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Chikarmane SA, Offit LR, Giess CS. Synthetic Mammography: Benefits, Drawbacks, and Pitfalls. Radiographics 2023; 43:e230018. [PMID: 37768863 DOI: 10.1148/rg.230018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Digital breast tomosynthesis (DBT) allows three-dimensional assessment of breast tissue; however, DBT requires a two-dimensional (2D) image for comparison with prior mammograms and accurate interpretation of calcifications. Traditionally, full-field digital mammography (FFDM) has been performed after the DBT image acquisition. Synthetic mammography (SM), the 2D reconstruction of the tomosynthesis slice dataset, has been designed to replace FFDM. Advantages of SM include decreased image acquisition time and decreased radiation exposure, with maintained or improved screening performance metrics. Because SM algorithms give extra weight to lesion-like characteristics (eg, calcifications and architectural distortions), they may enable increased visibility of these characteristics relative to that at FFDM. Although SM algorithms were designed to improve lesion identification, they have led to varied outcomes in studies reported in the literature. Compared with FFDM, SM has been reported to be associated with a higher false-positive rate for calcifications, decreased conspicuity of asymmetries, lower breast density assessments, and imaging artifacts (eg, metallic artifact, bright-band artifact, blurring of the axilla, and truncation artifact). The authors review the literature on SM, including its implementation, benefits, and artifacts. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Sona A Chikarmane
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (S.A.C., C.S.G.); and Harvard Medical School, Boston, MA (L.R.O.)
| | - Lily R Offit
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (S.A.C., C.S.G.); and Harvard Medical School, Boston, MA (L.R.O.)
| | - Catherine S Giess
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (S.A.C., C.S.G.); and Harvard Medical School, Boston, MA (L.R.O.)
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Kalyvas N, Chamogeorgaki A, Michail C, Skouroliakou A, Liaparinos P, Valais I, Fountos G, Kandarakis I. A Novel Method to Model Image Creation Based on Mammographic Sensors Performance Parameters: A Theoretical Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:2335. [PMID: 36850937 PMCID: PMC9968010 DOI: 10.3390/s23042335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Mammographic digital imaging is based on X-ray sensors with solid image quality characteristics. These primarily include (a) a response curve that yields high contrast and image latitude, (b) a frequency response given by the Modulation Transfer Function (MTF), which enables small detail imaging and (c) the Normalize Noise Power Spectrum (NNPS) that shows the extent of the noise effect on image clarity. METHODS In this work, a methodological approach is introduced and described for creating digital phantom images based on the measured image quality properties of the sensor. For this purpose, a mathematical phantom, simulating breast tissue and lesions of blood, adipose, muscle, Ca and Ca(50%)-P(50%) was created by considering the corresponding X-ray attenuation coefficients. The simulated irradiation conditions of the phantom used four mammographic spectra assuming exponential attenuation. Published data regarding noise and blur of a commercial RadEye HR CMOS imaging sensor were used as input data for the resulting images. RESULTS It was found that the Ca and Ca(50%)-P(50%) lesions were visible in all exposure conditions. In addition, the W/Rh spectrum at 28 kVp provided more detailed images than the corresponding Mo/Mo spectrum. CONCLUSIONS The presented methodology can act complementarily to image quality measurements, leading to initial optimization of the X-ray exposure parameters per clinical condition.
