X-ray characterisation of normal and neoplastic breast tissues

Plasma levels of leptin and mammographic density among postmenopausal women: a cross-sectional study

Introduction

Obesity has been linked to increased risk of breast cancer in postmenopausal women. Increased peripheral production of estrogens has been regarded as the main cause for this association, but other features of increased body fat mass may also play a part. Leptin is a protein produced mainly by adipose tissue and may represent a growth factor in cancer. We examined the association between leptin plasma levels and mammographic density, a biomarker for breast cancer risk.

Methods

We included data from postmenopausal women aged 55 and older, who participated in a cross-sectional mammography study in Tromsø, Norway. Mammograms, plasma leptin measurements as well as information on anthropometric and hormonal/reproductive factors were available from 967 women. We assessed mammographic density using a previously validated computer-assisted method. Multiple linear regression analysis was applied to investigate the association between mammographic density and quartiles of plasma leptin concentration. Because we hypothesized that the effect of leptin on mammographic density could vary depending on the amount of nondense or fat tissue in the breast, we also performed analyses on plasma leptin levels and mammographic density within tertiles of mammographic nondense area.

Results

After adjusting for age, postmenopausal hormone use, number of full-term pregnancies and age of first birth, there was an inverse association between leptin and absolute mammographic density (P_trend = 0.001). When we additionally adjusted for body mass index and mammographic nondense area, no statistically significant association between plasma leptin and mammographic density was found (P_trend = 0.16). Stratified analyses suggested that the association between plasma leptin and mammographic density could differ with the amount of nondense area of the mammogram, with the strongest association between leptin and mammographic absolute density in the stratum with the medium breast fat content (P_trend = 0.003, P for interaction = 0.05).

Conclusion

We found no overall consistent association between the plasma concentration of leptin and absolute mammographic density. Although weak, there was some suggestion that the association between leptin and mammographic density could differ with the amount of fat tissue in the breast.

Mammographic density and the risk and detection of breast cancer

BACKGROUND

Extensive mammographic density is associated with an increased risk of breast cancer and makes the detection of cancer by mammography difficult, but the influence of density on risk according to method of cancer detection is unknown.

METHODS

We carried out three nested case-control studies in screened populations with 1112 matched case-control pairs. We examined the association of the measured percentage of density in the baseline mammogram with risk of breast cancer, according to method of cancer detection, time since the initiation of screening, and age.

RESULTS

As compared with women with density in less than 10% of the mammogram, women with density in 75% or more had an increased risk of breast cancer (odds ratio, 4.7; 95% confidence interval [CI], 3.0 to 7.4), whether detected by screening (odds ratio, 3.5; 95% CI, 2.0 to 6.2) or less than 12 months after a negative screening examination (odds ratio, 17.8; 95% CI, 4.8 to 65.9). Increased risk of breast cancer, whether detected by screening or other means, persisted for at least 8 years after study entry and was greater in younger than in older women. For women younger than the median age of 56 years, 26% of all breast cancers and 50% of cancers detected less than 12 months after a negative screening test were attributable to density in 50% or more of the mammogram.

CONCLUSIONS

Extensive mammographic density is strongly associated with the risk of breast cancer detected by screening or between screening tests. A substantial fraction of breast cancers can be attributed to this risk factor.

Effective x-ray attenuation measurements with full field digital mammography

This work shows that effective x-ray attenuation coefficients may be estimated by applying Beer's Law to phantom image data acquired with the General Electric Senographe 2000D full field digital mammography system. Theoretical developments are provided indicating that an approximate form of the Beer's relation holds for polychromatic x-ray beams. The theoretical values were compared with experimentally determined measured values, which were estimated at various detector locations. The measured effective attenuation coefficients are in agreement with those estimated with theoretical developments and numerical integration. The work shows that the measured quantities show little spatial variation. The main ideas are demonstrated with polymethylmethacrylate and breast tissue equivalent phantom imaging experiments. The work suggests that the effective attenuation coefficients may be used as known values for radiometric standardization applications that compensate for the image acquisition influences. The work indicates that it is possible to make quantitative attenuation coefficient measurements from a system designed for clinical purposes.

X-ray spectrum optimization of full-field digital mammography: Simulation and phantom study

In contrast to conventional analog screen-film mammography new flat detectors have a high dynamic range and a linear characteristic curve. Hence, the radiographic technique can be optimized independently of the receptor exposure. It can be exclusively focused on the improvement of the image quality and the reduction of the patient dose. In this paper we measure the image quality by a physical quantity, the signal difference-to-noise ratio (SDNR), and the patient risk by the average glandular dose (AGD). Using these quantities, we compare the following different setups through simulations and phantom studies regarding the detection of microcalcifications and tumors for different breast thicknesses and breast compositions: Monochromatic radiation, three different anode/filter combinations: Molybdenum/molybdenum (Mo/Mo), molybdenum/rhodium (Mo/Rh), and tungsten/rhodium (W/Rh), different filter thicknesses, use of anti-scatter grids, and different tube voltages. For a digital mammography system based on an amorphous selenium detector it turned out that, first, the W/Rh combination is the best choice for all detection tasks studied. Second, monochromatic radiation can further reduce the AGD by a factor of up to 2.3, maintaining the image quality in comparison with a real polychromatic spectrum of an x-ray tube. And, third, the use of an anti-scatter grid is only advantageous for breast thicknesses larger than approximately 5 cm.

Evaluation of the minimum iodine concentration for contrast-enhanced subtraction mammography

Early manifestation of breast cancer is often very subtle and is displayed in a complex and variable pattern of normal anatomy that may obscure the disease. The use of dual-energy techniques, that can remove the structural noise, and contrast media, that enhance the region surrounding the tumour, could help us to improve the detectability of the lesions. The aim of this work is to investigate the use of an iodine-based contrast medium in mammography with two different double exposure techniques: K-edge subtraction mammography and temporal subtraction mammography. Both techniques have been investigated by using an ideal source, like monochromatic beams produced at a synchrotron radiation facility and a clinical digital mammography system. A dedicated three-component phantom containing cavities filled with different iodine concentrations has been developed and used for measurements. For each technique, information about the minimum iodine concentration, which provides a significant enhancement of the detectability of the pathology by minimizing the risk due to high dose and high concentration of contrast medium, has been obtained. In particular, for cavities of 5 and 8 mm in diameter filled with iodine solutions, the minimum concentration needed to obtain a contrast-to-noise ratio of 5 with a mean glandular dose of 2 mGy has been calculated. The minimum concentrations estimated with monochromatic beams and K-edge subtraction mammography are 0.9 mg ml(-1) and 1.34 mg ml(-1) for the biggest and smallest details, respectively, while for temporal subtraction mammography they are 0.84 mg ml(-1) and 1.31 mg ml(-1). With the conventional clinical system the minimum concentrations for the K-edge subtraction mammography are 4.13 mg ml(-1) (8 mm diameter) and 5.75 mg ml(-1) (5 mm diameter), while for the temporal subtraction mammography they are 1.01 mg ml(-1) (8 mm diameter) and 1.57 mg ml(-1) (5 mm diameter).

