Models of breast lesions based on three-dimensional X-ray breast images

Design and Use of a Custom Phantom for Regular Tests of Radiography Apparatus: A Feasibility Study

This study investigates the feasibility of employing an in-house-developed physical phantom dedicated to the weekly quality control testing of radiographic systems, performed by radiographers. For this purpose, a 3D phantom was fabricated, featuring test objects, including a model representing a lesion. Alongside this phantom, a commercial phantom, specifically, IBA's Primus L, was utilized. Weekly imaging of both phantoms was conducted over a span of four weeks, involving different imaging protocols and anode voltages. Subsequently, the obtained data underwent visual evaluation, as well as measurement of the intensity of selected regions of interest. The average values for three incident kilovoltages remained consistently stable over the four weeks, with the exception of the "low energy" case, which exhibited variability during the first week of measurements. Following experiments in "Week 1", the X-Ray unit was identified as malfunctioning and underwent necessary repairs. The in-house-developed phantom demonstrated its utility in assessing the performance of the X-Ray system.

In situtumor model for longitudinal in silico imaging trials

Objective.In this article, we introduce a computational model for simulating the growth of breast cancer lesions accounting for the stiffness of surrounding anatomical structures.Approach.In our model, ligaments are classified as the most rigid structures while the softer parts of the breast are occupied by fat and glandular tissues As a result of these variations in tissue elasticity, the rapidly proliferating tumor cells are met with differential resistance. It is found that these cells are likely to circumvent stiffer terrains such as ligaments, instead electing to proliferate preferentially within the more yielding confines of the breast's soft topography. By manipulating the interstitial tumor pressure in direct proportion to the elastic constants of the tissues surrounding the tumor, this model thus creates the potential for realizing a database of unique lesion morphology sculpted by the distinctive topography of each local anatomical infrastructure. We modeled the growth of simulated lesions within volumes extracted from fatty breast models, developed by Graffet alwith a resolution of 50μm generated with the open-source and readily available Virtual Imaging Clinical Trials for Regulatory Evaluation (VICTRE) imaging pipeline. To visualize and validate the realism of the lesion models, we leveraged the imaging component of the VICTRE pipeline, which replicates the siemens mammomat inspiration mammography system in a digital format. This system was instrumental in generating digital mammogram (DM) images for each breast model containing the simulated lesions.Results.By utilizing the DM images, we were able to effectively illustrate the imaging characteristics of the lesions as they integrated with the anatomical backgrounds. Our research also involved a reader study that compared 25 simulated DM regions of interest (ROIs) with inserted lesions from our models with DM ROIs from the DDSM dataset containing real manifestations of breast cancer. In general the simulation time for the lesions was approximately 2.5 hours, but it varied depending on the lesion's local environment.Significance.The lesion growth model will facilitate and enhance longitudinal in silico trials investigating the progression of breast cancer.

Spatial and channel attention-based conditional Wasserstein GAN for direct and rapid image reconstruction in ultrasound computed tomography

Ultrasound computed tomography (USCT) is an emerging technology that offers a noninvasive and radiation-free imaging approach with high sensitivity, making it promising for the early detection and diagnosis of breast cancer. The speed-of-sound (SOS) parameter plays a crucial role in distinguishing between benign masses and breast cancer. However, traditional SOS reconstruction methods face challenges in achieving a balance between resolution and computational efficiency, which hinders their clinical applications due to high computational complexity and long reconstruction times. In this paper, we propose a novel and efficient approach for direct SOS image reconstruction based on an improved conditional generative adversarial network. The generator directly reconstructs SOS images from time-of-flight information, eliminating the need for intermediate steps. Residual spatial-channel attention blocks are integrated into the generator to adaptively determine the relevance of arrival time from the transducer pair corresponding to each pixel in the SOS image. An ablation study verified the effectiveness of this module. Qualitative and quantitative evaluation results on breast phantom datasets demonstrate that this method is capable of rapidly reconstructing high-quality SOS images, achieving better generation results and image quality. Therefore, we believe that the proposed algorithm represents a new direction in the research area of USCT SOS reconstruction.

