Characterisation of noise and sharpness of images from four digital breast tomosynthesis systems for simulation of images for virtual clinical trials

Optimizing angular range in digital breast tomosynthesis: A phantom study investigating lesion detection across varied breast density and thickness

PURPOSE

To determine the optimal angular range (AR) for digital breast tomosynthesis (DBT) systems that provides highest lesion visibility across various breast densities and thicknesses.

METHOD

A modular DBT phantom, consisting of tissue-equivalent adipose and glandular modules, along with a module embedded with test objects (speckles, masses, fibers), was used to create combinations simulating different breast thicknesses, densities, and lesion locations. A prototype DBT system operated at four ARs (AR±7.5°, AR±12.5°, AR±19°, and AR±25°) to acquire 11 projection images for each combination, with separate fixed doses for thin and thick combinations. Three blinded radiologists independently assessed lesion visibility in reconstructed images; assessments were averaged and compared using linear mixed models.

RESULTS

Speckle visibility was highest with AR±7.5° or AR±12.5°, decreasing with wider ARs in all density and thickness combinations. The difference between AR±7.5° and AR±12.5° was not statistically significant, except for the tube-side speckles in thin-fatty combinations (5.83 [AR±7.5°] vs. 5.39 [AR±12.5°], P = 0.019). Mass visibility was not affected by AR in thick combinations, while AR±12.5° exhibited the highest mass visibility for both thin-fatty and thin-dense combinations (P = 0.032 and 0.007, respectively). Different ARs provided highest fiber visibility for different combinations; however, AR±12.5° consistently provided highest or comparable visibility. AR±12.5° showed highest overall lesion visibility for all density and thickness combinations.

CONCLUSIONS

AR±12.5° exhibited the highest overall lesion visibility across various phantom thicknesses and densities using a projection number of 11.

X-ray source motion blur modeling and deblurring with generative diffusion for digital breast tomosynthesis

Objective. Digital breast tomosynthesis (DBT) has significantly improved the diagnosis of breast cancer due to its high sensitivity and specificity in detecting breast lesions compared to two-dimensional mammography. However, one of the primary challenges in DBT is the image blur resulting from x-ray source motion, particularly in DBT systems with a source in continuous-motion mode. This motion-induced blur can degrade the spatial resolution of DBT images, potentially affecting the visibility of subtle lesions such as microcalcifications.Approach. We addressed this issue by deriving an analytical in-plane source blur kernel for DBT images based on imaging geometry and proposing a post-processing image deblurring method with a generative diffusion model as an image prior.Main results. We showed that the source blur could be approximated by a shift-invariant kernel over the DBT slice at a given height above the detector, and we validated the accuracy of our blur kernel modeling through simulation. We also demonstrated the ability of the diffusion model to generate realistic DBT images. The proposed deblurring method successfully enhanced spatial resolution when applied to DBT images reconstructed with detector blur and correlated noise modeling.Significance. Our study demonstrated the advantages of modeling the imaging system components such as source motion blur for improving DBT image quality.

Measurements of the noise power spectrum for digital x-ray imaging devices

Objective.The noise characteristics of digital x-ray imaging devices are determined by contributions such as photon noise, electronic noise, and fixed pattern noise, and can be evaluated from measuring the noise power spectrum (NPS), which is the power spectral density of the noise. Hence, accurately measuring NPS is important in developing detectors for acquiring low-noise digital x-ray images. To make accurate measurements, it is necessary to understand NPS, identify problems that may arise, and know how to process the obtained x-ray images.Approach.The primitive concept of NPS is first introduced with a periodogram-based estimate and its bias and variance are discussed. In measuring NPS based on the IEC62220 standards, various issues, such as the fixed pattern noise, high-precision estimates, and lag corrections, are summarized with simulation examples.Main results.High-precision estimates can be provided for an appropriate number of samples extracted from x-ray images while compromising spectral resolution. Depending on medical imaging systems, by eliminating the influence of fixed pattern noise, NPS, which represents only photon and electronic noise, can be efficiently measured. For NPS measurements in dynamic detectors, an appropriate lag correction technique can be selected depending on the emitted x-rays and image acquisition process.Significance.Various issues in measuring NPS are reviewed and summarized for accurately evaluating the noise performance of digital x-ray imaging devices.