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Affiliation(s)
- Nektarios Kalyvas
- Radiation Physics, Materials Technology and Biomedical Imaging Laboratory, Department of Biomedical Engineering, University of West Attica, 122 10 Athens, Greece
| | | | - Christos Michail
- Radiation Physics, Materials Technology and Biomedical Imaging Laboratory, Department of Biomedical Engineering, University of West Attica, 122 10 Athens, Greece
| | | | - Panagiotis Liaparinos
- Radiation Physics, Materials Technology and Biomedical Imaging Laboratory, Department of Biomedical Engineering, University of West Attica, 122 10 Athens, Greece
| | - Ioannis Valais
- Radiation Physics, Materials Technology and Biomedical Imaging Laboratory, Department of Biomedical Engineering, University of West Attica, 122 10 Athens, Greece
| | - George Fountos
- Radiation Physics, Materials Technology and Biomedical Imaging Laboratory, Department of Biomedical Engineering, University of West Attica, 122 10 Athens, Greece
| | - Ioannis Kandarakis
- Radiation Physics, Materials Technology and Biomedical Imaging Laboratory, Department of Biomedical Engineering, University of West Attica, 122 10 Athens, Greece
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Marshall NW, Bosmans H. Performance evaluation of digital breast tomosynthesis systems: physical methods and experimental data. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac9a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022]
Abstract
Abstract
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.
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Vancoillie L, Cockmartin L, Marshall N, Bosmans H. The impact on lesion detection via a multi-vendor study: A phantom-based comparison of digital mammography, digital breast tomosynthesis, and synthetic mammography. Med Phys 2021; 48:6270-6292. [PMID: 34407213 DOI: 10.1002/mp.15171] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The aim of this study is to perform a test object-based comparison of the imaging performance of digital mammography (DM), digital breast tomosynthesis (DBT), and synthetic mammography (SM). METHODS Two test objects were used, the CDMAM and the L1-structured phantom. Small-detail detectability was assessed using CDMAM and the microcalcification simulating specks in the L1-structured background. Detection of spiculated and non-spiculated mass-like objects was assessed using the L1 phantom. Six different systems were included: Amulet Innovality (Fujifilm), Senographe Pristina (GEHC), 3Dimensions (Hologic), Giotto Class (IMS), Clarity 2D/3D (Planmed), and Mammomat Revelation (Siemens). Images were acquired under automatic exposure control (AEC) and at adjusted levels of AEC/2 and 2 × AEC level. Threshold gold thickness (Ttr ) was established for the 0.13-mm-diameter CDMAM discs. Threshold diameters for the calcifications (dtr_c ), the spiculated masses (dtr_sm ), and for the non-spiculated masses (dtr_nsm ) were established. The threshold condition was defined as the thickness or diameter for a 62.5% correct score. RESULTS Ttr for DM was generally superior to DBT, which in turn was superior to SM, but for most systems, these differences between modes were not significant. For L1, no significant differences in dtr_c were found between DM and DBT. The increase in dtr_c from DM to SM at AEC dose was 1%, 19%, 11%, 14%, 46%, and 27% for the Fujifilm, GEHC, Hologic, IMS, Planmed, and Siemens, respectively, indicating significantly poorer performance for all vendors except for Fujifilm, Hologic, and IMS. For both mass types, DBT performed better than SM, while SM showed no significant difference with DM (except for Fujifilm spiculated masses). The dose had an impact on small-detail detectability for both phantoms but did not influence the detection of either mass type. CONCLUSIONS Both phantoms indicated potentially reduced small-detail detectability for SM versus DM and DBT and should therefore not be used in stand-alone mode. The L1 phantom demonstrated no significant difference in microcalcification detection between DM and DBT and also demonstrated the superiority of DBT, compared to DM for mass detection, for all six systems.