Development and CT image-domain validation of a computational lung lesion model for use in virtual imaging trials

PURPOSE

Computational abnormalities (e.g., lesion models) for use in medical imaging simulation studies are frequently generated using data collected from clinical images. Although this approach allows for highly-customizable lesion detectability studies on clinical computed tomography (CT) data, the ground-truth lesion models produced with this method do not provide a sufficiently realistic lesion morphology for use with current anthropomorphic simulation studies. This work is intended to demonstrate that the new anatomically-informed lesion model presented here is not inferior to the previous lesion model under CT imaging, and can therefore provide a more biologically-informed model for use with simulated CT imaging studies.

METHODS

The lesion model was simulated initially from a seed cell with 10 μm diameter placed in an anatomical location within segmented lung CT and was allowed to reproduce locally within the available solid angle in discrete time-intervals (corresponding to synchronous cell cycles) up to a size of ∼200 μm in diameter. Daughter cells of generation G were allowed also to reproduce on the next available time-step given sufficient space. At lesion sizes beyond 200 μm in diameter, the health of subregions of cells were tracked with a Markov chain technique, indicating which regions were likely to continue growing, which were likely stable, and which were likely to develop necrosis given their proximity to anatomical features and other lesion cells. For lesion sizes beyond 500 μm, the lesion was represented with three nested, triangulated surfaces (corresponding to proliferating, dormant, and necrotic regions), indicating how discrete volumes of the lesion were behaving at a particular time. Lesions were then assigned smoothly-varying material properties based on their cellular level health in each region, resulting in a multi-material lesion model. The lesions produced with this model were then voxelized and placed into lung CT images for comparison with both prior work and clinical data. This model was subject to an observer study in which cardiothoracic imaging radiologists assessed the realism of both clinical and synthetic lesions in CT images.

RESULTS

The useable outputs of this work were voxel- or surface-based, validated, computational lesions, at a scale clearly visible on clinical CT (3-4 cm). Analysis of the observer study results indicated that the computationally-generated lesions were indistinguishable from clinical lesions (AUC = 0.49, 95% CI = [0.36, 0.61]) and non-inferior to an earlier image-based lesion model-indicating the advantage of the model for use in both hybrid CT images and in simulated CT imaging of the lungs.

CONCLUSIONS

Results indicated the non-inferiority of this model as compared to previous methods, indicating the utility of the model for use in both hybrid CT images and in simulated CT imaging.

Realistic 3D printed CT imaging tumor phantoms for validation of image processing algorithms

Medical imaging phantoms are widely used for validation and verification of imaging systems and algorithms in surgical guidance and radiation oncology procedures. Especially, for the performance evaluation of new algorithms in the field of medical imaging, manufactured phantoms need to replicate specific properties of the human body, e.g., tissue morphology and radiological properties. Additive manufacturing (AM) technology provides an inexpensive opportunity for accurate anatomical replication with customization capabilities. In this study, we proposed a simple and cheap protocol using Fused Deposition Modeling (FDM) technology to manufacture realistic tumor phantoms based on the filament 3D printing technology. Tumor phantoms with both homogenous and heterogeneous radiodensity were fabricated. The radiodensity similarity between the printed tumor models and real tumor data from CT images of lung cancer patients was evaluated. Additionally, it was investigated whether a heterogeneity in the 3D printed tumor phantoms as observed in the tumor patient data had an influence on the validation of image registration algorithms. A radiodensity range between -217 to 226 HUs was achieved for 3D printed phantoms using different filament materials; this range of radiation attenuation is also observed in the human lung tumor tissue. The resulted HU range could serve as a lookup-table for researchers and phantom manufactures to create realistic CT tumor phantoms with the desired range of radiodensities. The 3D printed tumor phantoms also precisely replicated real lung tumor patient data regarding morphology and could also include life-like heterogeneity of the radiodensity inside the tumor models. An influence of the heterogeneity on accuracy and robustness of the image registration algorithms was not found.

