EVALUATION OF MODEL-BASED ITERATIVE RECONSTRUCTION IN ABDOMINAL COMPUTED TOMOGRAPHY IMAGING AT TWO DIFFERENT DOSE LEVELS.

The purpose of this study was to qualitatively evaluate recently introduced Model-based iterative reconstruction method (IMR) and routinely used iterative reconstruction algorithm iDose4 to investigate future dose reduction possibilities for abdominal CT exams. The study contained data from 34 patients who underwent abdominal CT in SkåneUniversityHospital Lund, Sweden. A low-dose scan (CTDIvol3.4 mGy) reconstructed with both iDose4 and IMR and a standard-dose scan (CTDIvol 5.3 mG) reconstructed with iDose4 alone were visually graded in ViewDEX v2.0 by four radiologists using modified EU image criteria. The visual grading characteristics analysis for the evaluation comparing iDose4 standard dose with IMR low dose did not show any statistically significant difference in five of six criteria. In one of the criteria, iDose4 was superior to IMR. The result show promising possibilities are introduced for substantial radiation dose reduction (35%) in abdominal CT imaging when replacing iDose4 with IMR. Still, care should be taken when considering the reproduction of adrenal glands.

VOLUMETRIC LOCALISATION OF DENSE BREAST TISSUE USING BREAST TOMOSYNTHESIS DATA.

This study attempted to use combined data from reconstructed digital breast tomosynthesis (DBT) volumes and density estimation of projection images to localise dense tissue inside the breast, using the assumption that the breast can be treated as consisting of only two types of tissue: fibroglandular (dense) and adipose (fatty). To be able to verify results, software breast phantoms generated using fractal Perlin noise were employed. Projection images were created using the PENELOPE Monte Carlo package. Dense tissue volume was estimated from the central projection image. The density image was used to determine the number of dense voxels at each pixel location, which were then placed using the DBT image as a template. The method proved capable of accurately determining the composition of 75±5 % of voxels.

ESTIMATES OF BREAST CANCER GROWTH RATE FROM MAMMOGRAMS AND ITS RELATION TO TUMOUR CHARACTERISTICS.

This study aimed to investigate the growth rate of 31 consecutive invasive breast cancers based on volume measures on at least two serial mammograms and its relation to histopathological findings. The average tumour volume-doubling time in all invasive breast cancer subtypes was 282 d (range 46-749 d). Grade III breast cancers had a significantly shorter average tumour volume-doubling time of 105 d (range 46-157 d) compared with Grade I and II tumours (average of 296 d, range 147-531 d and average of 353 d, range 139-749 d, respectively) (p = 0.002). Multiple linear regression identified that tumour volume-doubling time was positively associated with patient age, histological grade and progesterone receptor expression and inversely associated with axillary lymph node involvement, human epidermal growth factor receptor 2 and Ki-67 expression (p < 0.001). In conclusion, tumour volume-doubling time as estimated on serial mammography may provide important prognostic information relevant for clinical decision-making.

Visibility of microcalcification clusters and masses in breast tomosynthesis image volumes and digital mammography: a 4AFC human observer study.

PURPOSE: To investigate the visibility of simulated lesions in digital breast tomosynthesis (BT) image volumes compared with 2D digital mammography (DM). METHODS: Simulated lesions (masses and microcalcifications) were added to images of the same women acquired on a DM system (Mammomat Novation, Siemens) and a BT prototype. The same beam quality was used for the DM and BT acquisitions. The total absorbed dose resulting from a 25-projection BT acquisition and reconstruction (BT(25)) was approximately twice that of a single DM view. By excluding every other projection image from the reconstruction (BT(13)), approximately the same dose as in DM was effected. Simulated microcalcifications were digitally added with varying contrast to the DM and BT images. Simulated masses with 8 mm diameter were also added to BT images. A series of 4-alternative forced choice (4AFC) human observer experiments were conducted. Four medical physicists participated in all experiments, each consisting of 60 trials per experimental condition. The observers interpreted the BT image volumes in cine-mode at a fixed image sequence speed. The required threshold contrast (S(t)) to achieve a detectability index (d') of 2.5 (i.e., 92.5% correct decisions) was determined. RESULTS: The S(t) for mass detection in DM was approximately a factor of 2 higher than required in BT indicating that the detection of masses was improved under BT conditions compared to DM. S(t) for microcalcification detection was higher for BT than for DM at both BT dose levels (BT(25) and BT(13)), with a statistically significant difference in S(t) between DM and BT(13). These results indicate a dose-dependent decrease in detection performance in BT for detection of microcalcifications. CONCLUSIONS: In agreement with previous investigations, masses of size 8 mm can be detected with less contrast in BT than in DM indicating improved detection performance for BT. However, for the investigated microcalcifications, the results of this study indicate potentially worse performance for BT than for DM at the same dose level.