Detection of microcalcifications in digital mammograms using wavelet filter and Markov random field model

Clustered microcalcifcations (MCs) in digitized mammograms has been widely recognized as an early sign of breast cancer in women. This work is devoted to developing a computer-aided diagnosis (CAD) system for the detection of MCs in digital mammograms. Such a task actually involves two key issues: detection of suspicious MCs and recognition of true MCs. Accordingly, our approach is divided into two stages. At first, all suspicious MCs are preserved by thresholding a filtered mammogram via a wavelet filter according to the MPV (mean pixel value) of that image. Subsequently, Markov random field parameters based on the Derin-Elliott model are extracted from the neighborhood of every suspicious MCs as the primary texture features. The primary features combined with three auxiliary texture quantities serve as inputs to classifiers for the recognition of true MCs so as to decrease the false positive rate. Both Bayes classifier and back-propagation neural network were used for computer experiments. The data used to test this method were 20 mammograms containing 25 areas of clustered MCs marked by radiologists. Our method can readily remove 1341 false positives out of 1356, namely, 98.9% false positives were removed. Additionally, the sensitivity (true positives rate) is 92%, with only 0.75 false positives per image. From our experiments, we conclude that, with a proper choice of classifier, the texture feature based on Markov random field parameters combined with properly designed auxiliary features extracted from the texture context of the MCs can work outstandingly in the recognition of MCs in digital mammograms.

Breast composition measurements using retrospective standard mammogram form (SMF)

The standard mammogram form (SMF) representation of an x-ray mammogram is a standardized, quantitative representation of the breast from which the volume of non-fat tissue and breast density can be easily estimated, both of which are of significant interest in determining breast cancer risk. Previous theoretical analysis of SMF had suggested that a complete and substantial set of calibration data (such as mAs and kVp) would be needed to generate realistic breast composition measures and yet there are many interesting trials that have retrospectively collected images with no calibration data. The main contribution of this paper is to revisit our previous theoretical analysis of SMF with respect to errors in the calibration data and to show how and why that theoretical analysis did not match the results from the practical implementations of SMF. In particular, we show how by estimating breast thickness for every image we are, effectively, compensating for any errors in the calibration data. To illustrate our findings, the current implementation of SMF (version 2.2beta) was run over 4028 digitized film-screen mammograms taken from six sites over the years 1988-2002 with and without using the known calibration data. Results show that the SMF implementation running without any calibration data at all generates results which display a strong relationship with when running with a complete set of calibration data, and, most importantly, to an expert's visual assessment of breast composition using established techniques. SMF shows considerable promise in being of major use in large epidemiological studies related to breast cancer which require the automated analysis of large numbers of films from many years previously where little or no calibration data is available.

A computer simulation study comparing lesion detection accuracy with digital mammography, breast tomosynthesis, and cone-beam CT breast imaging

Although conventional mammography is currently the best modality to detect early breast cancer, it is limited in that the recorded image represents the superposition of a three-dimensional (3D) object onto a 2D plane. Recently, two promising approaches for 3D volumetric breast imaging have been proposed, breast tomosynthesis (BT) and CT breast imaging (CTBI). To investigate possible improvements in lesion detection accuracy with either breast tomosynthesis or CT breast imaging as compared to digital mammography (DM), a computer simulation study was conducted using simulated lesions embedded into a structured 3D breast model. The computer simulation realistically modeled x-ray transport through a breast model, as well as the signal and noise propagation through a CsI based flat-panel imager. Polyenergetic x-ray spectra of Mo/Mo 28 kVp for digital mammography, Mo/Rh 28 kVp for BT, and W/Ce 50 kVp for CTBI were modeled. For the CTBI simulation, the intensity of the x-ray spectra for each projection view was determined so as to provide a total average glandular dose of 4 mGy, which is approximately equivalent to that given in conventional two-view screening mammography. The same total dose was modeled for both the DM and BT simulations. Irregular lesions were simulated by using a stochastic growth algorithm providing lesions with an effective diameter of 5 mm. Breast tissue was simulated by generating an ensemble of backgrounds with a power law spectrum, with the composition of 50% fibroglandular and 50% adipose tissue. To evaluate lesion detection accuracy, a receiver operating characteristic (ROC) study was performed with five observers reading an ensemble of images for each case. The average area under the ROC curves (Az) was 0.76 for DM, 0.93 for BT, and 0.94 for CTBI. Results indicated that for the same dose, a 5 mm lesion embedded in a structured breast phantom was detected by the two volumetric breast imaging systems, BT and CTBI, with statistically significant higher confidence than with planar digital mammography, while the difference in lesion detection between BT and CTBI was not statistically significant.

A semianalytic model to extract differential linear scattering coefficients of breast tissue from energy dispersive x-ray diffraction measurements

The goal of this work is to develop a technique to measure the x-ray diffraction signals of breast biopsy specimens. A biomedical x-ray diffraction technology capable of measuring such signals may prove to be of diagnostic use to the medical field. Energy dispersive x-ray diffraction measurements coupled with a semianalytical model were used to extract the differential linear scattering coefficients [mus(x)] of breast tissues on absolute scales. The coefficients describe the probabilities of scatter events occuring per unit length of tissue per unit solid angle of detection. They are a function of the momentum transfer argument, x=sin(theta/2)/X, where theta=scatter angle and lambda=incident wavelength. The technique was validated by using a 3 mm diameter 50 kV polychromatic x-ray beam incident on a 5 mm diameter 5 mm thick sample of water. Water was used because good x-ray diffraction data are available in the literature. The scatter profiles from 6 degrees to 15 degrees in increments of 1 degrees were measured with a 3 mm x 3 mm x 2 mm thick cadmium zinc telluride detector. A 2 mm diameter Pb aperture was placed on top of the detector. The target to detector distance was 29 cm and the duration of each measurement was 10 min. Ensemble averages of the results compare well with the gold standard data of A. H. Narten ["X-ray diffraction data on liquid water in the temperature range 4 degrees C-200 degrees C," ORNL Report No. 4578 (1970)]. An average 7.68% difference for which most of the discrepancies can be attributed to the background noise at low angles was obtained. The preliminary measurements of breast tissue are also encouraging.

Volumetric breast density estimation from full-field digital mammograms

A method is presented for estimation of dense breast tissue volume from mammograms obtained with full-field digital mammography (FFDM). The thickness of dense tissue mapping to a pixel is determined by using a physical model of image acquisition. This model is based on the assumption that the breast is composed of two types of tissue, fat and parenchyma. Effective linear attenuation coefficients of these tissues are derived from empirical data as a function of tube voltage (kVp), anode material, filtration, and compressed breast thickness. By employing these, tissue composition at a given pixel is computed after performing breast thickness compensation, using a reference value for fatty tissue determined by the maximum pixel value in the breast tissue projection. Validation has been performed using 22 FFDM cases acquired with a GE Senographe 2000D by comparing the volume estimates with volumes obtained by semi-automatic segmentation of breast magnetic resonance imaging (MRI) data. The correlation between MRI and mammography volumes was 0.94 on a per image basis and 0.97 on a per patient basis. Using the dense tissue volumes from MRI data as the gold standard, the average relative error of the volume estimates was 13.6%.