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Affiliation(s)
- Liesbeth Vancoillie
- Department of Imaging and Pathology, KU Leuven, Division of Medical Physics & Quality Assessment, Leuven, Belgium
| | | | - Nicholas Marshall
- Department of Imaging and Pathology, KU Leuven, Division of Medical Physics & Quality Assessment, Leuven, Belgium.,Department of Radiology, UZ Leuven, Leuven, Belgium
| | - Hilde Bosmans
- Department of Imaging and Pathology, KU Leuven, Division of Medical Physics & Quality Assessment, Leuven, Belgium.,Department of Radiology, UZ Leuven, Leuven, Belgium
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Baldelli P, Cardarelli P, Flanagan F, Maguire S, Phelan N, Tomasi S, Taibi A. Evaluation of microcalcification contrast in clinical images for digital mammography and synthetic mammography. Eur J Radiol 2021; 140:109751. [PMID: 34000600 DOI: 10.1016/j.ejrad.2021.109751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/17/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this work was to compare, in a clinical study, digital mammography and synthetic mammography imaging by evaluating the contrast in microcalcifications of different sizes. METHODS A retrospective review of microcalcifications from 46 patients was undertaken. A Hologic 3-Dimensions mammography system and a HD Combo protocol was used for simultaneous acquisition of the digital and synthetic images. Microcalcifications were classified in accordance with their size, and patient breast images were classified in accordance with their density as adipose, moderately dense and dense. The contrast of the microcalcifications was measured and the contrast ratio between synthetic and digital images was compared. An additional qualitative assessment of the images was presented to correlate the conspicuity of the microcalcifications with the suppression of the structure noise. RESULTS Microcalcifications in adipose background always exhibit a comparable or better contrast on synthetic images, regardless their size. For moderately dense background, synthetic images show a better contrast in 91.2 % of cases for small microcalcifications and in 90.9 % of cases for large microcalcifications. For a dense background, better contrast is seen in 89.5 % of cases for small microcalcifications, and in 85.7 % of cases for large microcalcifications. The contrast ratio increases with increasing breast glandularity. The suppression of structure noise also contributes to the enhancement of microcalcifications in the synthetic images. CONCLUSIONS Synthetic mammography imaging is superior to digital mammography imaging in terms of microcalcification contrast, regardless their size and breast density.
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Affiliation(s)
- P Baldelli
- Breastcheck, National Breast Screening Program, 36 Eccles Street, Dublin 7, Ireland
| | - P Cardarelli
- National Institute for Nuclear Physics - Ferrara Division, via Saragat 1, 44122 Ferrara, Italy.
| | - F Flanagan
- Breastcheck, National Breast Screening Program, 36 Eccles Street, Dublin 7, Ireland; Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - S Maguire
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
| | - N Phelan
- Breastcheck, National Breast Screening Program, 36 Eccles Street, Dublin 7, Ireland
| | - S Tomasi
- Dept of Physics and Earth Sciences, University of Ferrara, via Saragat 1, 44122 Ferrara, Italy
| | - A Taibi
- Dept of Physics and Earth Sciences, University of Ferrara, via Saragat 1, 44122 Ferrara, Italy
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Application of artificial intelligence-based computer-assisted diagnosis on synthetic mammograms from breast tomosynthesis: comparison with digital mammograms. Eur Radiol 2021; 31:6929-6937. [PMID: 33710372 DOI: 10.1007/s00330-021-07796-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/22/2020] [Accepted: 02/16/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the diagnostic agreement and performances of synthetic and conventional mammograms when artificial intelligence-based computer-assisted diagnosis (AI-CAD) is applied. MATERIAL AND METHOD From January 2017 to April 2017, 192 patients (mean age 53.7 ± 11.7 years) diagnosed with 203 breast cancers were enrolled in this retrospective study. All patients underwent digital breast tomosynthesis (DBT) with digital mammograms (DM) simultaneously. Commercial AI-CAD was applied to the reconstructed synthetic mammograms (SM) from DBT and DM respectively and abnormality scores were calculated. We compared the median abnormality scores between DM and SM with the Wilcoxon signed-rank test and used the Bland-Altman analysis to evaluate agreements between the two mammograms and to investigate clinicopathological factors which might affect agreement. Diagnostic performances were compared using an area under the receiver operating characteristic curve (AUC). RESULT The abnormality scores showed a mean difference (bias) of - 3.26 (95% limits of agreement: - 32.69, 26.18) between the two mammograms by the Bland-Altman analysis. The concordance correlation coefficient was 0.934 (95% CI: 0.92, 0.946), suggesting high reproducibility. SM showed higher abnormality scores in cancer with distortion and occult findings, T1 and N0 cancer, and luminal type cancer than DM (all p ≤ 0.001). Diagnostic performance did not differ between the mammograms (AUC 0.945 for conventional mammograms, 0.938 for synthetic mammograms, p = 0.499). CONCLUSION AI-CAD can also work well on synthetic mammograms, showing good agreement and comparable diagnostic performance compared to its application to DM. KEY POINTS • AI-CAD which was developed based on imaging findings of digital mammograms can also be applied to synthetic mammograms. • AI-CAD showed good agreement and similar diagnostic performance when applied to both synthetic and digital mammograms. • With AI-CAD, synthetic mammograms showed relatively higher abnormality scores in cancer with distortion and occult findings, T1 and N0 cancer, and luminal type cancer than digital mammograms.
