Ideal-observer detectability in photon-counting differential phase-contrast imaging using a linear-systems approach.

PURPOSE: To provide a cascaded-systems framework based on the noise-power spectrum (NPS), modulation transfer function (MTF), and noise-equivalent number of quanta (NEQ) for quantitative evaluation of differential phase-contrast imaging (Talbot interferometry) in relation to conventional absorption contrast under equal-dose, equal-geometry, and, to some extent, equal-photon-economy constraints. The focus is a geometry for photon-counting mammography. METHODS: Phase-contrast imaging is a promising technology that may emerge as an alternative or adjunct to conventional absorption contrast. In particular, phase contrast may increase the signal-difference-to-noise ratio compared to absorption contrast because the difference in phase shift between soft-tissue structures is often substantially larger than the absorption difference. We have developed a comprehensive cascaded-systems framework to investigate Talbot interferometry, which is a technique for differential phase-contrast imaging. Analytical expressions for the MTF and NPS were derived to calculate the NEQ and a task-specific ideal-observer detectability index under assumptions of linearity and shift invariance. Talbot interferometry was compared to absorption contrast at equal dose, and using either a plane wave or a spherical wave in a conceivable mammography geometry. The impact of source size and spectrum bandwidth was included in the framework, and the trade-off with photon economy was investigated in some detail. Wave-propagation simulations were used to verify the analytical expressions and to generate example images. RESULTS: Talbot interferometry inherently detects the differential of the phase, which led to a maximum in NEQ at high spatial frequencies, whereas the absorption-contrast NEQ decreased monotonically with frequency. Further, phase contrast detects differences in density rather than atomic number, and the optimal imaging energy was found to be a factor of 1.7 higher than for absorption contrast. Talbot interferometry with a plane wave increased detectability for 0.1-mm tumor and glandular structures by a factor of 3-4 at equal dose, whereas absorption contrast was the preferred method for structures larger than ∼0.5 mm. Microcalcifications are small, but differ from soft tissue in atomic number more than density, which is favored by absorption contrast, and Talbot interferometry was barely beneficial at all within the resolution limit of the system. Further, Talbot interferometry favored detection of "sharp" as opposed to "smooth" structures, and discrimination tasks by about 50% compared to detection tasks. The technique was relatively insensitive to spectrum bandwidth, whereas the projected source size was more important. If equal photon economy was added as a restriction, phase-contrast efficiency was reduced so that the benefit for detection tasks almost vanished compared to absorption contrast, but discrimination tasks were still improved close to a factor of 2 at the resolution limit. CONCLUSIONS: Cascaded-systems analysis enables comprehensive and intuitive evaluation of phase-contrast efficiency in relation to absorption contrast under requirements of equal dose, equal geometry, and equal photon economy. The benefit of Talbot interferometry was highly dependent on task, in particular detection versus discrimination tasks, and target size, shape, and material. Requiring equal photon economy weakened the benefit of Talbot interferometry in mammography.

Contrast-enhanced spectral mammography with a photon-counting detector.

PURPOSE: Spectral imaging is a method in medical x-ray imaging to extract information about the object constituents by the material-specific energy dependence of x-ray attenuation. The authors have investigated a photon-counting spectral imaging system with two energy bins for contrast-enhanced mammography. System optimization and the potential benefit compared to conventional non-energy-resolved absorption imaging was studied. METHODS: A framework for system characterization was set up that included quantum and anatomical noise and a theoretical model of the system was benchmarked to phantom measurements. RESULTS: Optimal combination of the energy-resolved images corresponded approximately to minimization of the anatomical noise, which is commonly referred to as energy subtraction. In that case, an ideal-observer detectability index could be improved close to 50% compared to absorption imaging in the phantom study. Optimization with respect to the signal-to-quantum-noise ratio, commonly referred to as energy weighting, yielded only a minute improvement. In a simulation of a clinically more realistic case, spectral imaging was predicted to perform approximately 30% better than absorption imaging for an average glandularity breast with an average level of anatomical noise. For dense breast tissue and a high level of anatomical noise, however, a rise in detectability by a factor of 6 was predicted. Another approximately 70%-90% improvement was found to be within reach for an optimized system. CONCLUSIONS: Contrast-enhanced spectral mammography is feasible and beneficial with the current system, and there is room for additional improvements. Inclusion of anatomical noise is essential for optimizing spectral imaging systems.