Pituitary growth hormone and growth hormone-releasing hormone receptor genes and associations with mammographic measures and serum growth hormone

BACKGROUND

Mammographic density is a strong risk factor for breast cancer that is heritable and associated with blood levels of growth hormone and insulin-like growth factor-I (IGF-I). We tested single nucleotide polymorphisms (SNP) in pituitary growth hormone (GH1) and growth hormone-releasing hormone receptor (GHRHR) genes for an association with mammographic density, hormones of the growth hormone/IGF-I axis, and anthropometric variables.

METHODS

Mammograms from 348 women were measured using a computer-assisted method, blood collected, and DNA extracted. The SNPs genotyped were GH1 -57G>T, GH1 -75G >A, and GHRHR A57T. ANOVA and covariance were used to examine associations, adjusted for age, body mass index, ethnicity, and menopausal status, between each SNP and three measures of the mammogram: percent density, total dense area, and total nondense area. Similarly, the SNPs were tested for associations with serum growth hormone, IGF-I, IGFBP3, prolactin, and anthropometric variables.

RESULTS

GH1 -57G >T and GH1 -75G >A were both associated with percent density and total nondense area. GH1 -57T homozygotes had 5.2 more mean adjusted percent density than other subjects combined (P = 0.03) and 16.2 cm(2) (14.6%) less nondense area (P = 0.01). GH1 -75A homozygotes had 3.4 more percent density than subjects with at least one G allele (P = 0.04) and also had 32% higher serum growth hormone levels (P = 0.02).

CONCLUSION

We have found associations between mammographic density and two SNPs in the pituitary growth hormone gene, one of them also associated with serum growth hormone levels. These findings suggest that the GH1 gene may also influence breast cancer risk.

Method for determination of the mean fraction of glandular tissue in individual female breasts using mammography

The nationwide breast cancer screening programme using mammography has been in full operation in the Netherlands since 1997. Quality control of the screening programme has been assigned to the National Expert and Training Centre for Breast Cancer Screening. Limits are set to the mean glandular dose and the centre monitors these for all facilities engaged in the screening programme. This procedure is restricted to the determination of the entrance dose on a 5 cm thick polymethylmethacrylate (PMMA) phantom. The mean glandular dose for a compressed breast is estimated from these data. Individual breasts may deviate largely from this 5 cm PMMA breast model. Not only may the compressed breast size vary from 2 to 10 cm, but breast composition varies also. The mean glandular dose is dependent on the fraction of glandular tissue (glandularity) of the breast. To estimate the risk related to individual mammograms requires the development of a method for determination of the glandularity of individual breasts. A method has been developed to derive the glandularity using the attenuation of mammography x-rays in the breast. The method was applied to a series of mammograms at a screening unit. The results, i.e., a glandularity of 93% within the range of 0 to 1, were comparable with data in the literature. The glandularity as a function of compressed breast thickness is similar to results from other investigators using differing methods.

Beam hardening artefacts in computed tomography with photon counting, charge integrating and energy weighting detectors: a simulation study

Photon counting x-ray imaging provides efficient rejection of the electronics noise, no pulse height (Swank) noise, less noise due to optimal photon energy weighting and the possibility of energy resolved image acquisition. These advantages apply also to CT when projection data are acquired using a photon counting detector. However, photon counting detectors assign a weighting factor of 1 to all detected photons whereas the weighting factor of a charge integrating detector is proportional to the energy of the detected photon. Therefore, data collected by photon counting and charge integrating detectors represent the 'hardening' of the photon beam passed through the object differently. This affects the beam hardening artefacts in the reconstructed CT images. This work represents the first comparative evaluation of the effect of photon counting, charge integrating and energy weighting photon detectors on beam hardening artefacts in CT. Beam hardening artefacts in CT images were evaluated for 20 cm and 14 cm diameter water cylinders with bone and low contrast inserts, at 120 kVp and 90 kVp x-ray tube voltages, respectively. It was shown that charge integrating results in 1.8% less beam hardening artefacts from bone inserts (i.e., CT numbers in the 'shadow' of the bone are less by 1.8% as compared to CT numbers over the periphery of the image), as compared to photon counting. However, optimal photon energy weighting, which provides highest SNR, results in 7.7% higher beam hardening artefacts from bone inserts as compared to photon counting. The magnitude of the 'cupping' artefacts was lower by 1% for charge integrating and higher by 6.1% for energy weighting acquisitions as compared to photon counting. Only the photon counting systems provide an accurate representation of the beam hardening effect due to its flat energy weighting. Because of their energy dependent weighting factors, the charge integrating and energy weighting systems do not provide accurate representation of the beam hardening effect.

Contrast cancellation technique applied to digital x-ray imaging using silicon strip detectors

Dual-energy mammographic imaging experimental tests have been performed using a compact dichromatic imaging system based on a conventional x-ray tube, a mosaic crystal, and a 384-strip silicon detector equipped with full-custom electronics with single photon counting capability. For simulating mammal tissue, a three-component phantom, made of Plexiglass, polyethylene, and water, has been used. Images have been collected with three different pairs of x-ray energies: 16-32 keV, 18-36 keV, and 20-40 keV. A Monte Carlo simulation of the experiment has also been carried out using the MCNP-4C transport code. The Alvarez-Macovski algorithm has been applied both to experimental and simulated data to remove the contrast between two of the phantom materials so as to enhance the visibility of the third one.

Mammographic breast density as an intermediate phenotype for breast cancer

The amount of radiologically dense breast-tissue appearing on a mammogram varies between women because of differences in the composition of breast tissue, and is referred to here as mammographic density. This review presents evidence that mammographic density is a strong risk factor for breast cancer, and that risk of breast cancer is four to five times greater in women with density in more than 75% of the breast than in women with little or no density in the breast. Density in more than 50% of the breast could account for about a third of breast cancers. The epidemiology of mammographic density is consistent with its being a marker of susceptibility to breast cancer. Twin studies have shown that the proportion of the breast occupied by density, at a given age, is highly heritable, and inherited factors explain 63% of the variance. Mammographic breast density has the characteristics of a quantitative trait and might be determined by genes that are easier to identify than those for breast cancer itself. The genes that determine breast density might also be associated with risk of breast cancer, and their identification is also likely to provide insights into the biology of the breast and identify potential targets for preventive strategies.

Plasma Levels of Enterolactone and Percentage Mammographic Density among Postmenopausal Women

AIMS

Certain phytoestrogens, such as lignans, may protect against developing breast cancer. Enterolactone is a lignan metabolite produced by the intestinal flora from dietary precursors such as whole grains, vegetables, and fruits. Enterolactone has been shown to have weak estrogenic and antiestrogenic properties. We decided to examine the association between plasma levels of enterolactone and mammographic density, a biomarker for breast cancer risk.

METHODS

We included data from postmenopausal women ages 55 and older who participated in a cross-sectional mammogram study in Tromsø, Norway. Mammograms, plasma enterolactone measurements, as well as information on anthropometric and hormonal/reproduction factors were available on 616 women. We assessed mammographic density using a previously validated computer-assisted method. We estimated correlation coefficients and conducted multiple regression analyses.

