Recent advances in X-ray imaging of breast tissue: From two- to three-dimensional imaging

Understanding the risk of ionizing radiation in breast imaging: Concepts and quantities, clinical importance, and future directions

BACKGROUND

Conventional mammography remains the primary imaging modality for state-of-the-art breast imaging practice and its benefit (both on diagnostic and screening) was largely reported. In mammography, the typical Mean Glandular Dose (MGD) from X-ray radiation to the breast spans, on average, from 1 to 10 mGy, depending on breast thicknesses, percentage of fibroglandular tissue, and on the examination purpose.

METHODS

The aim of this narrative review is to describe the extent of radiation risk in X-ray breast imaging and discuss the main steps and parameters (e.g. MGD, screening frequency and number of examination views) that may have an influence on the radiation risk assessment.

RESULTS

Even though the radiation doses used with these examinations are very low, as compared to other medical or natural radiation exposures, there is a non-negligible associated risk of radiation-induced cancer. Accurate radiation risk assessment permits to better balance the overall estimation of the benefit-to-risk ratio in X-ray breast imaging.

CONCLUSIONS

It is expected that a better knowledge about radiation-induced cancer risk among population could improve the communications skills between patients and clinicians and could help to increase the awareness in women about radiation risk perception for a transparent and proper informed choice of imaging exam.

Functionalizing of magnetic nanoparticles as nano-architecture towards bioimaging and colorimetric recognition of MCF-7 cells: dual opto-sensing and fluorescence monitoring for early-stage diagnosis of breast cancer

Considering the high incidence of breast cancer, a sensitive and specific approach is crucial for its early diagnosis and follow-up treatment. Folate receptors (FR), which are highly expressed on the epithelial tissue such as breast cancer cells (e.g., MCF-7), have been used in cancer diagnosis and bioimaging. This study presents an innovative colorimetric and fluorescence bioimaging platform towards MCF-7 using folic acid (FA)-conjugated iron-oxide magnetite silica-based nanocomposite (Fe3O4@SiO2-3-aminopropyl)triethoxysilane (APTES-NH2)@cysteine (Cyt)-Cyt@FA). For identification of MCF-7, the polyvinylpyrrolidone (PVP)-capped-platinum (Pt) nanoparticle was utilized as a nanozyme to catalyze the reaction between 3,3',5,5'-tetramethylbenzidine (TMB) and H2O2 for visual detection of MCF-7 cells. Colorimetric changes are detectable by the naked eye and spectrophotometry at the wavelength of 450 nm, with a linear range of 50-5000 cells/mL and a detection limit of 30 cells/mL. The Fe3O4@SiO2-APTES-NH2@Cyt-Cyt@FA complex was modified with rhodamine B as a fluorescence bioimaging probe to monitor FR-overexpressed MCF-7 cells. The nanocomposite is biocompatible with a toxicity threshold of about 800 µg/mL. These methodologies facilitate bioimaging and colorimetric assays without sophisticated instrumentation, offering high specificity, sensitivity, repeatability, and stability, making them suitable as versatile methods for detecting and bioimaging cancer cells.

X-ray dark-field computed tomography for monitoring of tissue freezing

Accurately monitoring the extent of freezing in biological tissue is an important requirement for cryoablation, a minimally invasive cancer treatment that induces cell death by freezing tissue with a cryoprobe. During the procedure, monitoring is required to avoid unnecessary harm to the surrounding healthy tissue and to ensure the tumor is properly encapsulated. One commonly used monitoring method is attenuation-based computed tomography (CT), which visualizes the ice ball by utilizing its hypoattenuating properties compared to unfrozen tissue. However, the contrast between frozen and unfrozen tissue remains low. In a proof-of-principle experiment, we show that the contrast between frozen and unfrozen parts of a porcine phantom mimicking breast tissue can be greatly enhanced by acquiring X-ray dark-field images that capture the increasing small-angle scattering caused by the ice crystals formed during the procedure. Our results show that, compared to X-ray attenuation, the frozen region is detected significantly better in dark-field radiographs and CT scans of the phantom. These findings demonstrate that X-ray dark-field imaging could be a potential candidate for improved monitoring of cryoablation procedures.