Performance evaluation of digital breast tomosynthesis systems: physical methods and experimental data

Digital breast tomosynthesis (DBT) has become a well-established breast imaging technique, whose performance has been investigated in many clinical studies, including a number of prospective clinical trials. Results from these studies generally point to non-inferiority in terms of microcalcification detection and superior mass-lesion detection for DBT imaging compared to digital mammography (DM). This modality has become an essential tool in the clinic for assessment and ad-hoc screening but is not yet implemented in most breast screening programmes at a state or national level. While evidence on the clinical utility of DBT has been accumulating, there has also been progress in the development of methods for technical performance assessment and quality control of these imaging systems. DBT is a relatively complicated ‘pseudo-3D’ modality whose technical assessment poses a number of difficulties. This paper reviews methods for the technical performance assessment of DBT devices, starting at the component level in part one and leading up to discussion of system evaluation with physical test objects in part two. We provide some historical and basic theoretical perspective, often starting from methods developed for DM imaging. Data from a multi-vendor comparison are also included, acquired under the medical physics quality control protocol developed by EUREF and currently being consolidated by a European Federation of Organisations for Medical Physics working group. These data and associated methods can serve as a reference for the development of reference data and provide some context for clinical studies.

Computational models of direct and indirect X-ray breast imaging detectors for in silico trials

BACKGROUND

To facilitate in silico studies that investigate digital mammography (DM) and breast tomosynthesis (DBT), models replicating the variety in imaging performance of the DM and DBT systems, observed across manufacturers are needed.

PURPOSE

The main purpose of this work is to develop generic physics models for direct and indirect detector technology used in commercially available systems, with the goal of making them available open source to manufacturers to further tweak and develop the exact in silico replicas of their systems.

METHODS

We recently reported on an in silico version of the SIEMENS Mammomat Inspiration DM/DBT system using an open-source GPU-accelerated Monte Carlo x-ray imaging simulation code (MC-GPU). We build on the previous version of the MC-GPU codes to mimic the imaging performances of two other Food and Drug Administration (FDA)-approved DM/DBT systems, such as Hologic Selenia Dimensions (HSD) and the General Electric Senographe Pristina (GSP) systems. In this work, we developed a hybrid technique to model the optical spread and signal crosstalk observed in the GSP and HSD systems. MC simulations are used to track each x-ray photon till its first interaction within the x-ray detector. On the other hand, the signal spread in the x-ray detectors is modeled using previously developed analytical equations. This approach allows us to preserve the modeling accuracy offered by MC methods in the patient body, while speeding up secondary carrier transport (either electron-hole pairs or optical photons) using analytical equations in the detector. The analytical optical spread model for the indirect detector includes the depth-dependent spread and collection of optical photons and relies on a pre-computed set of point response functions that describe the optical spread as a function of depth. To understand the capabilities of the computational x-ray detector models, we compared image quality metrics like modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE), simulated with our models against measured data. Please note that the purpose of these comparisons with measured data would be to gauge if the model developed as part of this work could replicate commercially used direct and indirect technology in general and not to achieve perfect fits with measured data.

RESULTS

We found that the simulated image quality metrics such as MTF, NNPS, and DQE were in reasonable agreement with experimental data. To demonstrate the imaging performance of the three DM/DBT systems, we integrated the detector models with the VICTRE pipeline and simulated DM images of a fatty breast model containing a spiculated mass and a calcium oxalate cluster. In general, we found that the images generated using the indirect model appeared more blurred with a different noise texture and contrast as compared to the systems with direct detectors.

CONCLUSIONS

We have presented computational models of three commercially available FDA-approved DM/DBT systems, which implement both direct and indirect detector technology. The updated versions of the MC-GPU codes that can be used to replicate three systems are available in open source format through GitHub.

Virtual clinical trial to compare cancer detection using combinations of 2D mammography, digital breast tomosynthesis and synthetic 2D imaging

OBJECTIVES

This study was designed to compare the detection of subtle lesions (calcification clusters or masses) when using the combination of digital breast tomosynthesis (DBT) and synthetic mammography (SM) with digital mammography (DM) alone or combined with DBT.

