Performance of mammography equipment in the Macedonian breast screening campaign 2008/2009

Breast screening campaign in Macedonia started in the end of 2007 and 19 national mammography departments were included. Contrary to the European Guidelines for Quality Assurance in Mammography Screening, the quality assurance activities were not implemented before the start of the campaign, except at the University Clinic of Radiology, Skopje. The quality control tests were performed for the very first time at 13 mammography units under a licence-obtaining procedure. One of the machines was suspended from clinical and screening practice due to heavy malfunction of the generator, X-ray tube and automatic exposure control (AEC) system. Only 3 of the 13 mammography machines met the criteria for tube voltage (kV) accuracy. Two of the seven AEC systems were calibrated in the optimal optical density (OD) range (OD >1.4). AEC settings corresponded to the recommendations at eight units, while nine units met basic overall image quality criteria. Mean glandular dose (MGD) was higher than the recommended level of 2.5 mGy in four departments. Mean gradient of the film G 0.25–2.0 was below 2.8 at four units. Only two light boxes had a luminance of >1700 cd m−2 and six rooms had an ambient light level of <50 lx. The findings of this work clearly suggest that the performance of the mammography equipment involved in the campaign in almost 50 % do not supply basic quality criteria for a breast screening programme.