Evaluating spectral performance for quantitative contrast-enhanced breast CT with a GaAs based photon counting detector: a simulation approach.

Quantitative contrast-enhanced breast computed tomography (CT) has the potential to improve the diagnosis and management of breast cancer. Traditional CT methods using energy-integrated detectors and dual-exposure images with different incident spectra for material discrimination can increase patient radiation dose and be susceptible to motion artifacts and spectral resolution loss. Photon Counting Detectors (PCDs) offer a promising alternative approach, enabling acquisition of multiple energy levels in a single exposure and potentially better energy resolution. Gallium arsenide (GaAs) is particularly promising for breast PCD-CT due to its high quantum efficiency and reduction of fluorescence x-rays escaping the pixel within the breast imaging energy range. In this study, the spectral performance of a GaAs PCD for quantitative iodine contrast-enhanced breast CT was evaluated. A GaAs detector with a pixel size of 100µm, a thickness of 500µm was simulated. Simulations were performed using cylindrical phantoms of varying diameters (10 cm, 12 cm, and 16 cm) with different concentrations and locations of iodine inserts, using incident spectra of 50, 55, and 60 kVp with 2 mm of added aluminum filtration and and a mean glandular dose of 10 mGy. We accounted for the effects of beam hardening and energy detector response using TIGRE CT open-source software and the publicly available Photon Counting Toolkit (PcTK). Material-specific images of the breast phantom were produced using both projection and image-based material decomposition methods, and iodine component images were used to estimate iodine intake. Accuracy and precision of the proposed methods for estimating iodine concentration in breast CT images were assessed for different material decomposition methods, incident spectra, and breast phantom thicknesses. The results showed that both the beam hardening effect and imperfection in the detector response had a significant impact on performance in terms of Root Mean Squared Error (RMSE), precision, and accuracy of estimating iodine intake in the breast. Furthermore, the study demonstrated the effectiveness of both material decomposition methods in making accurate and precise iodine concentration predictions using a GaAs-based photon counting breast CT system, with better performance when applying the projection-based material decomposition approach. The study highlights the potential of GaAs-based photon counting breast CT systems as viable alternatives to traditional imaging methods in terms of material decomposition and iodine concentration estimation, and proposes phantoms and figures of merit to assess their performance.

Joint AAPM Task Group 282/EFOMP Working Group Report: Breast dosimetry for standard and contrast-enhanced mammography and breast tomosynthesis.

Currently, there are multiple breast dosimetry estimation methods for mammography and its variants in use throughout the world. This fact alone introduces uncertainty, since it is often impossible to distinguish which model is internally used by a specific imaging system. In addition, all current models are hampered by various limitations, in terms of overly simplified models of the breast and its composition, as well as simplistic models of the imaging system. Many of these simplifications were necessary, for the most part, due to the need to limit the computational cost of obtaining the required dose conversion coefficients decades ago, when these models were first implemented. With the advancements in computational power, and to address most of the known limitations of previous breast dosimetry methods, a new breast dosimetry method, based on new breast models, has been developed, implemented, and tested. This model, developed jointly by the American Association of Physicists in Medicine and the European Federation for Organizations of Medical Physics, is applicable to standard mammography, digital breast tomosynthesis, and their contrast-enhanced variants. In addition, it includes models of the breast in both the cranio-caudal and the medio-lateral oblique views. Special emphasis was placed on the breast and system models used being based on evidence, either by analysis of large sets of patient data or by performing measurements on imaging devices from a range of manufacturers. Due to the vast number of dose conversion coefficients resulting from the developed model, and the relative complexity of the calculations needed to apply it, a software program has been made available for download or online use, free of charge, to apply the developed breast dosimetry method. The program is available for download or it can be used directly online. A separate User's Guide is provided with the software.

Task-based assessment of digital mammography microcalcification detection with deep learning denoising algorithmss using in silico and physical phantom studies.