Attenuation coefficient in the energy range 14–36 keV of 3D printing materials for physical breast phantoms

Objective. To measure the monoenergetic x-ray linear attenuation coefficient, μ, of fused deposition modeling (FDM) colored 3D printing materials (ABS, PLAwhite, PLAorange, PET and NYLON), used as adipose, glandular or skin tissue substitutes for manufacturing physical breast phantoms. Approach. Attenuation data (at 14, 18, 20, 24, 28, 30 and 36 keV) were acquired at Elettra synchrotron radiation facility, with step-wedge objects, using the Lambert–Beer law and a CCD imaging detector. Test objects were 3D printed using the Ultimaker 3 FDM printer. PMMA, Nylon-6 and high-density polyethylene step objects were also investigated for the validation of the proposed methodology. Printing uniformity was assessed via monoenergetic and polyenergetic imaging (32 kV, W/Rh). Main results. Maximum absolute deviation of μ for PMMA, Nylon-6 and HD-PE was 5.0%, with reference to literature data. For ABS and NYLON, μ differed by less than 6.1% and 7.1% from that of adipose tissue, respectively; for PET and PLAorange the difference was less than 11.3% and 6.3% from glandular tissue, respectively. PLAorange is a good substitute of skin (differences from −9.4% to +1.2%). Hence, ABS and NYLON filaments are suitable adipose tissue substitutes, while PET and PLAorange mimick the glandular tissue. PLAwhite could be printed at less than 100% infill density for matching the attenuation of glandular tissue, using the measured density calibration curve. The printing mesh was observed for sample thicknesses less than 60 mm, imaged in the direction normal to the printing layers. Printing dimensional repeatability and reproducibility was less 1%. Significance. For the first time an experimental determination was provided of the linear attenuation coefficient of common 3D printing filament materials with estimates of μ at all energies in the range 14–36 keV, for their use in mammography, breast tomosynthesis and breast computed tomography investigations.

Thermoplastic 3D printing technology using a single filament for producing realistic patient-derived breast models

Objective. This work describes an approach for producing physical anthropomorphic breast phantoms from clinical patient data using three-dimensional (3D) fused-deposition modelling (FDM) printing.Approach. The source of the anthropomorphic model was a clinical Magnetic Resonance Imaging (MRI) patient image set, which was segmented slice by slice into adipose and glandular tissues, skin and tumour formations; thus obtaining a four component computational breast model. The segmented tissues were mapped to specific Hounsfield Units (HU) values, which were derived from clinical breast Computed Tomography (CT) data. The obtained computational model was used as a template for producing a physical anthropomorphic breast phantom using 3D printing. FDM technology with only one polylactic acid filament was used. The physical breast phantom was scanned at Siemens SOMATOM Definition CT. Quantitative and qualitative evaluation were carried out to assess the clinical realism of CT slices of the physical breast phantom.Main results. The comparison between selected slices from the computational breast phantom and CT slices of the physical breast phantom shows similar visual x-ray appearance of the four breast tissue structures: adipose, glandular, tumour and skin. The results from the task-based evaluation, which involved three radiologists, showed a high degree of realistic clinical radiological appearance of the modelled breast components. Measured HU values of the printed structures are within the range of HU values used in the computational phantom. Moreover, measured physical parameters of the breast phantom, such as weight and linear dimensions, agreed very well with the corresponding ones of the computational breast model.Significance. The presented approach, based on a single FDM material, was found suitable for manufacturing of a physical breast phantom, which mimics well the 3D spatial distribution of the different breast tissues and their x-ray absorption properties. As such, it could be successfully exploited in advanced x-ray breast imaging research applications.

Dataset of patient-derived digital breast phantoms for in silico studies in breast computed tomography, digital breast tomosynthesis, and digital mammography

PURPOSE

To present a dataset of computational digital breast phantoms derived from high-resolution three-dimensional (3D) clinical breast images for the use in virtual clinical trials in two-dimensional (2D) and 3D x-ray breast imaging.

