Mammography is the gold standard for breast cancer screening and has saved thousands of lives across the UAE and GCC region. But mammography is also the most technically demanding imaging modality from a quality control perspective — because the primary diagnostic task is detecting very small, low-contrast lesions (microcalcifications of 0.1mm, soft tissue masses with subtle density differences) in a radiation-sensitive patient population. A mammography system that is performing suboptimally may miss early-stage cancers that a well-maintained, well-calibrated system would detect. Quality control in mammography is not a regulatory formality — it is directly linked to clinical outcomes.
The clinical consequence of a missed early-stage breast cancer is years of disease progression before eventual symptomatic detection — converting a potentially curable Stage I cancer into a much more difficult to treat Stage III. A mammography system with degraded image quality misses these early lesions systematically — not randomly. Every patient imaged on a suboptimal system is at elevated risk of a false negative result.
This is why mammography QC standards are more stringent, more frequent and more comprehensively prescribed than QC standards for any other imaging modality. UAE facilities offering mammography — whether for symptomatic patients or for screening — are expected to implement a formal, systematic QC programme.
A comprehensive mammography QC programme covers multiple test frequencies:
Daily tests (performed by the radiographer): • Artifact evaluation — assessing the flat-field image for detector artifacts • Phantom image quality — assessing test object visibility in a standard phantom image • Compression force check — verifying the compression paddle applies the specified force range • Automatic Exposure Control (AEC) performance — verifying consistent exposure across the phantom thickness range
Weekly tests: • Repeat/reject analysis — tracking rejected and repeated images to identify systematic positioning or technique problems • System cleanliness — checking detector and compression paddle surfaces
Monthly tests: • Compression paddle deflection — checking for deformation • Phantom image quality scoring — formal recording and trending of phantom test scores
Annual tests (performed by medical physicist): • Full kVp, mAs, HVL and dose measurements • Spatial resolution and MTF measurement • Contrast-detail phantom imaging and scoring • AEC tracking assessment • Detector uniformity and artifact imaging • Patient dose estimation (mean glandular dose — MGD) • Dosimetric accuracy assessment
For mammography, the relevant dose metric is mean glandular dose (MGD) — the average absorbed dose to the glandular tissue of the breast, which is the radiosensitive tissue of concern. MGD depends on the breast thickness, composition and the X-ray beam quality.
FANR and international guidelines specify reference levels for MGD in mammography. The EUREF reference level for a standard 53mm compressed breast is 2 mGy per view. UAE facilities should measure their MGD routinely and compare it against this reference level — a facility with MGD consistently above the reference level should investigate and optimise its technique factors.
RevirzaMed's medical physicists measure MGD as part of the annual mammography QC assessment and report the values against UAE and international reference levels.
An increasing number of UAE mammography centres are investing in Digital Breast Tomosynthesis (DBT) — 3D mammography — which produces a series of thin-section reconstructed images through the breast in addition to or instead of standard 2D images. DBT has been shown to improve cancer detection rates and reduce recall rates compared to standard 2D mammography.
DBT introduces additional QC requirements — the system produces more images per examination, the dose per examination can be higher if not properly managed, and the reconstruction algorithm introduces artefacts that must be monitored. Facilities upgrading to DBT should ensure their QC programme is updated to cover the 3D acquisition and reconstruction performance.
Yes. FANR's radiation protection regulations require all ionising radiation facilities to operate a quality assurance programme that includes equipment performance testing. For mammography, this translates to a formal daily/weekly/monthly/annual QC programme. DOH Abu Dhabi and DHA Dubai have additional specific requirements for breast imaging facilities.
Yes. Many types of mammography performance degradation — reduced spatial resolution, slight AEC drift, early detector uniformity loss — are not apparent to clinical staff from routine clinical images. Only structured QC testing with quantitative measurements and trend analysis reliably detects these changes before they reach clinical significance.
RevirzaMed Healthcare Solutions — Abu Dhabi's trusted FANR Approval and medical equipment specialists since 2015.