Purpose: Recent research suggests that image quality degradation with reduced radiation exposure in mammography can be mitigated by postprocessing mammograms with denoising algorithms based on convolutional neural networks. Breast microcalcifications, along with extended soft-tissue lesions, are the primary breast cancer biomarkers in a clinical x-ray examination, with the former being more sensitive to quantum noise. We test one such publicly available denoising method to observe if an improvement in detection of small microcalcifications can be achieved when deep learning-based denoising is applied to half-dose phantom scans. Approach: An existing denoiser model (that was previously trained on clinical data) was applied to mammograms of an anthropomorphic physical phantom with hydroxyapatite microcalcifications. In addition, another model trained and tested using all synthetic (Monte Carlo) data was applied to a similar digital compressed breast phantom. Human reader studies were conducted to assess and compare image quality in a set of binary signal detection 4-AFC experiments, with proportion of correct responses used as a performance metric. Results: In both physical phantom/clinical system and simulation studies, we saw no apparent improvement in small microcalcification signal detection in denoised half-dose mammograms. However, in a Monte Carlo study, we observed a noticeable jump in 4-AFC scores, when readers analyzed denoised half-dose images processed by the neural network trained on a dataset composed of 50% signal-present (SP) and 50% signal-absent regions of interest (ROIs). Conclusions: Our findings conjecture that deep-learning denoising algorithms may benefit from enriching training datasets with SP ROIs, at least in cases with clusters of 5 to 10 microcalcifications, each of size ≲240 µm.

An empirical method for geometric calibration of a photon counting detector-based cone beam CT system.

BACKGROUND: Geometric calibration is essential in developing a reliable computed tomography (CT) system. It involves estimating the geometry under which the angular projections are acquired. Geometric calibration of cone beam CTs employing small area detectors, such as currently available photon counting detectors (PCDs), is challenging when using traditional-based methods due to detectors' limited areas. OBJECTIVE: This study presented an empirical method for the geometric calibration of small area PCD-based cone beam CT systems. METHODS: Unlike the traditional methods, we developed an iterative optimization procedure to determine geometric parameters using the reconstructed images of small metal ball bearings (BBs) embedded in a custom-built phantom. An objective function incorporating the sphericities and symmetries of the embedded BBs was defined to assess performance of the reconstruction algorithm with the given initial estimated set of geometric parameters. The optimal parameter values were those which minimized the objective function. The TIGRE toolbox was employed for fast tomographic reconstruction. To evaluate the proposed method, computer simulations were carried out using various numbers of spheres placed in various locations. Furthermore, efficacy of the method was experimentally assessed using a custom-made benchtop PCD-based cone beam CT. RESULTS: Computer simulations validated the accuracy and reproducibility of the proposed method. The precise estimation of the geometric parameters of the benchtop revealed high-quality imaging in CT reconstruction of a breast phantom. Within the phantom, the cylindrical holes, fibers, and speck groups were imaged in high fidelity. The CNR analysis further revealed the quantitative improvements of the reconstruction performed with the estimated parameters using the proposed method. CONCLUSION: Apart from the computational cost, we concluded that the method was easy to implement and robust.

Inclusion of a GaAs detector model in the Photon Counting Toolkit software for the study of breast imaging systems.

We present an upgraded version of the Photon Counting Toolkit (PcTK), a freely available by request MATLAB tool for the simulation of semiconductor-based photon counting detectors (PCD), which has been extended and validated to account for gallium arsenide (GaAs)-based PCD(s). The modified PcTK version was validated by performing simulations and acquiring experimental data for three different cases. The LAMBDA 60 K module planar detector (X-Spectrum GmbH, Germany) based on the Medipix3 ASIC technology was used in all cases. This detector has a 500-µm thick GaAs sensor and a 256 × 256-pixel array with 55 µm pixel size. The first validation was a comparison between simulated and measured spectra from a 109Cd radionuclide source. In the second validation study, experimental measurements and simulations of mammography spectra were generated to observe the performance of the GaAs version of the PcTK with polychromatic radiation used in conventional x-ray imaging systems. The third validation study used single event analysis to validate the spatio-energetic model of the extended PcTK version. Overall, the software provided a good agreement between simulated and experimental data, validating the accuracy of the GaAs model. The software could be an attractive tool for accurate simulation of breast imaging modalities relying on photon counting detectors and therefore could assist in their characterization and optimization.