METHODS

A set of 166 cases without cancer was acquired on a DBT mammography system. Realistic subtle calcification clusters and masses in the DM images and DBT planes were digitally inserted into 104 of the acquired cases. Three study arms were created: DM alone, DM with DBT and SM with DBT. Five mammographic readers located the centre of any lesion within the images that should be recalled for further investigation and graded their suspiciousness. A JAFROC figure of merit (FoM) and lesion detection fraction (LDF) were calculated for each study arm. The visibility of the lesions in the DBT images was compared with SM and DM images.

RESULTS

For calcification clusters, there were no significant differences (p > 0.075) in FoM or LDF. For masses, the FoM and LDF were significantly improved in the arms using DBT compared to DM alone (p < 0.001). On average, both calcification clusters and masses were more visible on DBT than on DM and SM images.

CONCLUSIONS

This study demonstrated that masses were detected better with DBT than with DM alone and there was no significant difference (p = 0.075) in LDF between DM&DBT and SM&DBT for calcifications clusters. Our results support previous studies that it may be acceptable to not acquire digital mammography alongside tomosynthesis for subtle calcification clusters and ill-defined masses.

KEY POINTS

• The detection of masses was significantly better using DBT than with digital mammography alone. • The detection of calcification clusters was not significantly different between digital mammography and synthetic 2D images combined with tomosynthesis. • Our results support previous studies that it may be acceptable to not acquire digital mammography alongside tomosynthesis for subtle calcification clusters and ill-defined masses for the imaging technology used.

VIRTUAL CLINICAL TRIALS IN MEDICAL IMAGING SYSTEM EVALUATION AND OPTIMISATION

Virtual clinical trials (VCTs) can be used to evaluate and optimise medical imaging systems. VCTs are based on computer simulations of human anatomy, imaging modalities and image interpretation. OpenVCT is an open-source framework for conducting VCTs of medical imaging, with a particular focus on breast imaging. The aim of this paper was to evaluate the OpenVCT framework in two tasks involving digital breast tomosynthesis (DBT). First, VCTs were used to perform a detailed comparison of virtual and clinical reading studies for the detection of lesions in digital mammography and DBT. Then, the framework was expanded to include mechanical imaging (MI) and was used to optimise the novel combination of simultaneous DBT and MI. The first experiments showed close agreement between the clinical and the virtual study, confirming that VCTs can predict changes in performance of DBT accurately. Work in simultaneous DBT and MI system has demonstrated that the system can be optimised in terms of the DBT image quality. We are currently working to expand the OpenVCT software to simulate MI acquisition more accurately and to include models of tumour growth. Based on our experience to date, we envision a future in which VCTs have an important role in medical imaging, including support for more imaging modalities, use with rare diseases and a role in training and testing artificial intelligence (AI) systems.

Comparison of Narrow-angle and Wide-angle Digital Breast Tomosynthesis Systems in Clinical Practice

Digital breast tomosynthesis (DBT) is a pseudo 3D mammography imaging technique that has become widespread since gaining Food and Drug Administration approval in 2011. With this technology, a variable number of tomosynthesis projection images are obtained over an angular range between 15° and 50° for currently available clinical DBT systems. The angular range impacts various aspects of clinical imaging, such as radiation dose, scan time, and image quality, including visualization of calcifications, masses, and architectural distortion. This review presents an overview of the differences between narrow- and wide-angle DBT systems, with an emphasis on their applications in clinical practice. Comparison examples of patients imaged on both narrow- and wide-angle DBT systems illustrate these differences. Understanding the potential variable appearance of imaging findings with narrow- and wide-angle DBT systems is important for radiologists, particularly when comparison images have been obtained on a different DBT system. Furthermore, knowledge about the comparative strengths and limitations of DBT systems is needed for appropriate equipment selection.

The regulation of hyphae growth in Candida albicans

In the last decades, Candida albicans has served as the leading causal agent of life-threatening invasive infections with mortality rates approaching 40% despite treatment. Candida albicans (C. albicans) exists in three biological phases: yeast, pseudohyphae, and hyphae. Hyphae, which represent an important phase in the disease process, can cause tissue damage by invading mucosal epithelial cells then leading to blood infection. In this review, we summarized recent results from different fields of fungal cell biology that are instrumental in understanding hyphal growth. This includes research on the differences among C. albicans phases; the regulatory mechanism of hyphal growth, extension, and maintaining cutting-edge polarity; cross regulations of hyphal development and the virulence factors that cause serious infection. With a better understanding of the mechanism on mycelium formation, this review provides a theoretical basis for the identification of targets in candidiasis treatment. It also gives some reference to the study of antifungal drugs.