Virtual dosimetry study with three cone-beam breast computed tomography scanners using a fast GPU-based Monte Carlo code

Objective. To compare the dosimetric performance of three cone-beam breast computed tomography (BCT) scanners, using real-time Monte Carlo-based dose estimates obtained with the virtual clinical trials (VCT)-BREAST graphical processing unit (GPU)-accelerated platform dedicated to VCT in breast imaging. Approach. A GPU-based Monte Carlo (MC) code was developed for replicatingin silicothe geometric, x-ray spectra and detector setups adopted, respectively, in two research scanners and one commercial BCT scanner, adopting 80 kV, 60 kV and 49 kV tube voltage, respectively. Our cohort of virtual breasts included 16 anthropomorphic voxelized breast phantoms from a publicly available dataset. For each virtual patient, we simulated exams on the three scanners, up to a nominal simulated mean glandular dose of 5 mGy (primary photons launched, in the order of 1011-1012per scan). Simulated 3D dose maps (recorded for skin, adipose and glandular tissues) were compared for the same phantom, on the three scanners. MC simulations were implemented on a single NVIDIA GeForce RTX 3090 graphics card.Main results.Using the spread of the dose distribution as a figure of merit, we showed that, in the investigated phantoms, the glandular dose is more uniform within less dense breasts, and it is more uniformly distributed for scans at 80 kV and 60 kV, than at 49 kV. A realistic virtual study of each breast phantom was completed in about 3.0 h with less than 1% statistical uncertainty, with 109primary photons processed in 3.6 s computing time.Significance. We reported the first dosimetric study of the VCT-BREAST platform, a fast MC simulation tool for real-time virtual dosimetry and imaging trials in BCT, investigating the dose delivery performance of three clinical BCT scanners. This tool can be adopted to investigate also the effects on the 3D dose distribution produced by changes in the geometrical and spectrum characteristics of a cone-beam BCT scanner.

Tri-directional x-ray phase contrast multimodal imaging using one hexagonal mesh modulator

Objective. X-ray phase contrast imaging is a promising technique for future clinical diagnostic as it can provide enhanced contrast in soft tissues compared to traditional x-ray attenuation-contrast imaging. However, the strict requirements on the x-ray coherence and the precise alignment of optical elements limit its applications towards clinical use. To solve this problem, mesh-based x-ray phase contrast imaging method with one hexagonal mesh is proposed for easy alignment and better image visualization.Approach. The mesh produces structured illuminations and the detector captures its distortions to reconstruct the absorption, differential phase contrast (DPC) and dark-field (DF) images of the sample. In this work, we fabricated a hexagonal mesh to simultaneously retrieve DPC and DF signals in three different directions with single shot. A phase retrieval algorithm to obtain artifacts-free phase from DPC images with three different directions is put forward and false color dark-field image is also reconstructed with tri-directional images. Mesh-shifting method based on this hexagonal mesh modulator is also proposed to reconstruct images with better image quality at the expense of increased dose.Main results. In numerical simulations, the proposed hexagonal mesh outperforms the traditional square mesh in image evaluation metrics performance and false color visualization with the same radiation dose. The experimental results demonstrate its feasiblity in real imaging systems and its advantages in quantitive imaging and better visualization. The proposed hexagonal mesh is easy to fabricate and can be successfully applied to x-ray source with it spot size up to 300μm.Significance. This work opens new possibilities for quantitative x-ray non-destructive imaging and may also be instructive for research fields such as x-ray structured illumination microscopy (SIM), x-ray spectral imaging and x-ray phase contrast and dark-field computed tomography (CT).

Multiscale X-ray phase-contrast tomography: From breast CT to micro-CT for virtual histology

Phase-contrast imaging techniques address the issue of poor soft-tissue contrast encountered in traditional X-ray imaging. This can be accomplished with the propagation-based phase-contrast technique by employing a coherent photon beam, which is available at synchrotron facilities, as well as long sample-to-detector distances. This study demonstrates the optimization of propagation-based phase-contrast computed tomography (CT) techniques for multiscale X-ray imaging of the breast at the Elettra synchrotron facility (Trieste, Italy). Two whole breast mastectomy samples were acquired with propagation-based breast-CT using a monochromatic synchrotron beam at a pixel size of 60 µm. Paraffin-embedded blocks sampled from the same tissues were scanned with propagation-based micro-CT imaging using a polychromatic synchrotron beam at a pixel size of 4 µm. Images of both methodologies and of the same sample were spatially registered. The resulting images showed the transition from whole breast imaging with propagation-based breast-CT methodology to virtual histology with propagation-based micro-CT imaging of the same sample. Additionally, conventional histological images were matched to virtual histology images. Phase-contrast images offer a high resolution with low noise, which allows for a highly precise match between virtual and conventional histology. Furthermore, those techniques allow a clear discernment of breast structures, lesions, and microcalcifications, being a promising clinically-compatible tool for breast imaging in a multiscale approach, to either assist in the detection of cancer in full volume breast samples or to complement structure identification in paraffin-embedded breast tissue samples.