Theoretical comparison and optimization of cadmium telluride and gallium arsenide photon-counting detectors for contrast-enhanced spectral mammography.

Purpose: Most photon-counting detectors (PCDs) being developed use cadmium telluride (CdTe), which has nonoptimal characteristic x-ray emission with energies in the range used for breast imaging. New PCD using a gallium arsenide (GaAs) has been developed. Since GaAs has characteristic x-rays lower in energy than those of CdTe, it is hypothesized that this new PCD might be beneficial for spectral x-ray breast imaging. Approach: We performed simulations using realistic mammography x-ray spectra with both CdTe and GaAs PCDs. Five different experiments were conducted, each comparing the performance of CdTe and GaAs: (1) sensitivity of iodine quantification to charge cloud size and electronic noise, (2) effect of photon spectrum on iodine quantification, (3) effect of varying the number of energy bins, (4) a dose analysis to assess any possible dose reduction from using either detector, and (5) spectral performance of ideal CdTe and GaAs PCDs. For each study, 3 sets of 5000 noise realizations were used to calculate the Cramer-Rao lower bound (CRLB) of iodine quantification. Results: For all spectra studied, GaAs gave a lower CRLB for iodine quantification, with 10 of the 12 spectra showing a statistically significant difference ( p ≤ 0.05 ). The photon energy spectrum that optimized iodine detection for both detector materials was the 40 kVp beam with 2-mm Al filtration, which produced CRLBs of 0.282 cm 2 and 0.257 cm 2 for CdTe and GaAs, respectively, when using five energy bins. Conclusion: GaAs is a promising detector material for contrast-enhanced spectral mammography that offers better spectral performance than CdTe.

4D digital anthropomorphic breast phantom for iodinated contrast-enhanced imaging.

Purpose: Differentiating between benign and malignant masses is one of the biggest challenges in breast imaging. The challenge is ingrained in the similarity of the attenuation coefficients between different types of lesion tissues and fibroglandular tissues. Contrast-enhanced imaging techniques can take advantage of the differing metabolism in different tissues, therefore, potentially allowing better differentiation of malignant and benign lesions. To facilitate the development and optimization of such technologies, we propose a fully digital 4D phantom that features time-varying enhancement patterns for different tissue types. Approach: The 4D model is based on a static, anthropomorphic 3D digital breast phantom. Masses inserted into the 3D phantom are based on a previously published model. Physiological parameters that capture the key characteristics of masses, e.g., wash-in and wash-out rates indicating metabolic level, are employed in the model to simulate fundamental features for categorizing mass types. The two-compartmental model, a well-known model in the field of pharmacokinetics, is used to depict the diffusion process of the contrast agent. Two methods are proposed to allow for the simulations of lesions with necrotic cores of varying shapes and sizes. Results: The fourth dimension of the phantom models different time-varying enhancement patterns for different materials including fibroglandular tissue and lesion tissue. Metabolic characteristics of mass models can be adjusted to provide different enhancement patterns. The parameters of the 4D phantom can also be adjusted to fit different scenarios. The usage of the phantom is demonstrated by simulating mammograms at different time frames. Conclusion: A 4D digital anthropomorphic breast phantom that models different time-varying contrast enhancement patterns is presented. This phantom could be an integral tool for use in in silico trials to assess image quality of iodinated contrast-enhanced mammography, digital breast tomosynthesis, and breast computed tomography systems.

Classification of breast microcalcifications with GaAs photon-counting spectral mammography using an inverse problem approach.