Technical evaluation of image quality in synthetic mammograms obtained from 15° and 40° digital breast tomosynthesis in a commercial system: a quantitative comparison

Digital breast tomosynthesis (DBT) has recently gained interest both for breast cancer screening and diagnosis. Its employment has increased also in conjunction with digital mammography (DM), to improve cancer detection and reduce false positive recall rate. Synthetic mammograms (SMs) reconstructed from DBT data have been introduced to replace DM in the DBT + DM approach, for preserving the benefits of the dual-acquisition modality whilst reducing radiation dose and compression time. Therefore, different DBT models have been commercialized and the effective potential of each system has been investigated. In particular, wide-angle DBT was shown to provide better depth resolution than narrow-angle DBT, while narrow-angle DBT allows better identification of microcalcifications compared to wide-angle DBT. Given the increasing employment of SMs as supplement to DBT, a comparison of image quality between SMs obtained in narrow-angle and wide-angle DBT is of practical interest. Therefore, the aim of this phantom study was to evaluate and compare the image quality of SMs reconstructed from 15° (SM₁₅) and 40° (SM₄₀) DBT in a commercial system. Spatial resolution, noise and contrast properties were evaluated through the modulation transfer function (MTF), noise power spectrum, maps of signal-to-noise ratio (SNR), image contrast, contrast-to-noise ratio (CNR) and contrast-detail (CD) thresholds. SM₄₀ expressed higher MTF than SM₁₅, but also lower SNR and CNR levels. SM₁₅ and SM₄₀ were characterized by slight different texture, and a different behavior in terms of contrast was found. SM₁₅ provided better CD performances than SM₄₀. These results suggest that the employment of wide/narrow-angle DBT + SM images should be optimized based on the specific image task.

Verification of the accuracy of a hybrid breast imaging simulation framework for virtual clinical trial applications

Purpose: The impact of system parameters on signal detectability can be studied with simulation platforms. We describe the steps taken to verify and confirm the accuracy of a local platform developed for the use in virtual clinical trials. Approach: The platform simulates specific targets into existing two-dimensional full-field digital mammography and digital breast tomosynthesis images acquired on a Siemens Inspiration system. There are three steps: (1) creation of voxel models or analytical objects; (2) generation of a realistic object template with accurate resolution, scatter, and noise properties; and (3) insertion and reconstruction. Four objects were simulated: a 0.5-mm aluminium (Al) sphere and a 0.2-mm-thick Al sheet in a PMMA stack, a 0.8-mm steel edge and a three-dimensional mass model in a structured background phantom. Simulated results were compared to acquired data. Results: Peak contrast and signal difference-to-noise ratio (SDNR) were in close agreement ( < 5 % error) for both sphere and sheet. The similarity of pixel value profiles for sphere and sheet in the x y direction and the artifact spread function for real and simulated spheres confirmed accurate geometric modeling. Absolute and relative average deviation between modulation transfer function measured from a real and simulated edges showed accurate sharpness modelling for spatial frequencies up to the Nyquist frequency. Real and simulated objects could not be differentiated visually. Conclusions: The results indicate that this simulation framework is a strong candidate for use in virtual clinical studies.

In-plane image quality and NPWE detectability index in digital breast tomosynthesis

A rigorous 2D analysis of signal and noise transfer applied to reconstructed planes in digital breast tomosynthesis (DBT) is necessary for system characterization and optimization. This work proposes a method for assessing technical image quality and system detective quantum efficiency (DQE_sys) for reconstructed planes in DBT. Measurements of 2D in-plane modulation transfer function (MTF) and noise power spectrum (NPS) were made on five DBT systems using different acquisition parameters, reconstruction algorithms and plane spacing. This work develops the noise equivalent quanta (NEQ), DQE_sys and detectability index (d') calculated using a non-prewhitening model observer with eye filter (NPWE) for reconstructed DBT planes. The images required for this implementation were acquired using a homogeneous test object of thickness 40 mm poly(methyl) methacrylate plus 0.5 mm Al; 2D MTF was calculated from an Al disc of thickness 0.2 mm and diameter 50 mm positioned within the phantom. The radiant contrast of the MTF disc and the air kerma at the system input were used as normalization factors. The NPWE detectability index was then compared to the in-plane contrast-detail (c-d) threshold measured using the CDMAM phantom. The MTF and NPS measured on the different systems showed a strong anisotropy, consistent with the cascaded models developed in the literature for DBT. Detectability indices calculated from the measured MTF and NPS successfully predicted changes in c-d detectability for details between 0.1 mm and 2.0 mm, for DBT plane spacings between 0.5 mm and 10 mm, and for air kerma values at the system input between 157 µGy and 1170 μGy. The linear Pearson correlation between the detectability index and threshold gold thickness of the CDMAM phantom was -0.996. The method implements a parametric means of assessing the technical image quality of reconstructed DBT planes, providing valuable information for optimization of DBT systems.

