The myth of the 50-50 breast.

PURPOSE: For dosimetry and for work in optimization of x-ray imaging of the breast, it is commonly assumed that the breast is composed of 50% fibroglandular tissue and 50% fat. The purpose of this study was to assess whether this assumption was realistic. METHODS: First, data obtained from an experimental breast CT scanner were used to validate an algorithm that measures breast density from digitized film mammograms. Density results obtained from a total of 2831 women, including 191 women receiving CT and from mammograms of 2640 women from three other groups, were then used to estimate breast compositions. RESULTS: Mean compositions, expressed as percent fibroglandular tissue (including the skin), varied from 13.7% to 25.6% among the groups with an overall mean of 19.3%. The mean compressed breast thickness for the mammograms was 5.9 cm (sigma = 1.6 cm). 80% of the women in our study had volumetric breast density less than 27% and 95% were below 45%. CONCLUSIONS: Based on the results obtained from the four groups of women in our study, the "50-50" breast is not a representative model of the breast composition.

Developing a methodology for three-dimensional correlation of PET-CT images and whole-mount histopathology in non-small-cell lung cancer.

BACKGROUND: Understanding the three-dimensional (3D) volumetric relationship between imaging and functional or histopathologic heterogeneity of tumours is a key concept in the development of image-guided radiotherapy. Our aim was to develop a methodologic framework to enable the reconstruction of resected lung specimens containing non-small-cell lung cancer (NSCLC), to register the result in 3D with diagnostic imaging, and to import the reconstruction into a radiation treatment planning system. METHODS AND RESULTS: We recruited 12 patients for an investigation of radiology-pathology correlation (RPC) in nsclc. Before resection, imaging by positron emission tomography (PET) or computed tomography (CT) was obtained. Resected specimens were formalin-fixed for 1-24 hours before sectioning at 3-mm to 10-mm intervals. To try to retain the original shape, we embedded the specimens in agar before sectioning. Consecutive sections were laid out for photography and manually adjusted to maintain shape. Following embedding, the tissue blocks underwent whole-mount sectioning (4-mum sections) and staining with hematoxylin and eosin. Large histopathology slides were used to whole-mount entire sections for digitization. The correct sequence was maintained to assist in subsequent reconstruction. Using Photoshop (Adobe Systems Incorporated, San Jose, CA, U.S.A.), contours were placed on the photographic images to represent the external borders of the section and the extent of macroscopic disease. Sections were stacked in sequence and manually oriented in Photoshop. The macroscopic tumour contours were then transferred to MATLAB (The Mathworks, Natick, MA, U.S.A.) and stacked, producing 3D surface renderings of the resected specimen and embedded gross tumour. To evaluate the microscopic extent of disease, customized "tile-based" and commercial confocal panoramic laser scanning (TISSUEscope: Biomedical Photometrics, Waterloo, ON) systems were used to generate digital images of whole-mount histopathology sections. Using the digital whole-mount images and imaging software, we contoured the gross and microscopic extent of disease. Two methods of registering pathology and imaging were used. First, selected pet and ct images were transferred into Photoshop, where they were contoured, stacked, and reconstructed. After importing the pathology and the imaging contours to MATLAB, the contours were reconstructed, manually rotated, and rigidly registered. In the second method, MATLAB tumour renderings were exported to a software platform for manual registration with the original pet and ct images in multiple planes. Data from this software platform were then exported to the Pinnacle radiation treatment planning system in DICOM (Digital Imaging and Communications in Medicine) format. CONCLUSIONS: There is no one definitive method for 3D volumetric RPC in nsclc. An innovative approach to the 3D reconstruction of resected nsclc specimens incorporates agar embedding of the specimen and whole-mount digital histopathology. The reconstructions can be rigidly and manually registered to imaging modalities such as ct and pet and exported to a radiation treatment planning system.

Sci-Thurs PM: Delivery-03: Optical imaging of microscopic radiation dose gradients using a digital microscope.

Using superior localization and immobilization methods, stereotactic radiosurgery is capable of delivering spheres of dose as small as a few millimetres in diameter to intracranial targets. For targets abutting critical structures, the most conformal treatments minimize adverse radiation side effects and it is important, therefore, to ensure proper quality assurance prior to delivering high doses of radiation to eloquent brain locations in a single fraction. This work examines the capability of a digital microscope, with translation stage and associated software, to resolve dose gradients in Gafchromic EBT™ film at the micron level. In order to validate the microscope-film system from a radiation physics approach, films were irradiated to produce very steep penumbrae by using very small fields, lower photon energies and minimal geometric penumbra contribution. Orthovoltage film irradiations were done by placing films in phantom beneath pinhole collimators. The experimentally determined off-axis dose profiles were compared with Monte Carlo computer simulations which replicated the irradiation geometry and served to validate our measured data. The measured 80% - 20% penumbral widths were 46 µm ± 26 µm (100 kVp, 2 mm field size) and 69 µm ± 27 µm (300 kVp, 2 mm field size). In the energy range covered, the measured penumbral widths agreed with Monte Carlo computer simulations within experimental uncertainty. The effects of noise originating from both the film and the microscope system are discussed and improvements to this system suggested.