The purpose of this study was to investigate the use of a Gallium Arsenide (GaAs) photon-counting spectral mammography system to differentiate between Type I and Type II calcifications. Type I calcifications, consisting of calcium oxalate dihydrate (CO) or weddellite compounds are more often associated with benign lesions in the breast, and Type II calcifications containing hydroxyapatite (HA) are associated with both benign and malignant lesions in the breast. To be able to differentiate between these two calcification types, it is necessary to be able to estimate the full spectrum of the x-ray beam transmitted through the breast. We propose a novel method for estimating the energy-dependent x-ray transmission fraction of a beam using a photon counting detector with a limited number of energy bins. Using the estimated x-ray transmission through microcalcifications, it was observed that calcification type can be accurately estimated with machine learning. The study was carried out on a custom-built laboratory benchtop system using the SANTIS 0804 GaAs detector prototype system from DECTRIS Ltd with two energy thresholds enabled. Four energy thresholds detector was simulated by taking two separate acquisitions in which two energy thresholds were enabled for each acquisition and set at (12 keV, 21 keV) and then (29 keV, 36 keV). Measurements were performed using BR3D (CIRS, Norfolk, VA) breast imaging phantoms mimicking 100% adipose and 100% glandular tissues swirled together in an approximate 50/50 ratio by weight with the addition of in-house-developed synthetic microcalcifications. First, an inverse problem-based approach was used to estimate the full energy x-ray transmission fraction factor using known basis transmission factors from varying thicknesses of aluminum and polymethyl methacrylate (PMMA). Second, the classification of Type I and Type II calcifications was performed using the estimated energy-dependent transmission fraction factors for the pixels containing calcifications. The results were analyzed using receiver operating characteristic (ROC) analysis and demonstrated good discrimination performance with the area under the ROC curve greater than 84%. They indicated that GaAs photon-counting spectral mammography has potential use as a non-invasive method for discrimination between Type I and Type II calcifications. Results from this study suggested that GaAs-based spectral mammography could serve as a non-invasive measure for ruling out malignancy of calcifications found in the breast. Additional studies in more clinically realistic conditions involving breast tissues samples with smaller microcalcification specks should be performed to further explore the feasibility of this approach.

Fabrication of microcalcifications for insertion into phantoms used to evaluate x-ray breast imaging systems.

Physical breast phantoms can be used to evaluate x-ray imaging systems such as mammography, digital breast tomosynthesis and dedicated breast computed tomography (bCT). These phantoms typically attempt to mimic x-ray attenuation properties of adipose and fibroglandular tissues within the breast. In order to use these phantoms for task-based objective assessment of image quality, relevant diagnostic features should be modeled within the phantom, such as mass lesions and/or microcalcifications. Evaluating imaging system performance in detecting microcalcifications is of particular interest due to its' clinical significance. Many previously-developed phantoms have used materials that model microcalcifications using unrealistic chemical composition, which do not accurately portray their desired x-ray attenuation and scatter properties. We report here on a new method for developing real microcalcification simulants that can be embedded in breast phantoms. This was achieved in several steps, including cross-linking hydroxyapatite and calcium oxalate powders with a binder called polyvinylpyrrolidone (PVP), and mechanical compression. The fabricated microcalcifications were evaluated by measuring their x-ray attenuation and scatter properties using x-ray spectroscopy and x-ray diffraction systems, respectively, and were demonstrated with x-ray mammography and bCT images. Results suggest that using these microcalcification models will make breast phantoms more realistic for use in evaluating task-based detection performance of the abovementioned breast imaging techniques, and bode well for extending their use to spectral imaging and x-ray coherent scatter computed tomography.

Erratum: Characterization of a GaAs photon-counting detector for mammography.

[This corrects the article DOI: 10.1117/1.JMI.8.3.033504.].

Characterization of a GaAs photon-counting detector for mammography.

Purpose: The purpose of this study was to evaluate the potential of a prototype gallium arsenide (GaAs) photon-counting detector (PCD) for imaging of the breast. Approach: First, the contrast-to-noise ratio (CNR) using different aluminum/poly(methyl methacrylate) (PMMA) phantoms of different thicknesses were measured. Second, microcalcification detection accuracy using a receiver operating characteristic study with three observers reading an ensemble of images was measured. Finally, the feasibility of using a GaAs system with two energy bins for contrast-enhanced mammography was investigated. Results: For the first two studies, the GaAs detector was compared with a commercial mammography system. The CNR was estimated by imaging 18-, 36-, and 110 - µ m -thick aluminum targets placed on top of 6 cm of PMMA plates and was found to be similar or better over a range of exposures. We observed a similar performance of detecting microcalcifications with the GaAs detector over a range of clinically applicable dose levels with a small increase at lower dose levels. The results also showed that contrast-enhanced spectral mammography using a GaAs PCD is feasible and beneficial. Conclusions: Results from this study suggest that performance with this new detector seems either slightly improved or equivalent to a commercial mammography system that used an energy-integrated detector. No attempt at optimizing exposure techniques for the GaAs detector was performed. Further research is needed to determine optimal acquisition parameters for the GaAs detector and to develop more sophisticated material decomposition algorithms that promise to provide improved quantitative estimates of iodine uptake.