The role of digital breast tomosynthesis in breast cancer screening: a manufacturer- and metrics-specific analysis

Aim

Digital Breast Tomosynthesis (DBT), with or without Digital Mammography (DM) or Synthetic Mammography (SM), has been introduced or is under consideration for its introduction in breast cancer screening in several countries, as it has been shown that it has advantages over DM. Despite this there is no agreement on how to implement DBT in screening, and in many cases there is a lack of official guidance on the optimum usage of each commercially available system. The aim of this review is to carry out a manufacturer-specific summary of studies on the implementation of DBT in breast cancer screening.

Methods

An exhaustive literature review was undertaken to identify clinical observer studies that evaluated at least one of five common metrics: sensitivity, specificity, area under the curve (AUC) of the receiver-operating characteristics (ROC) analysis, recall rate and cancer detection rate. Four common DBT implementation methods were discussed in this review: (1) DBT, (2) DM with DBT, (3) 1-view DBT with or without 1-view DM or 2-view DM and (4) DBT with SM.

Results

A summary of 89 studies, selected from a database of 677 studies, on the assessment of the implementation of DBT in breast cancer screening is presented in tables and discussed in a manufacturer- and metric-specific approach. Much more studies were carried out using some DBT systems than others. For one implementation method of DBT by one manufacturer there is a shortage of studies, for another implementation there are conflicting results. In some cases, there is a strong agreement between studies, making the advantages and disadvantages of each system clear.

Conclusion

The optimum implementation method of DBT in breast screening, in terms of diagnostic benefit and patient radiation dose, for one manufacturer does not necessarily apply to other manufacturers.

Technical Note: Noise models for virtual clinical trials of digital breast tomosynthesis

PURPOSE

To investigate the use of an affine-variance noise model, with correlated quantum noise and spatially dependent quantum gain, for the simulation of noise in virtual clinical trials (VCT) of digital breast tomosynthesis (DBT).

METHODS

Two distinct technologies were considered: an amorphous-selenium (a-Se) detector with direct conversion and a thallium-doped cesium iodide (CsI(Tl)) detector with indirect conversion. A VCT framework was used to generate noise-free projections of a uniform three-dimensional simulated phantom, whose geometry and absorption match those of a polymethyl methacrylate (PMMA) uniform physical phantom. The noise model was then used to generate noisy observations from the simulated noise-free data, while two clinically available DBT units were used to acquire projections of the PMMA physical phantom. Real and simulated projections were then compared using the signal-to-noise ratio (SNR) and normalized noise power spectrum (NNPS).

RESULTS

Simulated images reported errors smaller than 4.4% and 7.0% in terms of SNR and NNPS, respectively. These errors are within the expected variation between two clinical units of the same model. The errors increase to 65.8% if uncorrelated models are adopted for the simulation of systems featuring indirect detection. The assumption of spatially independent quantum gain generates errors of 11.2%.

CONCLUSIONS

The investigated noise model can be used to accurately reproduce the noise found in clinical DBT. The assumption of uncorrelated noise may be adopted if the system features a direct detector with minimal pixel crosstalk.

Multi-domain features for reducing false positives in automated detection of clustered microcalcifications in digital breast tomosynthesis

PURPOSE

In digital breast tomosynthesis (DBT) imaging, a microcalcification (MC) cluster may span across different slices and blurring exists in the out-of-focus slices. We developed a radiomics approach to extract features from focus slice and combine multiple spatial domains to reduce false positives (FPs) in an automated pipeline of detecting MC clusters.