An efficient pre-object collimator based on an x-ray lens.

A multiprism lens (MPL) is a refractive x-ray lens with one-dimensional focusing properties. If used as a pre-object collimator in a scanning system for medical x-ray imaging, it reduces the divergence of the radiation and improves on photon economy compared to a slit collimator. Potential advantages include shorter acquisition times, a reduced tube loading, or improved resolution. We present the first images acquired with a MPL in a prototype for a scanning mammography system. The lens showed a gain of flux of 1.32 compared to a slit collimator at equal resolution, or a gain in resolution of 1.31-1.44 at equal flux. We expect the gain of flux in a clinical setup with an optimized MPL and a custom-made absorption filter to reach 1.67, or 1.45-1.54 gain in resolution.

Physical characterization of a scanning photon counting digital mammography system based on Si-strip detectors.

The physical performance of a scanning multislit full field digital mammography system was determined using basic image quality parameters. The system employs a direct detection detector comprised of linear silicon strip sensors in an edge-on geometry connected to photon counting electronics. The pixel size is 50 microm and the field of view 24 x 26 cm2. The performance was quantified using the presampled modulation transfer function, the normalized noise power spectrum and the detective quantum efficiency (DQE). Compared to conventional DQE methods, the scanning geometry with its intrinsic scatter rejection poses additional requirements on the measurement setup, which are investigated in this work. The DQE of the photon counting system was found to be independent of the dose level to the detector in the 7.6-206 microGy range. The peak DQE was 72% and 73% in the scan and slit direction, respectively, measured with a 28 kV W-0.5 mm Al anode-filter combination with an added 2 mm Al filtration.

Scatter rejection in multislit digital mammography.

The scatter to primary ratio (SPR) was measured on a scanning multislit full-field digital mammography system for different thickness of breast equivalent material and different tube voltages. Scatter within the detector was measured separately and was found to be the major source of scatter in the assembly. Measured total SPRs below 6% are reported for breast range 3-7 cm. The performance of the multislit assembly is compared to other imaging geometries with different scatter rejection schemes by using the scatter detective quantum efficiency.

AEC for scanning digital mammography based on variation of scan velocity.

A theoretical evaluation of nonuniform x-ray field distributions in mammography was conducted. An automatic exposure control (AEC) is proposed for a scanning full field digital mammography system. It uses information from the leading part of the detector to vary the scan velocity dynamically, thus creating a nonuniform x-ray field in the scan direction. Nonuniform radiation fields were also created by numerically optimizing the scan velocity profile to each breast's transmission distribution, with constraints on velocity and acceleration. The goal of the proposed AEC is to produce constant pixel signal-to-noise ratio throughout the image. The target pixel SNR for each image could be set based on the breast thickness, breast composition, and the beam quality as to achieve the same contrast-to-noise ratio between images for structures of interest. The results are quantified in terms of reduction in entrance surface air kerma (ESAK) and scan time relative to a uniform x-ray field. The theoretical evaluation was performed on a set of 266 mammograms. The performance of the different methods to create nonuniform fields decreased with increased detector width, from 18% to 11% in terms of ESAK reduction and from 30% to 25% in terms of scan time reduction for the proposed AEC and detector widths from 10 to 60 mm. Some correlation was found between compressed breast thickness and the projected breast area onto the image field. This translated into an increase of the ESAK and decrease of the scan time reduction with breast thickness. Ideally a nonuniform field in two dimensions could reduce the entrance dose by 39% on average, whereas a field nonuniform in only the scanning dimension ideally yields a 20% reduction. A benefit with the proposed AEC is that the risk of underexposing the densest region of the breast can be virtually eliminated.