RESULTS

Mean mammographic density increased slightly across quartiles of enterolactone; the women in the highest quartile had, on average, 3.1% (absolute difference) higher percentage mammographic density compared with the lowest quartile (P(trend) < 0.01). After adjustment for age, body mass index, number of full-term pregnancies, age at first birth, and use of postmenopausal hormone therapy, the mean difference in density was reduced to 2.0% (P(trend) = 0.05). Results were similar when restricted to the 454 current hormone nonusers. The fully adjusted statistical model explained 28.3% of the total variability in mammographic percentage density, with body mass index contributing 18.2% and enterolactone only 0.9%.

CONCLUSION

In our study, higher levels of enterolactone were associated with slightly higher percentage mammographic density. Our results suggest that if higher enterolactone levels reduce the risk of developing breast cancer in postmenopausal women, then this effect is not through lowering mammographic density.

Simulation study of a quasi-monochromatic beam for x-ray computed mammotomography

The purpose of this simulation study was to evaluate the feasibility, benefits, and potential operating parameters of a quasi-monochromatic beam from a tungsten-target x-ray source yielding projection images. The application is intended for newly developed cone beam computed mammotomography (CmT) of an uncompressed breast. The value of a near monochromatic x-ray source for a fully 3D CmT application is the expected improved ability to separate tissues with very small differences in attenuation coefficients. The quasi-monochromatic beam is expected to yield enhanced tomographic image quality along with a low dose, equal to or less than that of dual view x-ray mammography. X-ray spectra were generated with a validated projection x-ray simulation tool (XSpect) for a range of tungsten tube potentials (40-100 kVp), filter materials (Z=51-65), and filter thicknesses (10th to 1000th value layer determined at 60 kVp). The breast was modeled from ICRU-44 breast tissue specifications, and a breast lesion was modeled as a 0.5 cm thick mass. The detector was modeled as a digital flat-panel detector with a 0.06 cm thick CsI x-ray absorption layer. Computed figures of merit (FOMs) included the ratio of mean beam energy post-breast to pre-breast and the ratio of lesion contrasts for edge-located and center-located lesions as indices of breast beam hardening, and SNR2/exposure and SNR2/dose as indices of exposure and dose efficiencies. The impact of optimization of these FOMs on lesion contrast is also examined. For all simulated filter materials at each given attenuation thickness [10th, 100th, 500th, 1000th value layers (VLs)], the mean and standard deviation of the pre-breast spectral full-width at tenth-maximum (FWTM) were 16.1 +/- 2.4, 10.3 +/- 2.2, 7.3 +/- 1.4, and 6.5 +/- 1.5 keV, respectively. The change in beam width at the tenth maximum from pre-breast to post-breast spectra ranged from 4.7 to 1.1 keV, for the thinnest and thickest filters, respectively. The higher Z filters (Z=57-63) produced a quasi-monochromatic beam that allowed the widest tube potential operating range (50-70 kVp) while maintaining minimal beam hardening and maximal SNR2/exposure and SNR2/dose, and providing a contrast greater than that obtained in the unfiltered case. Figures of merit improved with increasing filter thickness, with diminishing returns beyond the 500th value layer attenuation level. Operating parameters required to produce optimal spectra, while keeping exposures equal to that of dual view mammography, are within the capability of the commercial x-ray tube proposed for our experimental study, indicating that use of these highly attenuating filters is viable. Additional simulations comparing Mo/Mo, Mo/Rh, and W/Rh target/filter combinations indicate that they exhibit significantly lower SNR2/exposure than the present approach, precluding them from being used for computed mammotomography, while maintaining dose limitations and obtaining sufficient SNR. Beam hardening was also much higher in the existing techniques (17%-42%) than for our technique (2%). Simulations demonstrate that this quasi-monochromatic x-ray technique may enhance tissue separation for a newly developed cone beam computed mammotomography application for an uncompressed breast.

Risk Factors for Breast Cancer Associated with Mammographic Features in Singaporean Chinese Women

Background: Mammographic density has been found to be a strong risk factor for breast cancer and to be associated with age, body weight, parity, and menopausal status. Most studies to date have been carried out in Western populations. The purpose of the study described here was to determine in a cross-sectional study in a Singaporean Chinese population the demographic, menstrual, reproductive, and anthropometric factors that are associated with quantitative variations in age-adjusted percentage mammographic densities and to examine the association of these factors with the dense and nondense areas of the mammogram.

Method: We used mammograms and questionnaire data collected from subjects in the Singapore Breast Screening Project. Women ages 45 to 69 years participated and 84% of those screened were Chinese. Mammograms were digitized and percentage density was measured and analyzed in relation to the questionnaire data.

Results: Percentage mammographic density was associated with several risk factors for breast cancer, most of them also associated, in opposite directions, with the dense and nondense components of the image. Percentage density was associated with age and weight (both negatively), height and age at first birth (both positively), and number of births and postmenopausal status (both negatively). Percentage density was weakly associated with a previous breast biopsy but was not associated with age at menarche or menopause, with use of hormones, or with a family history of breast cancer.

Conclusion: Percentage mammographic density in Singaporean Chinese women has similar associations with risk factors for breast cancer to those seen in Caucasians.

Acoustically modulated x-ray phase contrast imaging

We report the use of ultrasonic radiation pressure with phase contrast x-ray imaging to give an image proportional to the space derivative of a conventional phase contrast image in the direction of propagation of an ultrasonic beam. Intense ultrasound is used to exert forces on objects within a body giving displacements of the order of tens to hundreds of microns. Subtraction of images made with and without the ultrasound field gives an image that removes low spatial frequency features and highlights high frequency features. The method acts as an acoustic 'contrast agent' for phase contrast x-ray imaging, which in soft tissue acts to highlight small density changes.

Tunable, monochromatic X-rays: an enabling technology for molecular/cellular imaging and therapy

Pulsed, tunable, monochromatic X-rays hold great potential as a cellular and molecular probe. These beams can be tuned to the binding energy of orbital electrons in atoms, making them extremely useful in diagnostic k-edge imaging and Auger cascade radiotherapy. Their wide tunability makes them ideal for the performance of various techniques as disparate as protein crystallography and three-dimensional, compressionless, monochromatic mammography. Since only the frequency best suited to the task at hand is used, radiation exposure to patients or animals is exceedingly low when compared to standard X-ray techniques.

Experimental manipulation of radiographic density in mouse mammary gland

INTRODUCTION

Extensive mammographic density in women is associated with increased risk for breast cancer. Mouse models provide a powerful approach to the study of human diseases, but there is currently no model that is suited to the study of mammographic density.

METHODS

We performed individual manipulations of the stromal, epithelial and matrix components of the mouse mammary gland and examined the alterations using in vivo and ex vivo radiology, whole mount staining and histology.

