A Three-Year Multi-Site Evaluation of Technical Performance and Radiation Safety at 24 Saudi Arabian Healthcare Institutions (2022–2024)
Abstract
Purpose
To conduct a comprehensive multi-center audit evaluating the technical performance, image quality, and radiation safety of digital mammography systems across 24 unique healthcare facilities in Saudi Arabia. This study aims to establish a longitudinal performance baseline and verify compliance with international ACR and national SFDA quality standards.
Methods
Standardized medical physics evaluations were conducted on 31 digital mammography systems from three manufacturers: Hologic (n=22), Fujifilm (n=8), and Siemens (n=1). Performance metrics were measured using calibrated RaySafe X2 equipment, including X-ray generator precision (kVp/mAs), Half-Value Layer (HVL), and Mean Glandular Dose (MGD). The ACR Mammography Accreditation Phantom were used as the standard for image quality assessment, with evaluations of fiber, speck, and mass visibility, supplemented by Contrast-to-Noise Ratio (CNR) analysis.
Results
The audit demonstrated a 100% compliance rate for radiation safety, with all Mean Glandular Dose (MGD) values remaining below the 3.0 mGy threshold, ranging from 0.27 to 2.59 mGy. However, critical technical failures were identified in 16% of the units (n=5). Specific findings included: Generator Failures: Significant kVp accuracy errors reaching up to 13.4% identified in three units. Image Quality Degradation: Severe CNR failures (<1.0) and inability to meet ACR phantom scoring criteria for fibers. Progressive Performance Decline: Longitudinal analysis of one unit revealed a transition from marginal performance (CNR 3.1) to critical detector failure (CNR 0) over a seven-month period.
Conclusion
This multi-center audit demonstrates that while radiation safety is universally maintained across the facilities, technical failures affecting diagnostic image quality occur in a significant minority of units. These findings underscore the necessity of rigorous medical physics oversight and the use of standardized phantoms, as adherence to safety dose limits does not guarantee the image contrast required for early cancer detection.