Exploring CNN potential in discriminating benign and malignant calcifications in conventional and dual-energy FFDM: simulations and experimental observations.

Purpose: Deep convolutional neural networks (CNN) have demonstrated impressive success in various image classification tasks. We investigated the use of CNNs to distinguish between benign and malignant microcalcifications, using either conventional or dual-energy mammography x-ray images. The two kinds of calcifications, known as type-I (calcium oxalate crystals) and type-II (calcium phosphate aggregations), have different attenuation properties in the mammographic energy range. However, variations in microcalcification shape, size, and density as well as compressed breast thickness and breast tissue background make this a challenging discrimination task for the human visual system. Approach: Simulations (conventional and dual-energy mammography) and phantom experiments (conventional mammography only) were conducted using the range of breast thicknesses and randomly shaped microcalcifications. The off-the-shelf Resnet-18 CNN was trained on the regions of interest with calcification clusters of the two kinds. Results: Both Monte Carlo simulations and experimental phantom data suggest that deep neural networks can be trained to separate the two classes of calcifications with high accuracy, using dual-energy mammograms. Conclusions: Our work shows the encouraging results of using the CNNs for non-invasive testing for type-I and type-II microcalcifications and may stimulate further research in this area with expanding presence of the novel breast imaging modalities like dual-energy mammography or systems using photon-counting detectors.

Using convolutional neural networks to discriminate between cysts and masses in Monte Carlo-simulated dual-energy mammography.

PURPOSE: A substantial percentage of recalls (up to 20%) in screening mammography is attributed to extended round lesions. Benign fluid-filled breast cysts often appear similar to solid tumors in conventional mammograms. Spectral imaging (dual-energy or photon-counting mammography) has been shown to discriminate between cysts and solid masses with clinically acceptable accuracy. This work explores the feasibility of using convolutional neural networks (CNNs) for this task. METHODS: A series of Monte Carlo experiments was conducted with digital breast phantoms and embedded synthetic lesions to produce realistic dual-energy images of both lesion types. We considered such factors as nonuniform anthropomorphic background, size of the mass, breast compression thickness, and variability in lesion x-ray attenuation. These data then were used to train a deep neural network (ResNet-18) to learn the differences in x-ray attenuation of cysts and masses. RESULTS: Our simulation results showed that the CNN-based classifier could reliably discriminate between cystic and solid mass round lesions in dual-energy images with an area under the receiver operating characteristic curve (ROC AUC) of 0.98 or greater. CONCLUSIONS: The proposed approach showed promising performance and ease of implementation, and could be applied to novel photon-counting detector-based spectral mammography systems.

Assessment of task-based performance from five clinical DBT systems using an anthropomorphic breast phantom.

PURPOSE: Digital breast tomosynthesis (DBT) is a limited-angle tomographic breast imaging modality that can be used for breast cancer screening in conjunction with full-field digital mammography (FFDM) or synthetic mammography (SM). Currently, there are five commercial DBT systems that have been approved by the U.S. FDA for breast cancer screening, all varying greatly in design and imaging protocol. Because the systems are different in technical specifications, there is a need for a quantitative approach for assessing them. In this study, the DBT systems are assessed using a novel methodology with an inkjet-printed anthropomorphic phantom and four alternative forced choice (4AFC) study scheme. METHOD: A breast phantom was fabricated using inkjet printing and parchment paper. The phantom contained 5-mm spiculated masses fabricated with potassium iodide (KI)-doped ink and microcalcifications (MCs) made with calcium hydroxyapatite. Images of the phantom were acquired on all five systems with DBT, FFDM, and SM modalities where available using beam settings under automatic exposure control. A 4AFC study was conducted to assess reader performance with each signal under each modality. Statistical analysis was performed on the data to determine proportion correct (PC), standard deviations, and levels of significance. RESULTS: For masses, overall detection was highest with DBT. The difference in PC was statistically significant between DBT and SM for most systems. A relationship was observed between increasing PC and greater gantry span. For MCs, performance was highest with DBT and FFDM compared to SM. The difference between PC of DBT and PC of SM was statistically significant for all manufacturers. CONCLUSIONS: This methodology represents a novel approach for evaluating systems. This study is the first of its kind to use an inkjet-printed anthropomorphic phantom with realistic signals to assess performance of clinical DBT imaging systems.