METHODS

We performed a retrospective study on a cohort of 290 Chinese women patients with a total of 580 DBT volumes. We developed an automated MC detection pipeline that consists of two stages: an initial detection to identify a set of MC candidates that may include many FPs, followed by a radiomics-based classification model to identify and reduce the FPs. We extract both two-dimensional (2D) and three-dimensional (3D) radiomics features from multiple spatial domains, including a focus slice, projection image, and tomographic volume. A linear discriminant classifier was used coupled with a sequential forward feature selection procedure. The free-response operating characteristics (FROC) curve and partial area under the FROC curve (pAUC) in the FP rate range of 0 to 2 per DBT volume were used to evaluate the model's performance.

RESULTS

At a sensitivity of 90%, the FP rate was reduced from 1.3 to 0.2 per DBT volume after applying the multi-domain-based classification on the initial detections. The multi-domain yielded a significantly higher pAUC compared to the initial detection (increase of pAUC = 0.2278, P < 0.0001), focus slice (increase of pAUC = 0.0345, P = 0.0152), project image (increase of pAUC = 0.1043, P < 0.0001), and tomographic volume (increase of pAUC = 0.0791, P = 0.0032).

CONCLUSION

The radiomic features extracted from the three domains may provide complementary information and their integration can significantly reduce FPs in automated detection of MCs in DBT volumes on a large Chinese women population.

Cascaded systems analysis of a-Se/a-Si and a-InGaZnO TFT passive and active pixel sensors for tomosynthesis

Medical imaging systems like full field digital mammography (FFDM) and digital breast tomosynthesis (DBT) commonly use amorphous selenium (a-Se) based passive pixel sensor (PPS) direct conversion x-ray detectors. On one hand, direct conversion detectors inherently offer better resolution characteristics in terms of a higher modulation transfer function (MTF), in comparison to the indirect CsI:Tl PPS x-ray imager. On the other hand, especially at lower doses, this superior performance of the direct imager is seldom retained in its detective quantum efficiency (DQE) curves. It is well known that a-Se PPS x-ray imagers suffer from high additive electronic noise originating from the from the amorphous silicon (a-Si) thin film transistor (TFT) array that is being used in the current back-plane technology. This degrades the noise power spectrum (NPS) and subsequently the overall DQE. To address this deficiency, we propose to replace the PPS back-plane by active pixel sensor (APS) back-plane technology, which has the potential to reduce the back-plane electronic noise by amplifying the input signal, especially at low doses. The proposed APS is based on amorphous In-Ga-Zn-O (a-IGZO) TFT technology, which can offer high mobility (5-20 cm² V^-1 s^-1), low leakage current (<10^-13 A) and low flicker noise (Hooge's parameter α _H ~ 1.5 [Formula: see text] 10^-3), leading to better imager noise performance. To test our hypothesis, we used linear cascaded systems analysis to model the imaging performance (MTF, NPS and DQE) of the PPS and APS a-Se direct imagers. This model was first validated using experimentally measured data obtained for a 85 µm pixel pitch a-Se/a-Si TFT PPS imager. Using this model, we analyzed the noise performance of the direct a-Se and indirect CsI:Tl x-ray a-IGZO APS imagers at different dose and electronic noise levels. Obtained results clearly showed that lowering back-plane electronic noise can significantly improve the performance of the a-Se/a-IGZO TFT APS imager. Our simulated results showed that a higher DQE at lower radiation doses (maximum DQE of 0.6 can be achieved at an exposure level of 1 µGy) can be achieved with the a-Se detector, thereby making this combination a promising candidate for low dose applications like DBT.

The threshold detectable mass diameter for 2D-mammography and digital breast tomosynthesis

Digital breast tomosynthesis (DBT) is currently under consideration for replacement of, or combined use with 2D-mammography in national breast screening programmes. To investigate the potential benefits that DBT can bring to screening, the threshold detectable lesion diameters were measured for different forms of DBT in comparison to 2D-mammography. The aim of this study was to compare the threshold detectable mass diameters obtained with narrow angle (15°/15 projections) and wide angle (50°/25 projections) DBT in comparison to 2D-mammography. Simulated images of 60 mm thick compressed breasts were produced with and without masses using a set of validated image modelling tools for 2D-mammography and DBT. Image processing and reconstruction were performed using commercial software. A series of 4-alternative forced choice (4AFC) experiments was conducted for signal detection with the masses as targets. The threshold detectable mass diameter was found for each imaging modality with a mean glandular dose of 2.5 mGy. The resulting values of the threshold diameter for 2D-mammography (10.2 ± 1.4 mm) were found to be larger (p < 0.001) than those for narrow angle DBT (6.0 ± 1.1 mm) and wide angle DBT (5.6 ± 1.2 mm). There was no significant difference between the threshold diameters for wide and narrow angle DBT. Implications for the introduction of DBT alone or in combination with 2D-mammography in breast cancer screening are discussed.