ACQUISITION AND VALIDATION METHODS

Uncompressed computational breast phantoms for investigations in dedicated breast CT (BCT) were derived from 150 clinical 3D breast images acquired via a BCT scanner at UC Davis (California, USA). Each image voxel was classified in one out of the four main materials presented in the field of view: fibroglandular tissue, adipose tissue, skin tissue, and air. For the image classification, a semi-automatic software was developed. The semi-automatic classification was compared via manual glandular classification performed by two researchers. A total of 60 compressed computational phantoms for virtual clinical trials in digital mammography (DM) and digital breast tomosynthesis (DBT) were obtained from the corresponding uncompressed phantoms via a software algorithm simulating the compression and the elastic deformation of the breast, using the tissue's elastic coefficient. This process was evaluated in terms of glandular fraction modification introduced by the compression procedure. The generated cohort of 150 uncompressed computational breast phantoms presented a mean value of the glandular fraction by mass of 12.3%; the average diameter of the breast evaluated at the center of mass was 105 mm. Despite the slight differences between the two manual segmentations, the resulting glandular tissue segmentation did not consistently differ from that obtained via the semi-automatic classification. The difference between the glandular fraction by mass before and after the compression was 2.1% on average. The 60 compressed phantoms presented an average glandular fraction by mass of 12.1% and an average compressed thickness of 61 mm.

DATA FORMAT AND ACCESS

The generated digital breast phantoms are stored in DICOM files. Image voxels can present one out of four values representing the different classified materials: 0 for the air, 1 for the adipose tissue, 2 for the glandular tissue, and 3 for the skin tissue. The generated computational phantoms datasets were stored in the Zenodo public repository for research purposes (http://doi.org/10.5281/zenodo.4529852, http://doi.org/10.5281/zenodo.4515360).

POTENTIAL APPLICATIONS

The dataset developed within the INFN AGATA project will be used for developing a platform for virtual clinical trials in x-ray breast imaging and dosimetry. In addition, they will represent a valid support for introducing new breast models for dose estimates in 2D and 3D x-ray breast imaging and as models for manufacturing anthropomorphic physical phantoms.

Radiochromic film dosimetry in synchrotron radiation breast computed tomography: a phantom study

This study relates to the INFN project SYRMA-3D for in vivo phase-contrast breast computed tomography using the SYRMEP synchrotron radiation beamline at the ELETTRA facility in Trieste, Italy. This peculiar imaging technique uses a novel dosimetric approach with respect to the standard clinical procedure. In this study, optimization of the acquisition procedure was evaluated in terms of dose delivered to the breast. An offline dose monitoring method was also investigated using radiochromic film dosimetry. Various irradiation geometries have been investigated for scanning the prone patient's pendant breast, simulated by a 14 cm-diameter polymethylmethacrylate cylindrical phantom containing pieces of calibrated radiochromic film type XR-QA2. Films were inserted mid-plane in the phantom, as well as wrapped around its external surface, and irradiated at 38 keV, with an air kerma value that would produce an estimated mean glandular dose of 5 mGy for a 14 cm-diameter 50% glandular breast. Axial scans were performed over a full rotation or over 180°. The results point out that a scheme adopting a stepped rotation irradiation represents the best geometry to optimize the dose distribution to the breast. The feasibility of using a piece of calibrated radiochromic film wrapped around a suitable holder around the breast to monitor the scan dose offline is demonstrated.

New calculation method for 3D dose distribution in tetrahedral-mesh phantoms in Geant4

The tetrahedral-mesh (TM) geometry, which is a very promising geometry for computational human phantoms, has a limitation in 3D dose distribution calculation for medical applications. Even though Geant4 provides the read-out geometry for calculating 3D dose distribution in the TM geometry, this method significantly slows down the computation speed. In the present study, we developed a new method, called Moving Voxel-based Dose-Distribution Calculator (MVDDC), to rapidly calculate a 3D dose distribution in a TM geometry. To evaluate the performance of the MVDDC method, a simple TM cubic phantom and a human phantom were implemented in Geant4. Subsequently, the phantoms were irradiated with proton spot beams under various conditions, and the obtained results were compared with those of the read-out geometry method. The results show that there is no significant difference between the dose distributions calculated using the new method and the read-out geometry method. With respect to the computational performance, the speeds of simulations using the MVDDC were approximately 1.4-2.7 times faster than those of the simulations using the read-out geometry method.