Computational reader design and statistical performance evaluation of an in-silico imaging clinical trial comparing digital breast tomosynthesis with full-field digital mammography.

A recent study reported on an in-silico imaging trial that evaluated the performance of digital breast tomosynthesis (DBT) as a replacement for full-field digital mammography (FFDM) for breast cancer screening. In this in-silico trial, the whole imaging chain was simulated, including the breast phantom generation, the x-ray transport process, and computational readers for image interpretation. We focus on the design and performance characteristics of the computational reader in the above-mentioned trial. Location-known lesion (spiculated mass and clustered microcalcifications) detection tasks were used to evaluate the imaging system performance. The computational readers were designed based on the mechanism of a channelized Hotelling observer (CHO), and the reader models were selected to trend human performance. Parameters were tuned to ensure stable lesion detectability. A convolutional CHO that can adapt a round channel function to irregular lesion shapes was compared with the original CHO and was found to be suitable for detecting clustered microcalcifications but was less optimal in detecting spiculated masses. A three-dimensional CHO that operated on the multiple slices was compared with a two-dimensional (2-D) CHO that operated on three versions of 2-D slabs converted from the multiple slices and was found to be optimal in detecting lesions in DBT. Multireader multicase reader output analysis was used to analyze the performance difference between FFDM and DBT for various breast and lesion types. The results showed that DBT was more beneficial in detecting masses than detecting clustered microcalcifications compared with FFDM, consistent with the finding in a clinical imaging trial. Statistical uncertainty smaller than 0.01 standard error for the estimated performance differences was achieved with a dataset containing approximately 3000 breast phantoms. The computational reader design methodology presented provides evidence that model observers can be useful in-silico tools for supporting the performance comparison of breast imaging systems.

Objective assessment of task performance: a comparison of two FFDM detectors using an anthropomorphic breast phantom.

Current digital mammography systems primarily employ one of two types of detectors: indirect conversion, typically using a cesium-iodine scintillator integrated with an amorphous silicon photodiode matrix, or direct conversion, using a photoconductive layer of amorphous selenium (a-Se) combined with thin-film transistor array. The goal of this study was to evaluate a methodology for objectively assessing image quality to compare human observer task performance in detecting microcalcification clusters and extended mass-like lesions achieved with different detector types. The proposed assessment methodology uses a novel anthropomorphic breast phantom fabricated with ink-jet printing. In addition to human observer detection performance, standard linear metrics such as modulation transfer function, noise power spectrum, and detective quantum efficiency (DQE) were also measured to assess image quality. An Analogic Anrad AXS-2430 a-Se detector used in a commercial FFDM/DBT system and a Teledyne Dalsa Xineos-2329 with CMOS pixel readout were evaluated and compared. The DQE of each detector was similar over a range of exposures. Similar task performance in detecting microcalcifications and masses was observed between the two detectors over a range of clinically applicable dose levels, with some perplexing differences in the detection of microcalcifications at the lowest dose measurement. The evaluation approach presented seems promising as a new technique for objective assessment of breast imaging technology.

A four-alternative forced choice (4AFC) methodology for evaluating microcalcification detection in clinical full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) systems using an inkjet-printed anthropomorphic phantom.