RESULTS

Areas of density were generated that resembled densities in mammographic images of the human breast, and the nature of the imposed changes was confirmed at the cellular level. Furthermore, two genetic models, one deficient in epithelial structure (Pten conditional tissue specific knockout) and one with hyperplastic epithelium and mammary tumors (MMTV-PyMT), were used to examine radiographic density.

CONCLUSION

Our data show the feasibility of altering and imaging mouse mammary gland radiographic density by experimental and genetic means, providing the first step toward modelling the biological processes that are responsible for mammographic density in the mouse.

Microcalcification detection using cone-beam CT mammography with a flat-panel imager

The purpose of this study was to investigate microcalcification detectability using CT mammography with a flat-panel imager. To achieve this, a computer simulation was developed to model an amorphous-silicon, CsI based flat-panel imager system using a linear cascaded model. The breast was modelled as a hemi-ellipsoid shape with composition of 50% adipose and 50% glandular tissue. Microcalcifications were modelled as small spheres having a composition of calcium carbonate. The results show that with a mean glandular dose equivalent to that typically used in two-view screening mammography, CT mammography with a flat-panel detector is capable of providing images where most microcalcifications are detectable. A receiver operating characteristic (ROC) study was conducted by five physicist observers viewing simulated CT mammography reconstructions. The results suggest that the microcalcification with its diameter equal to or greater than 0.175 mm can be detected with an average area under the ROC curve (AUC) greater than 0.95 using 0.1 or 0.2 mm pixelized detectors. The results also indicate that the optimal pixel size of the detector is around 0.2 mm for microcalcification detection, based on the trade-off between detectability of microcalcifications and the time required for data acquisition and reconstruction.

Breast tomography with synchrotron radiation: preliminary results

A system for in vivo breast imaging with monochromatic x-rays has been designed and built at the synchrotron radiation facility Elettra in Trieste (Italy) and will be operational in 2004. The system design involves the possibility of performing both planar mammography and breast tomography. In the present work, the first results obtained with a test set-up for breast tomography are shown and discussed. Tomographic images of in vitro breasts were acquired using monochromatic x-ray beams in the energy range 20-28 keV and a linear array silicon pixel detector. Tomograms were reconstructed using standard filtered backprojection algorithms; the effect of different filters was evaluated. The attenuation coefficients of fibroglandular and adipose tissue were measured, and a quantitative comparison of images acquired at different energies was performed by calculating the differential signal-to-noise ratio of fibroglandular details in adipose tissue. All images required a dose comparable to the dose delivered in clinical, conventional mammography and showed a high resolution of the breast structures without the overlapping effects that limit the visibility of the structures in 2D mammography. A quantitative evaluation of the images proves that the image quality at a given dose increases in the considered energy range and for the considered breast sizes.

Dual-energy imaging in full-field digital mammography: a phantom study

A dual-energy technique which employs the basis decomposition method is being investigated for application to digital mammography. A three-component phantom, made up of plexiglas, polyethylene, and water, was doubly exposed with the full-field digital mammography system manufactured by General Electric. The 'low' and 'high' energy images were recorded with a Mo/Mo anode-filter combination and a Rh/Rh combination, respectively. The total dose was kept within the acceptable levels of conventional mammography. The first hybrid images obtained with the dual-energy algorithm are presented in comparison with a conventional radiograph of the phantom. Image-quality characteristics at contrast cancellation angles between plexiglas and water are discussed. Preliminary results show that a combination of a standard Mo-anode 28 kV radiograph with a Rh-anode 49 kV radiograph provides the best compromise between image-quality and dose in the hybrid image.

A volumetric method for estimation of breast density on digitized screen-film mammograms

A method is described for the quantitative volumetric analysis of the mammographic density (VBD) from digitized screen-film mammograms. The method is based on initial calibration of the imaging system with a tissue-equivalent plastic device and the subsequent correction for variations in exposure factors and film processing characteristics through images of an aluminum step wedge placed adjacent to the breast during imaging. From information about the compressed breast thickness and technique factors used for taking the mammogram as well as the information from the calibration device, VBD is calculated. First, optical sensitometry is used to convert images to Log relative exposure. Second, the images are corrected for x-ray field inhomogeneity using a spherical section PMMA phantom image. The effectiveness of using the aluminum step wedge in tracking down the variations in exposure factors and film processing was tested by taking test images of the calibration device, aluminum step wedge and known density phantoms at various exposure conditions and also at different times over one year. Results obtained on known density phantoms show that VBD can be estimated to within 5% accuracy from the actual value. A first order thickness correction is employed to correct for inaccuracy in the compression thickness indicator of the mammography units. Clinical studies are ongoing to evaluate whether VBD can be a better indicator for breast cancer risk.

Optimum momentum transfer arguments for x-ray forward scatter imaging

In our research program we have shown through modeling, related numerical calculations, and experimental measurements that there exists a potential use of scattered radiation for medical x-ray imaging. Each incident photon of wavelength lambda which scatters at a small angle theta with respect to its initial direction of travel has a change in momentum characterized by the photon momentum transfer argument x = lambda(-1) sin(theta/2). In this work, we show that in order to maximize the signal-to-noise ratio (SNR) obtained with scattered x rays, one must detect photons with specific x values. Using a photon counting detector to distinguish 2-cm-thick polymethyl methacrylate and nylon targets situated within a 15-cm-diam spherical water phantom with an 80 kV beam yields experimentally SNR/square root(K(air)c) = 12.8 +/- 0.2 (mJ/kg)(-1/2) when using the photons between x = 0.5 and 0.7 nm(-1). Here K(air)c is the air collision kerma and the average momentum transfer argument, x, is calculated by weighting x by the incident photon fluence distribution. The model predicts a value of SNR/square root(K(air)c) = 12.9 (mJ/kg)(-1/2). If we choose to form the signal with the range in x extended to be from 0.5 to 1.0 nm(-1) then, despite the detection of more scattered photons, experimentally SNR/square root(K(air)c) decreases by 38% to 7.9 +/- 0.3 (mJ/kg)(-1/2). The model predicts a value of 9.46 (mJ/kg)(-1/2). Results for energy integrating detectors are in general similar to those for photon counters, but there exist cases where a significant decrease in SNR can occur. For example, for measurements in air with the two plastics at theta = 3 degrees the SNR for an energy integrator was found to be 52% that of a photon counter. Numerical calculations predict that the effects of spectral blur can be significant when a narrow angular range is used for detection. Preliminary numerical predictions for breast tissues suggest a potential use of x-ray scatter in the field of mammography.