Evaluation of Digital Breast Tomosynthesis as Replacement of Full-Field Digital Mammography Using an In Silico Imaging Trial

IMPORTANCE

Expensive and lengthy clinical trials can delay regulatory evaluation of innovative technologies, affecting patient access to high-quality medical products. Simulation is increasingly being used in product development but rarely in regulatory applications.

OBJECTIVES

To conduct a computer-simulated imaging trial evaluating digital breast tomosynthesis (DBT) as a replacement for digital mammography (DM) and to compare the results with a comparative clinical trial.

DESIGN, SETTING, AND PARTICIPANTS

The simulated Virtual Imaging Clinical Trial for Regulatory Evaluation (VICTRE) trial was designed to replicate a clinical trial that used human patients and radiologists. Images obtained with in silico versions of DM and DBT systems via fast Monte Carlo x-ray transport were interpreted by a computational reader detecting the presence of lesions. A total of 2986 synthetic image-based virtual patients with breast sizes and radiographic densities representative of a screening population and compressed thicknesses from 3.5 to 6 cm were generated using an analytic approach in which anatomical structures are randomly created within a predefined breast volume and compressed in the craniocaudal orientation. A positive cohort contained a digitally inserted microcalcification cluster or spiculated mass.

MAIN OUTCOMES AND MEASURES

The trial end point was the difference in area under the receiver operating characteristic curve between modalities for lesion detection. The trial was sized for an SE of 0.01 in the change in area under the curve (AUC), half the uncertainty in the comparative clinical trial.

RESULTS

In this trial, computational readers analyzed 31 055 DM and 27 960 DBT cases from 2986 virtual patients with the following Breast Imaging Reporting and Data System densities: 286 (9.6%) extremely dense, 1200 (40.2%) heterogeneously dense, 1200 (40.2%) scattered fibroglandular densities, and 300 (10.0%) almost entirely fat. The mean (SE) change in AUC was 0.0587 (0.0062) (P < .001) in favor of DBT. The change in AUC was larger for masses (mean [SE], 0.0903 [0.008]) than for calcifications (mean [SE], 0.0268 [0.004]), which was consistent with the findings of the comparative trial (mean [SE], 0.065 [0.017] for masses and -0.047 [0.032] for calcifications).

CONCLUSIONS AND RELEVANCE

The results of the simulated VICTRE trial are consistent with the performance seen in the comparative trial. While further research is needed to assess the generalizability of these findings, in silico imaging trials represent a viable source of regulatory evidence for imaging devices.

A comparative study of physical image quality in digital and synthetic mammography from commercially available mammography systems

We present a comparison between full field digital mammography and synthetic mammography, performed on several mammography systems from four different manufacturers. The analysis is carried out on both the digital and synthetic images of two commercially available mammography phantoms, and focuses on a set of objective metrics that encode the geometrical appearance of imaging features of diagnostic interest. In particular, we measured sizes and contrasts of several clusters of microcalcification specks, shapes and contrasts of circular masses, and the power spectrum of background regions mimicking the heterogeneous texture of the breast parenchyma. Despite the potential issues of tomosynthesis in terms of image blurring, the synthetic images do not highlight any globally significant differences in the rendering of the details of interest, when compared to the original digital mammograms: relative contrasts are generally preserved, as well as the geometry of broad structures. We conclude that, as far as the considered objective metrics are concerned, the image quality of synthetic mammography does not exhibit significant differences with respect to the one of full field digital mammography, for all the considered systems.