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Barca P, Lamastra R, Tucciariello RM, Traino A, Marini C, Aringhieri G, Caramella D, Fantacci ME. Technical evaluation of image quality in synthetic mammograms obtained from 15° and 40° digital breast tomosynthesis in a commercial system: a quantitative comparison. Phys Eng Sci Med 2020; 44:23-35. [PMID: 33226534 DOI: 10.1007/s13246-020-00948-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Patrizio Barca
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy.
| | - Rocco Lamastra
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy
- INFN, Pisa Section, Pisa, Italy
| | - Raffaele Maria Tucciariello
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy
- INFN, Pisa Section, Pisa, Italy
| | - Antonio Traino
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Carolina Marini
- S.D. Radiologia Senologica, "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Giacomo Aringhieri
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Maria Evelina Fantacci
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy
- INFN, Pisa Section, Pisa, Italy
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Petropoulos AE, Skiadopoulos SG, Karahaliou AN, Messaris GAT, Arikidis NS, Costaridou LI. Quantitative assessment of microcalcification cluster image quality in digital breast tomosynthesis, 2-dimensional and synthetic mammography. Med Biol Eng Comput 2019; 58:187-209. [DOI: 10.1007/s11517-019-02072-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/05/2019] [Indexed: 12/01/2022]
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Barca P, Lamastra R, Aringhieri G, Tucciariello RM, Traino A, Fantacci ME. Comprehensive assessment of image quality in synthetic and digital mammography: a quantitative comparison. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:1141-1152. [PMID: 31728938 DOI: 10.1007/s13246-019-00816-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/03/2019] [Indexed: 12/16/2022]
Abstract
Recent advances in digital breast tomosynthesis (DBT) technology were focused on the reconstruction of 2D "Synthesized Mammograms" (SMs) from DBT dataset. The introduction of SMs could avoid an additional digital mammography (DM) which is often required in complement to DBT examinations. Therefore, breast absorbed dose and compression time can be significantly reduced in DBT+SM procedures with respect to DBT+DM modality. However, to date, a limited number of studies have objectively characterised the image quality of SMs with respect to DM images. Therefore, the aim of this phantom study was to comprehensively compare SMs and DM images in terms of several image quality parameters. A Selenia Dimensions system (Hologic, Bedford, Mass, USA) was employed in this work. Five different phantoms were adopted to study noise, contrast and spatial resolution properties of the images. Specifically, noise power spectrum (NPS), maps of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), modulation transfer function (MTF) and contrast-detail (CD) thresholds were evaluated both for SM and DM modalities. SMs were characterised by different texture, noise and SNR spatial distribution properties with respect to DM images. Additionally, while in some conditions SM provides higher CNR than DM, lower overall performances in terms spatial resolution and CD curves were found in comparison to DM images. Therefore, given the great benefits of SMs in terms of dose and compression time saving, further clinical investigations on SMs image quality properties could be of practical interest to integrate our findings.
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Affiliation(s)
- Patrizio Barca
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy. .,INFN, Pisa Section, Pisa, Italy.
| | - Rocco Lamastra
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy.,INFN, Pisa Section, Pisa, Italy
| | - Giacomo Aringhieri
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Raffaele Maria Tucciariello
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy.,INFN, Pisa Section, Pisa, Italy
| | - Antonio Traino
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Maria Evelina Fantacci
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy.,INFN, Pisa Section, Pisa, Italy
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