Signal-to-noise ratio evaluation in dual-energy radiography with synchrotron radiation

Dual-energy radiography is an effective technique that allows removal of contrast between pairs of materials in order to display details of interest on a uniform background. In mammographic images the detection of small nodules is often impeded by obscuring background 'clutter' resulting from the contrast between normal tissues (glandular and adipose) in their neighbourhood. We consider whether it could be possible to apply dual-energy radiography to the breast, which is hypothetically principally composed of three tissues, glandular, adipose and cancerous, in order to remove the contrast due to the distribution of normal tissues and, as a consequence, to enhance the intrinsic contrast of the pathology. The purpose of this work is to test the limitations of dual-energy radiography on a three-component phantom under optimum conditions of the source and detector. We use a synchrotron monochromatic beam, produced at the ELETTRA synchrotron facility (Trieste, Italy), and an imaging plate detector, in order to acquire two images at low and high energies of a phantom composed of polyethylene, plexiglas and water. For evaluation of the potential of this procedure we studied the signal-to-noise ratio (SNR) of polyethylene and water on a set of images obtained by applying the dual-energy procedure. We found that the SNR of polyethylene and water is around the detectability threshold (according to Rose's criteria) at the contrast cancellation angles. Finally we evaluated the air entrance dose required for this double exposure, resulting in 0.81 mGy for the low-energy image and 0.01 mGy for the high-energy image. To obtain the same image quality for a standard breast of 5.5 cm, mean glandular doses of 3.50 mGy and 0.03 mGy at 17 keV and at 34 keV, respectively, are required.

The association of breast mitogens with mammographic densities

Radiologically dense breast tissue (mammographic density) is strongly associated with risk of breast cancer, but the biological basis for this association is unknown. In this study we have examined the association of circulating levels of hormones and growth factors with mammographic density. A total of 382 subjects, 193 premenopausal and 189 postmenopausal, without previous breast cancer or current hormone use, were selected in each of five categories of breast density from mammography units. Risk factor information, anthropometric measures, and blood samples were obtained, and oestradiol, progesterone, sex hormone binding globulin, growth hormone, insulin-like growth factor-I and its principal binding protein, and prolactin measured. Mammograms were digitised and measured using a computer-assisted method. After adjustment for other risk factors, we found in premenopausal women that serum insulin-like growth factor-I levels, and in postmenopausal women, serum levels of prolactin, were both significantly and positively associated with per cent density. Total oestradiol and progesterone levels were unrelated to per cent density in both groups. In postmenopausal women, free oestradiol (negatively), and sex hormone binding globulin (positively), were significantly related to per cent density. These data show an association between blood levels of breast mitogens and mammographic density, and suggest a biological basis for the associated risk of breast cancer.

Heritability of mammographic density, a risk factor for breast cancer

BACKGROUND

Women with extensive dense breast tissue visible on a mammogram have a risk of breast cancer that is 1.8 to 6.0 times that of women of the same age with little or no density. Menopausal status, weight, and parity account for 20 to 30 percent of the age-adjusted variation in the percentage of dense tissue.

METHODS

We undertook two studies of twins to determine the proportion of the residual variation in the percentage of density measured by mammography that can be explained by unmeasured additive genetic factors (heritability). A total of 353 pairs of monozygotic twins and 246 pairs of dizygotic twins were recruited from the Australian Twin Registry, and 218 pairs of monozygotic twins and 134 pairs of dizygotic twins were recruited in Canada and the United States. Information on putative determinants of breast density was obtained by questionnaire. Mammograms were digitized, randomly ordered, and read by a blinded investigator.

RESULTS

After adjustment for age and measured covariates, the correlation coefficient for the percentage of dense tissue was 0.61 for monozygotic pairs in Australia, 0.67 for monozygotic pairs in North America, 0.25 for dizygotic pairs in Australia, and 0.27 for dizygotic pairs in North America. According to the classic twin model, heritability (the proportion of variants attributable to additive genetic factors) accounted for 60 percent of the variation in density (95 percent confidence interval, 54 to 66) in Australian twins, 67 percent (95 percent confidence interval, 59 to 75) in North American twins, and 63 percent (95 percent confidence interval, 59 to 67) in all twins studied.

CONCLUSIONS

These results show that the population variation in the percentage of dense tissue on mammography at a given age has high heritability. Because mammographic density is associated with an increased risk of breast cancer, finding the genes responsible for this phenotype could be important for understanding the causes of the disease.

Mammogram synthesis using a 3D simulation. I. Breast tissue model and image acquisition simulation

A method is proposed for generating synthetic mammograms based upon simulations of breast tissue and the mammographic imaging process. A computer breast model has been designed with a realistic distribution of large and medium scale tissue structures. Parameters controlling the size and placement of simulated structures (adipose compartments and ducts) provide a method for consistently modeling images of the same simulated breast with modified position or acquisition parameters. The mammographic imaging process is simulated using a compression model and a model of the x-ray image acquisition process. The compression model estimates breast deformation using tissue elasticity parameters found in the literature and clinical force values. The synthetic mammograms were generated by a mammogram acquisition model using a monoenergetic parallel beam approximation applied to the synthetically compressed breast phantom.

A calibration approach to glandular tissue composition estimation in digital mammography

The healthy breast is almost entirely composed of a mixture of fatty, epithelial, and stromal tissues which can be grouped into two distinctly attenuating tissue types: fatty and glandular. Further, the amount of glandular tissue is linked to breast cancer risk, so an objective quantitative analysis of glandular tissue can aid in risk estimation. Highnam and Brady have measured glandular tissue composition objectively. However, they argue that their work should only be used for "relative" tissue measurements unless a careful calibration has been performed. In this work, we perform such a "careful calibration" on a digital mammography system and use it to estimate breast tissue composition of patient breasts. We imaged 0%, 50%, and 100% glandular-equivalent phantoms of varying thicknesses for a number of clinically relevant x-ray techniques on a digital mammography system. From these images, we extracted mean signal and noise levels and computed calibration curves that can be used for quantitative tissue composition estimation. In this way, we calculate the percent glandular composition of a patient breast on a pixelwise basis. This tissue composition estimation method was applied to 23 digital mammograms. We estimated the quantitative impact of different error sources on the estimates of tissue composition. These error sources include compressed breast height estimation error, residual scattered radiation, quantum noise, and beam hardening. Errors in the compressed breast height estimate contribute the most error in tissue composition--on the order of +/-7% for a 4 cm compressed breast height: The spatially varying scattered radiation will contribute quantitatively less error overall, but may be significant in regions near the skinline. It is calculated that for a 4 cm compressed breast height, a residual scatter signal error is mitigated by approximately sixfold in the composition estimate. The error in composition due to the quantum noise, which is the limiting noise source in the system, is shown to be less than 1% glandular for most breasts.

Cone-beam volume CT breast imaging: feasibility study

X-ray projection mammography, using a film/screen combination, or digital techniques, has proven to be the most effective imaging modality currently available for early detection of breast cancer. However, the inherent superimposition of structures makes a small carcinoma (a few millimeters in size) difficult to detect when it is occult or in dense breasts, leading to a high false-positive biopsy rate. Cone-beam x-ray-projection-based volume imaging using flat panel detectors (FPDs) may allow obtaining three-dimensional breast images, resulting in more accurate diagnosis of structures and patterns of lesions while eliminating the hard compression of breasts. This article presents a novel cone-beam volume computed tomographic breast imaging (CBVCTBI) technique based on the above techniques. Through a variety of computer simulations, the key issues of the system and imaging techniques were addressed, including the x-ray imaging geometry and corresponding reconstruction algorithms, x-ray characteristics of breast tissue and lesions, x-ray setting techniques, the absorbed dose estimation, and the quantitative effect of x-ray scattering on image quality. The preliminary simulation results support the proposed CVBCTBI modality for breast imaging in respect to its feasibility and practicability. The absorbed dose level is comparable to that of current mammography and will not be a prominent problem for this imaging technique. Compared to conventional mammography, the proposed imaging technique with isotropic spatial resolution will potentially provide significantly better low-contrast detectability of breast tumors and more accurate location of breast lesions.