Technical characterization of five x-ray detectors for paediatric radiography applications

Physical image quality of five x-ray detectors used in the paediatric imaging department is characterized with the aim of establishing the range/scope of imaging performance provided by these detectors for neonatal imaging. Two computed radiography (CR) detectors (MD4.0 powder imaging plate (PIP) and HD5.0 needle imaging plate (NIP), Agfa HealthCare NV, B-2640 Mortsel, Belgium) and three flat panel detectors (FPD) (the Agfa DX-D35C and DX-D45C and the DRX-2530C (Carestream Health Inc., Rochester, NY 14608, USA)) were assessed. Physical image quality was characterized using the detector metrics given by the International Electrotechnical Commission (IEC 62220-1) to measure modulation transfer function (MTF), the noise power spectrum (NPS) and the detective quantum efficiency (DQE) using the IEC-specified beam qualities of RQA3 and RQA5. The DQE was evaluated at the normal operating detector air kerma (DAK) level, defined at 2.5 µGy for all detectors, and at factors of 1/3.2 and 3.2 times the normal level. MTF curves for the different detectors were similar at both RQA3 and RQA5 energies; the average spatial frequency for the 50% point (MTF0.5) at RQA3 was 1.26 mm^-1, with a range from 1.20 mm^-1 to 1.37 mm^-1. The DQE of the NIP CR compared to the PIP CR was notably greater and similar to that for the FPD devices. At RQA3, average DQE for the FPD and NIP (at 0.5 mm^-1; 2.5 µGy) was 0.57 compared to 0.26 for the PIP CR. At the RQA5 energy, the DRX-2530C and the DX-D45C had the highest DQE (~0.6 at 0.5 mm^-1; 2.5 µGy). Noise separation analysis using the polynomial model showed higher electronic noise for the DX-D35C and DRX-2530C detectors; this explains the reduced DQE seen at 0.7 µGy/image. The NIP CR detector offers notably improved DQE performance compared to the PIP CR system and a value similar to the DQE for FPD devices at the RQA3 energy.

Can Breast Compression Be Reduced in Digital Mammography and Breast Tomosynthesis?

OBJECTIVE

The objective of this study was to investigate the impact of decreasing breast compression during digital mammography and breast tomosynthesis (DBT) on perceived pain and image quality.

MATERIALS AND METHODS

In this two-part study, two groups of women with prior mammograms were recruited. In part 1, subjects were positioned for craniocaudal (CC) and mediolateral oblique (MLO) views, and four levels of compression force were applied to evaluate changes in breast thickness, perceived pain, and relative tissue coverage. No imaging was performed. In part 2, two MLO DBT images of one breast of each patient were acquired at standard and reduced compression. Blurring artifacts and tissue coverage were judged by three breast imaging radiologists, and compression force, breast thickness, relative tissue coverage, and perceived pain were recorded.

RESULTS

Only the first reduction in force was feasible because further reduction resulted in inadequate breast immobilization. Mean force reductions of 48% and 47% for the CC and MLO views, respectively, resulted in a significantly reduced perceived pain level, whereas the thickness of the compressed breast increased by 0.02 cm (CC view) and 0.09 (MLO view, part 1 of the study) and 0.38 cm (MLO view, part 2 of the study), respectively, with no change in tissue coverage or increase in motion blurring.

CONCLUSION

Mammography and DBT acquisitions may be possible using half of the compression force used currently, with a significant and substantial reduction in perceived pain with no clinically significant change in breast thickness and tissue coverage.

Simulation of images of CDMAM phantom and the estimation of measurement uncertainties of threshold gold thickness

PURPOSE

To demonstrate a method of simulating mammography images of the CDMAM phantom and to investigate the coefficient of variation (CoV) in the threshold gold thickness (tT) measurements associated with use of the phantom.

METHODS

The noise and sharpness of Hologic Dimensions and GE Essential mammography systems were characterized to provide data for the simulation. The simulation method was validated by comparing the tT results of real and simulated images of the CDMAM phantom for three different doses and the two systems. The detection matrices produced from each of 64 images using CDCOM software were randomly resampled to create 512 sets of 8, 16 and 32 images to estimate the CoV of tT. Sets of simulated images for a range of doses were used to estimate the CoVs for a range of diameters and threshold thicknesses.

RESULTS

No significant differences were found for tT or the CoV between real and simulated CDMAM images. It was shown that resampling from 256 images was required for estimating the CoV. The CoV was around 4% using 16 images for most of the phantom but is over double that for details near the edge of the phantom.

CONCLUSIONS

We have demonstrated a method to simulate images of the CDMAM phantom for different systems at a range of doses. We provide data for calculating uncertainties in tT. Any future review of the European guidelines should take into consideration the calculated uncertainties for the 0.1mm detail.