PURPOSE: The advent of three-dimensional breast imaging systems such as digital breast tomosynthesis (DBT) has great promise for improving the detection and diagnosis of breast cancer. With these new technologies comes an essential need for testing methods to assess the resultant image quality. Although randomized clinical trials are the gold standard for assessing image quality, phantom-based studies can provide a simpler and less burdensome approach. In this work, a complete framework is presented for task-based evaluation of microcalcification (MCs) detection performance for DBT imaging systems. METHODS: The framework consists of three parts. The first part is a realistic anthropomorphic physical breast phantom created through inkjet printing, with parchment paper and iodine-doped ink. The second is a method for inserting realistic MCs fabricated from calcium hydroxyapatite. The reproducibility and stability of the phantom materials were investigated through multiple samples of parchment and ink over 6 months. The final part is an analysis using a four-alternative forced choice (4AFC) reader study. To demonstrate the framework, a task-based 4AFC study was conducted using a clinical system to compare performance from DBT, synthetic mammography (SM), and full-field digital mammography (FFDM). Nine human observers read images containing MC clusters imaged with all three modalities and tried to correctly locate the MCs. The proportion correct (PC) was measured as the number of correctly detected clusters out of all trials. RESULTS: Overall, readers scored the highest with FFDM, (PC = 0.95 ± 0.03) then DBT (0.85 ± 0.04), and finally SM (0.44 ± 0.06). For the parchment and ink samples, the linear attenuation properties were very stable over 6 months. In addition, little difference was found between the various parchment and ink samples, indicating good reproducibility. CONCLUSIONS: This framework presents a promising methodology for evaluating diagnostic task performance of clinical breast DBT systems.

Classification of breast microcalcifications using dual-energy mammography.

The potential of dual-energy mammography for microcalcification classification was investigated with simulation and phantom studies. Classification of type I/II calcifications was performed using the tissue attenuation ratio as a performance metric. The simulation and phantom studies were carried out using breast phantoms of 50% fibroglandular and 50% adipose tissue composition and thicknessess ranging from 3 to 6 cm. The phantoms included models of microcalcifications ranging in size between 200 and 900 µ m . The simulation study was carried out with fixed MGD of 1.5 mGy using various low- and high-kVp spectra, aluminum filtration thicknesses, and exposure distribution ratios to predict an optimized imaging protocol for the phantom study. Attenuation ratio values were calculated for microcalcification signals of different types at two different voltage settings. ROC analysis showed that classification performance as indicated by the area under the ROC curve was always greater than 0.95 for 1.5 mGy deposited mean glandular dose. This study provides encouraging first results in classifying malignant and benign microcalcifications based solely on dual-energy mammography images.

Advances in digital and physical anthropomorphic breast phantoms for x-ray imaging.

PURPOSE: With the advent of three-dimensional (3D) breast imaging modalities such as digital breast tomosynthesis (DBT) and dedicated breast CT (bCT), research into new anthropomorphic breast phantoms has accelerated. These breast phantoms are important for the optimization of new breast imaging systems, assessing new regulatory submissions to prove safety and effectiveness, and for developing new approaches to acceptance and constancy testing of 3D breast imaging systems. This paper provides a review of current research investigating both digital and physical breast phantom development for use in x-ray based imaging. METHODS: Two approaches for designing anthropomorphic, digital breast phantoms are discussed, procedural model-based phantom generation, where breast features are expressed using mathematical models, and patient-based generation, where breast structures from tissue specimens or patient-based breast MR or CT volumes are segmented. Following this discussion, a review of physical anthropomorphic phantoms is given, with emphasis on the advantages and disadvantages present with each approach. CONCLUSIONS: This paper provides a summary of the state-of-the-art in anthropomorphic breast phantom development for x-ray breast imaging. The primary advantage of model-based digital phantoms is that an unlimited number of phantoms with varying size, shape, and density can be generated. Current research on model-based breast phantoms is producing more and more realistic breast models; however, they probably are not yet able to pass the so-called "fool the radiologist" visualization test. Empirical patient-based breast phantoms are typically based on clinical breast CT data and look more realistic. However, clinical breast CT images have limited spatial resolution and thus do not always portray the finer details in the breast. A number of innovative solutions have been proposed for fabricating physical anthropomorphic breast phantoms based on digital phantom models; however, a number of challenges remain, including realistic modeling of x-ray attenuation properties and accurately representing high-frequency structures within breast.