Application value of digital tungsten-molybdenum dual target three-dimensional positioning indwelling guide wire excision biopsy in diagnosis of breast microcalcification

OBJECTIVE

To explore the application value of digital tungsten-molybdenum double target three-dimensional positioning indwelling guide wire and guided surgical resection biopsy in the diagnosis of breast microcalcification.

METHODS

A retrospective analysis of 168 patients with negative clinical palpation and molybdenum target X-ray examination found breast abnormalities were equally divided into two groups according to different surgical positioning methods. The control and observation group underwent gross positioning biopsy and digital tungsten-molybdenum dual-target three-dimensional positioning indwelling guide wire to guide surgical resection biopsy, respectively. The results of molybdenum target X-ray examination and the success rate of one-time complete resection of the lesions were compared between the two groups, and the corresponding relationship between the pathological diagnosis results of the lesions after surgical resection and the performance of mammography in the observation group was compared.

RESULTS

There was no significant difference in age and molybdenum target X-ray examination results between the two groups (P > 0.05). General information is comparable; the success rate of one-time complete resection of lesions in the observation group was significantly higher than that in the control group (95.2% vs 78.6%, P = 0.024). There were 34 cases of malignant lesions in the observation group, accounting for 40.5% (34/84), including 11 cases of invasive ductal carcinoma (64.7%), 50 cases of benign lesions, accounting for 59.5% (50/84), including 16 cases of breast lobular hyperplasia (32%), 18 cases of breast cystic hyperplasia (36%).

CONCLUSION

In diagnosis of breast microcalcifications, surgical resection biopsy guided using digital tungsten-molybdenum double target three-dimensional positioning indwelling guide wire achieves high success rate and has advantages of high safety and accurate diagnosis. Thus, it has potential to play a greater role in early diagnosis of breast cancer and is worthy of clinical application.

Experimental demonstration of ultrahigh sensitivity Talbot-Lau interferometer for low dose mammography

Objective. Even though the techniques used for breast cancer identification have advanced over the years, current mammography based on x-rays absorption, the 'gold standard' screening test at present, still has some shortcomings as concerns sensitivity and specificity to early-stage cancers, due to poor differentiation between tumor and normal tissues, especially in the case of the dense breasts. We investigate a possible additional technique for breast cancer detection with higher sensitivity and low dose, x-ray phase-contrast or refraction-based imaging with ultrahigh angular sensitivity grating interferometers, having several meters length.Approach.Towards this goal, we built and tested on a mammography phantom, a table-top laboratory setup based on a 5.7 m long Talbot-Lau interferometer with angular sensitivity better than 1μrad. We used a high-power x-ray tungsten anode tube with a 400μm focal spot, operated at 40 kVp and 15 mA with a 2 mm aluminum filter.Main results.The results reported in our paper confirm the ultrahigh sensitivity and dose economy possible with our setup. The visibility of objects simulating cancerous formations is strongly increased in the refraction images over the attenuation ones, even at a low dose of 0.32 mGy. Notably, the smallest fiber of 400μm diameter and calcifications specs of 160μm in diameter are detected, even though the spatial resolution at the object of our magnification M ∼ 2 setup with a 400μm source spot is only ∼250μm.Significance.Our experiments on a mammography phantom illustrate the capabilities of the proposed technique and can open the way toward low-dose interferometric mammography.

Optimization of the exposure parameters in digital mammography for diverse glandularities using the contrast-detail metric

PURPOSE

This investigation aims to study the optimization in digital mammography, considering a diverse percentage of breast glandularity using the contrast-detail metric.

METHODS

The Figure of Merit (FOM), defined as the ratio of the square of the Inverted Image Quality Figure (IQF_INV) by the Mean Glandular Dose (MGD), was used. A Monte Carlo simulation study was carried out to calculate the Normalized Glandular Dose (D_gN). A contrast detail analysis employing the test object Contrast-Detail Mammography Phantom (CDMAM, type 3.4) was performed in the Hologic digital mammography system-model Selenia located in the Research Center in Radiation Sciences and Technologies (CPqCTR) facilities (Brazil). It employed the CIRS phantom with 20 %, 30 %, 50 % of glandularity, and 6.0 cm in thickness.