Dual-energy tissue cancellation in mammography with quasi-monochromatic x-rays

Dual-energy radiography has not evolved into a routine clinical examination yet due to intrinsic limitations of both dual-kVp imaging and single-exposure imaging with conventional x-ray sources. The recent introduction of novel quasi-monochromatic x-ray sources and detectors could lead to interesting improvements, especially in mammography where the complex structure of healthy tissues often masks the detectability of lesions. A dual-energy radiography technique based on a tissue cancellation algorithm has been developed for mammography, with the aim of maximizing the low intrinsic contrast of pathologic tissues while being able to minimize or cancel the contrast between glandular and fat tissues. Several images of a plastic test object containing various tissue equivalent inserts were acquired in the energy range 17-36 keV using a quasi-monochromatic x-ray source and a scintillator-coated CCD detector. Images acquired at high and low energies were nonlinearly combined to generate two energy-independent basis images. Suitable linear combinations of these two basis images result in the elimination of the contrast of a given material with respect to another. This makes it possible to selectively cancel certain details in the processed image.

X-ray scattering from human breast tissues and breast-equivalent materials

The angular distributions of photons scattered by human breast tissues (adipose and glandular) and by eight breast-equivalent materials (water, polymethylmethacrylate, nylon, polyethylene and four commercial breast-equivalent materials simulating different glandular-adipose proportions) have been measured at a photon energy of 17.44 keV (Kalpha-radiation of Mo). Transmission target geometry has been used with an acceptance of +/- 0.6 degrees and an uncertainty of approximately 7%. Experimental molecular form factors were extracted from diffraction patterns normalizing the number of scattered photons with theoretical data in regions where no structure is expected. Linear attenuation coefficients have been measured for all samples at this energy. The results for water, polymethylmethacrylate, nylon and adipose tissue agree with former reported data. The results for human breast tissues at low and medium scattering angle (1-25 degrees, corresponding to the momentum transfer region between 0.2 and 3 nm(-1)) differ from the breast-equivalent materials. The results for adipose tissue are similar to the corresponding values from commercial breast-equivalent materials while the results for glandular tissue are similar to those for water.

Dedicated breast CT: radiation dose and image quality evaluation

PURPOSE

To evaluate the feasibility of breast computed tomography (CT) in terms of radiation dose and image quality.

MATERIALS AND METHODS

Validated Monte Carlo simulation techniques were used to estimate the average glandular dose (AGD). The calculated photon fluence at the detector for high-quality abdominal CT (120 kVp, 300 mAs, 5-mm section thickness) was the benchmark for assessing the milliampere seconds and corresponding radiation dose necessary for breast CT. Image noise was measured by using a 10-cm-diameter cylinder imaged with a clinical CT scanner at 10-300 mAs for 80, 100, and 120 kVp. A cadaveric breast was imaged in the coronal plane to approximate the acquisition geometry of a proposed breast CT scanner.

RESULTS

The AGD for 80-kVp breast CT was comparable to that for two-view mammography of 5-cm breasts (compressed breast thickness). For thicker breasts, the breast CT dose was about one-third less than that for two-view mammography. The maximum dose at mammography assessed in 1-mm(3) voxels was far higher (20.0 mGy) than that at breast CT (5.4 mGy) for a typical 5-cm 50% glandular breast. CT images of an 8-cm cadaveric breast (AGD, 6.3 mGy) were subjectively superior to digital mammograms (AGD, 10.1 mGy) of the same specimen.

CONCLUSION

The potential of high signal-to-noise ratio images with low anatomic noise, which are obtainable at dose levels comparable to those for mammography, suggests that dedicated breast CT should be studied further for its potential in breast cancer screening and diagnosis.

A mammographic dilemma: calcification or haemosiderin as a cause of opacities? Validation of a new digital diagnostic tool

Core biopsies of an area of microcalcification demonstrated large collections of macrophages containing haemosiderin, with evidence of minimal microcalcification on H&E staining. Algorithms were developed that were capable of differentiating with high accuracy those signs due to calcification, using quantitative measurements such as the apparent volume composition of calcium. Using the linear attenuation coefficients of calcification and assuming an ellipsoid model for the 3-dimensional shape of calcification, we computed the relative calcification volume for each region of interest. The difference in the linear attenuation coefficients of iron and calcification allowed the two to be differentiated on a mammogram based on this measure of relative calcification volume.

An innovative digital imaging set-up allowing a low-dose approach to phase contrast applications in the medical field

Recently, new imaging modalities based on the detection of weak phase perturbations effects, among which are phase contrast and diffraction imaging, have been developed by several researchers. Due to their high sensitivity to weakly absorbing details, these techniques seem to be very promising for applications in the medical field. On the other hand, digital radiology is undergoing a wide diffusion, and its benefits are presently very well understood. Up to now, however, the strong pixel size constraints associated with phase contrast pattern detection limited the possibility of exploiting the advantages of phase contrast in digital radiology applications. In this paper, an innovative setup capable of removing the pixel size constraints, and thus opening the way to low dose digital phase contrast imaging, is described. Furthermore, we introduce an imaging technique based on the detection of radiation scattered at small angles: the information extracted from the sample is increased at no dose expense. We believe that several radiological fields, mammography being the first important example, may benefit from the herein described innovative imaging techniques.

Image quality and dose in film-screen magnification mammography

Extended exposure times in magnification mammography are a result of the reduced X-ray tube currents required for a small focal spot. The consequences of this are the potential for reduced image quality through motion blur during exposure as well as the onset of film reciprocity law failure. Previous investigators have suggested increasing the X-ray tube potential as a practical mechanism for reducing exposure times in magnification mammography and have demonstrated negligible image quality degradation at least up to 32 kVp. This paper describes a film-screen magnification mammography study that expands upon this previous work to investigate the magnitude of the reduction of breast mean glandular dose and exposure time and the changes in subjective image quality (visibility of low contrast details in an RMI 152 phantom) with increases in tube potential between 28 kVp and 35 kVp. Measures of changes in the radiographic contrast and in the scatter-to-primary ratio (SPR) in magnification geometry as a function of tube potential were also obtained. Evidence for reciprocity law failure was also assessed. For a constant film optical density, increasing the X-ray tube potential from 28 kVp to 35 kVp reduced the mean glandular dose from 3.9 mGy to 2.7 mGy and reduced the exposure time from 3.2 s to 1.0 s. Over this range, the detection rate of fibrils and microcalcification-mimicking specks did not vary with tube potential at the 0.05 level of significance. It was found that only the low contrast mass detail detection rate at 35 kVp was significantly less than that at 28 kVp. The measured radiographic contrast decreased with tube potential and the SPR increased with tube potential. However, both changes were weak, and linear regressions determined that the 95% confidence intervals of the slopes relating both contrast and SPR with tube potential encompassed zero. It is concluded that magnification mammography performed at 34 kVp yields significant reductions in exposure time and mean glandular dose, with a detail detection capability similar to that at 28 kVp.