Breast cancer screening with tomosynthesis--initial experiences.

Experiences gained so far using tomosynthesis for breast cancer screening will be reported. A short summary of results from preparatory studies will also be presented. The sensitivity and specificity of breast tomosynthesis (BT) will be compared with conventional two-dimensional digital mammography (DM) for breast cancer screening in a population-based study. Over 2000 women have been examined so far with BT and DM. The BT reading is significantly more time-consuming than the DM reading. Preparatory studies have shown that BT has a higher diagnostic precision and higher accuracy of size measurements and stage determination than DM. There is potential to use lower compression force with BT compared with DM, without decreasing the diagnostic accuracy. BT might play an important role in clinical as well as screening mammography. A large-scale population-based study to investigate BT as a screening modality is underway.

In-plane visibility of lesions using breast tomosynthesis and digital mammography.

PURPOSE: The purpose of this work was to evaluate the visibility of simulated lesions in 2D digita mammography (DM) and breast tomosynthesis (BT) images of patients. METHODS: Images of the same women were acquired on both a DM system (Mammomat Novation, Siemens Healthcare, Erlangen, Germany) and a BT prototype system adapted from the same type of DM system. Using the geometrical properties of the two systems, simulated lesions were projected and added to each DM image as well as to each BT projection image prior to 3D reconstruction. The same beam quality and approximately the same total absorbed dose to the glandular tissue were used for each breast image acquisition on the two systems. A series of four-alternative forced choice human observer experiments was conducted for each of five simulated lesion diameters: 0.2, 1, 3, 8, and 25 mm. An additional experiment was conducted for the 0.2 mm lesion in BT only at twice the dose level (BT2x). Threshold signal was defined as the lesion signal intensity required for a detectability index (d') of 2.5. Four medical physicists participated in all experiments. One experiment, consisting of 60 cases, was conducted per test condition (i.e., lesion size and signal combination). RESULTS: For the smallest lesions (0.2 mm), the threshold signal for DM was 21% lower than for BT at equivalent dose levels, and BT2x was 26% lower than DM. For the lesions larger than 1 mm, the threshold signal increased linearly (in log space) with the lesion diameter for both DM and BT, with DM requiring around twice the signal as BT. The difference in the threshold signal between BT and DM at each lesion size was statistically significant, except for the 0.2 mm lesion between BT2x and DM. CONCLUSIONS: The results of this study indicate that low-signal lesions larger than 1.0 mm may be more visible in BT compared to DM, whereas 0.2 mm lesions may be better visualized with DM compared to BT, when compared at equal dose.

The effect of reduced breast compression in breast tomosynthesis: human observer study using clinical cases.

The aim of this study was to investigate whether the compression force used with conventional mammography can be reduced with breast tomosynthesis (BT), without adversely affecting the visualisation of normal and pathological structures. Forty-five women were examined with BT using full (same as for 2D mammography) and half compression force. Both examinations were performed with the same acquisition parameters. A total of 103 paired structure images were evaluated according to specified image quality criteria. Three experienced radiologists participated in the study. They had to make a forced choice, i.e. choose the image they felt best fulfilled the image quality criteria. The results showed no evident difference in the image quality, indicating that BT may be performed with substantially less compression force compared with 2D mammography. A majority of the examined women felt that half compression was more comfortable than full compression.