RESULTS

It was obtained new acquisition parameters for all glandularities that achieved a decrease in the MGD up to ∼ 50 %, maintaining the same image quality. The study was validated using the CIRS, TORMAM, and ACR phantoms through the contrast-to-noise ratio (CNR), the signal-to-noise ratio (SNR), and the MGD values obtained with the optimized parameters and the four AEC modes, which are the optimization proposed by the manufacturer.

CONCLUSIONS

In this work, a new procedure was proposed that estimated the IQF_INV value using the equivalence criterion between the CIRS phantom and the CDMAM test object with their respective PMMA plates. Based on the optimization carried out in this investigation, the AEC parameters, considering diverse glandularities, could be improved. This achievement permits the implementation of new protocols that optimize the ratio between the image's quality and the breast dose with 6.0 cm in thickness and 20 %, 30 %, and 50 % glandularity using contrast-detail metric.

Volumetric High-Resolution X-Ray Phase-Contrast Virtual Histology of Breast Specimens With a Compact Laboratory System

The assessment of margin involvement is a fundamental task in breast conserving surgery to prevent recurrences and reoperations. It is usually performed through histology, which makes the process time consuming and can prevent the complete volumetric analysis of large specimens. X-ray phase contrast tomography combines high resolution, sufficient penetration depth and high soft tissue contrast, and can therefore provide a potential solution to this problem. In this work, we used a high-resolution implementation of the edge illumination X-ray phase contrast tomography based on "pixel-skipping" X-ray masks and sample dithering, to provide high definition virtual slices of breast specimens. The scanner was originally designed for intra-operative applications in which short scanning times were prioritised over spatial resolution; however, thanks to the versatility of edge illumination, high-resolution capabilities can be obtained with the same system simply by swapping x-ray masks without this imposing a reduction in the available field of view. This makes possible an improved visibility of fine tissue strands, enabling a direct comparison of selected CT slices with histology, and providing a tool to identify suspect features in large specimens before slicing. Combined with our previous results on fast specimen scanning, this works paves the way for the design of a multi-resolution EI scanner providing intra-operative capabilities as well as serving as a digital pathology system.

Quantitative X-ray phase contrast computed tomography with grating interferometry : Biomedical applications of quantitative X-ray grating-based phase contrast computed tomography

The ability of biomedical imaging data to be of quantitative nature is getting increasingly important with the ongoing developments in data science. In contrast to conventional attenuation-based X-ray imaging, grating-based phase contrast computed tomography (GBPC-CT) is a phase contrast micro-CT imaging technique that can provide high soft tissue contrast at high spatial resolution. While there is a variety of different phase contrast imaging techniques, GBPC-CT can be applied with laboratory X-ray sources and enables quantitative determination of electron density and effective atomic number. In this review article, we present quantitative GBPC-CT with the focus on biomedical applications.

High-resolution multicontrast tomography with an X-ray microarray anode-structured target source

Talbot–Lau interferometry (TLI) holds remarkable potential for multicontrast X-ray imaging but suffers from technical challenges associated with microfabrication and limited efficiency. We tackle the frontier challenges in this field by developing a microarray anode–structured target source with a built-in structured illumination scheme. Our development facilitates high-resolution and high-sensitivity TLI imaging without the absorption source grating. We demonstrate the tri-contrast tomography capability with a Drum fish tooth specimen and separate the biological features with different combinations of physical properties. Our approach not only addresses the long-standing challenges in the field of X-ray TLI phase-contrast imaging but also features a compact setup that can potentially be made broadly available to academia research and industrial applications.

Multicontrast X-ray imaging with high resolution and sensitivity using Talbot–Lau interferometry (TLI) offers unique imaging capabilities that are important to a wide range of applications, including the study of morphological features with different physical properties in biological specimens. The conventional X-ray TLI approach relies on an absorption grating to create an array of micrometer-sized X-ray sources, posing numerous limitations, including technical challenges associated with grating fabrication for high-energy operations. We overcome these limitations by developing a TLI system with a microarray anode–structured target (MAAST) source. The MAAST features an array of precisely controlled microstructured metal inserts embedded in a diamond substrate. Using this TLI system, tomography of a Drum fish tooth with high resolution and tri-contrast (absorption, phase, and scattering) reveals useful complementary structural information that is inaccessible otherwise. The results highlight the exceptional capability of high-resolution multicontrast X-ray tomography empowered by the MAAST-based TLI method in biomedical applications.