A comparison of fixed and variable kVp technique protocols for film-screen mammography

Mammographic image quality, contrast and dose for a variable tube potential (kVp) technique protocol for film-screen mammography have been investigated. In this protocol, the tube potential is increased for larger breast thicknesses. Comparisons were made with fixed kVp protocols, in which the tube potential is kept constant and the breast thickness compensated for by prolonging the exposure ("fixed kVp" protocol). All measurements were performed on a mammography unit with a molybdenum target and filter. Image quality was quantified by image contrast, image detail detection and the minimum detectable dimension of low contrast objects. It was demonstrated that for a compressed breast thickness of less than about 40 mm, varying the tube potential had a negligible effect upon dose but a significant effect upon image quality. For a compressed breast thickness greater than about 60 mm, the effect of the tube potential upon image quality was much reduced; however, the effect upon dose was significantly greater. The variable kVp protocol takes advantage of this feature to yield a significantly lower dose for thicker breasts with a small reduction in image quality, often only within experimental uncertainty. For an exposure under automatic exposure control, increasing the tube potential from 26 kVp to 30 kVp for a breast of a reference tissue composition (50% adipose and 50% glandular) with a compressed thickness of 60 mm reduced the mean glandular dose from 6 mGy to 3.9 mGy (-35%), but increased the minimum detectable dimension of a low contrast mass from 0.8 (+/- 0.1) mm to 1.1 (+/- 0.1) mm. Adopting a variable kVp protocol led to a median patient mean glandular dose per film of 2.7 mGy, nearly independent of compressed breast thickness. In our survey, the mean age of women presenting for mammography is younger and the mean compressed breast thickness is less than reported from screening centres. This suggests that there will be a higher proportion of denser, glandular tissue in the breasts incorporated within this survey than for surveys from screening centres. The clinical use of the variable kVp protocol allows the extraction from patient data of separate changes in breast composition which are due to patient age and breast thickness. It is concluded that the reference breast tissue composition is not an accurate representation of the women presenting at this centre.

X-ray scatter signatures for normal and neoplastic breast tissues

Measurements of breast tissue scattering properties have been made in an energy dispersive x-ray diffraction system over the momentum transfer range of 0.70 to 3.50 nm(-1). One hundred samples of excised tissue have been used. Results from the diffraction system have been compared with the histological analysis for each individual sample. It has been found that tissue types can be characterized on the basis of the shape of the scatter spectrum and on its relative intensity. The shapes are significantly different between tissue types in the range 1.0 to 1.8 nm(-1) and suggest that if particular values of momentum transfer are monitored, a discriminating signal could be obtained. Analysis of the maximum intensity in the signature also reveals a change of up to a factor of 2 between adipose and fat-free tissues.

Breast dosimetry

The estimation of the absorbed dose to the breast is an important part of the quality control of the mammographic examination. Knowledge of breast dose is essential for the design and performance assessment of mammographic imaging systems. This review gives a historical introduction to the measurement of breast dose. The mean glandular dose (MGD) is introduced as an appropriate measure of breast dose. MGD can be estimated from measurements of the incident air kerma at the surface of the breast and the application of an appropriate conversion factor. Methods of calculating and measuring this conversion factor are described and the results discussed. The incident air kerma itself may be measured for patients or for a test phantom simulating the breast. In each case the dose may be determined using TLD measurements, or known exposure parameters and measurements of tube output. The methodology appropriate to each case is considered and the results from sample surveys of breast dose are presented. Finally the various national protocols for breast dosimetry are compared.

Electron density of normal and pathological breast tissues using a Compton scattering technique

Compton (incoherently) scattered photons which are directly proportional to the electron density of the scatterer, have been employed in characterising human breast tissues. Gamma ray photons scattered incoherently from normal and pathological breast tissue samples of nine breast cancer patients were measured using a high purity germanium detector and an americium (Am-241) source. The breast tissue samples were obtained from female patients undergoing mastectomy. The samples were examined in freeze dried form and the results were corrected for the reduction in the water content of each tissue type by use of the Mixture Rule. This study is aimed at providing electron density information in support of the introduction of new tissue substitute materials for mammography phantoms.

Computerized evaluation of mammographic image quality using phantom images

A simple, quick and computerized method for quantitatively evaluating the image quality of mammography phantom images has been developed. Images of the American College of Radiology (ACR) mammographic accreditation phantoms were acquired under different X-ray techniques, scored and ranked subjectively by five expert readers, and digitized for quantitative analysis. The contrast and signal-to-noise (contrast-to-noise) ratios of the main nodule and microcalcification group were obtained accurately and reproducibly using an image processing protocol. The contrast values were successful at discriminating differences in image quality due to variations in scatter conditions (as a result of different kVp's, and the presence or absence of an acrylic scatterer and/or a moving Bucky grid). They were more precise, reproducible and sensitive than the ACR score. In particular, the contrast of the main nodule was highly correlated (r(s) = 0.988: p<0.001) with the ranking of image quality by our panel of expert readers.

Mammography spectrum measurement using an x-ray diffraction device

The use of a diffraction spectrometer developed by Deslattes for the determination of mammographic kV is extended to the measurement of accurate, relative x-ray spectra. Raw x-ray spectra (photon fluence versus energy) are determined by passing an x-ray beam through a bent quartz diffraction crystal, and the diffracted x-rays are detected by an x-ray intensifying screen coupled to a charge coupled device. Two nonlinear correction procedures, one operating on the energy axis and the other operating on the fluence axis, are described and performed on measured x-ray spectra. The corrected x-ray spectra are compared against tabulated x-ray spectra measured under nearly identical conditions. Results indicate that the current device is capable of producing accurate relative x-ray spectral measurements in the energy region from 12 keV to 40 keV, which represents most of the screen-film mammography energy range. Twelve keV is the low-energy cut-off, due to the design geometry of the device. The spectrometer was also used to determine the energy-dependent x-ray mass attenuation coefficients for aluminium, with excellent results in the 12-30 keV range. Additional utility of the device for accurately determining the attenuation characteristics of various normal and abnormal breast tissues and phantom substitutes is anticipated.

Detection of microcalcifications in digital mammograms using wavelets

This paper presents an approach for detecting microcalcifications in digital mammograms employing wavelet-based subband image decomposition. The microcalcifications appear in small clusters of few pixels with relatively high intensity compared with their neighboring pixels. These image features can be preserved by a detection system that employs a suitable image transform which can localize the signal characteristics in the original and the transform domain. Given that the microcalcifications correspond to high-frequency components of the image spectrum, detection of microcalcifications is achieved by decomposing the mammograms into different frequency subbands, suppressing the low-frequency subband, and, finally, reconstructing the mammogram from the subbands containing only high frequencies. Preliminary experiments indicate that further studies are needed to investigate the potential of wavelet-based subband image decomposition as a tool for detecting microcalcifications in digital mammograms.