Visibility of simulated microcalcifications-A hardcopy-based comparison of three mammographic systemsa)

Breast phantoms for 2D digital mammography with realistic anatomical structures and attenuation characteristics based on clinical images using 3D printing

The aim of this work was to develop a production process for breast phantoms for 2D digital mammography (DM) with realistic anatomical structures and attenuation characteristics based on clinical images using 3D printing. The presented production process is based on PolyJet 3D printing technology using a polypropylene like printing material. First, an attenuation calibration function for this material and the achievable lateral resolution of the printing process of about 200 µm was determined. Subsequently, to generate the digital 3D model of the breast phantom, the pixel intensities of the unprocessed clinical image that are related to the attenuation along the z-axis of the breast, were converted to corresponding phantom heights using the calibration function. To validate the process, an image of the 3D printed breast phantom was acquired on the full field digital mammography (FFDM) system used for calibration and compared with the clinical image in terms of anatomical structures and associated attenuation characteristics. The exposure parameters and image impression of the phantom were evaluated using five other FFDM systems of different manufacturers and types. Results demonstrated that the anatomical structures in the images and the attenuation characteristics of a female breast and the derived phantom agreed on the FFDM system used for calibration. The automatic exposure control segmentation, the automatically selected exposure parameters and the image postprocessing of the clinical and phantom image indicated a high level of conformity. As shown, the phantom is also suitable for other FFDM systems. In conclusion, an approach to produce anthropomorphic breast phantoms for DM offering realistic anatomical structures and attenuation characteristics based on clinical images was successfully developed. As shown, the phantom realistically simulated the original female breast. Therefore, it is expected that such phantoms are promising to support bridging the gap between physical-technical and diagnostic image quality assessment. In addition, they enable a variety of practical and scientific applications for which present technical phantoms are not suitable.

Detection of microcalcifications by characteristic magnetic susceptibility effects using MR phase image cross-correlation analysis

PURPOSE

To develop and evaluate a new method for detecting calcium deposits using their characteristic magnetic susceptibility effects on magnetic resonance (MR) images at high fields and demonstrate its potential in practice for detecting breast microcalcifications.

METHODS

Characteristic dipole signatures of calcium deposits were detected in magnetic resonance phase images by computing the cross-correlation between the acquired data and a library of templates containing simulated phase patterns of spherical deposits. The influence of signal-to-noise ratio and various other MR parameters on the results were assessed using simulations and validated experimentally. The method was tested experimentally for detection of calcium fragments within gel phantoms and calcium-like inhomogeneities within chicken tissue at 7 T with optimized MR acquisition parameters. The method was also evaluated for detection of simulated microcalcifications, modeled from biopsy samples of malignant breast cancer, inserted in silico into breast magnetic resonance imaging (MRIs) of healthy subjects at 7 T. For both assessments of calcium fragments in phantoms and biopsy-based simulated microcalcifications in breast MRIs, receiver operator characteristic curve analyses were performed to determine the cross-correlation index cutoff, for achieving optimal sensitivity and specificity, and the area under the curve (AUC), for measuring the method's performance.

RESULTS

The method detected calcium fragments with sizes of 0.14-0.79 mm, 1 mm calcium-like deposits, and simulated microcalcifications with sizes of 0.4-1.0 mm in images with voxel sizes between (0.2 mm)(3) and (0.6 mm)(3). In images acquired at 7 T with voxel sizes of (0.2 mm)(3)-(0.4 mm)(3), calcium fragments (size 0.3-0.4 mm) were detected with a sensitivity, specificity, and AUC of 78%-90%, 51%-68%, and 0.77%-0.88%, respectively. In images acquired with a human 7 T scanner, acquisition times below 12 min, and voxel sizes of (0.4 mm)(3)-(0.6 mm)(3), simulated microcalcifications with sizes of 0.6-1.0 mm were detected with a sensitivity, specificity, and AUC of 75%-87%, 54%-87%, and 0.76%-0.90%, respectively. However, different microcalcification shapes were indistinguishable.

CONCLUSIONS

The new method is promising for detecting relatively large microcalcifications (i.e., 0.6-0.9 mm) within the breast at 7 T in reasonable times. Detection of smaller deposits at high field may be possible with higher spatial resolution, but such images require relatively long scan times. Although mammography can detect and distinguish the shape of smaller microcalcifications with superior sensitivity and specificity, this alternative method does not expose tissue to ionizing radiation, is not affected by breast density, and can be combined with other MRI methods (e.g., dynamic contrast-enhanced MRI and diffusion weighted MRI), to potentially improve diagnostic performance.

Diagnostic quality of 50 and 100 μm computed radiography compared with screen-film mammography in operative breast specimens

OBJECTIVE

To compare reader ratings of the clinical diagnostic quality of 50 and 100 μm computed radiography (CR) systems with screen-film mammography (SFM) in operative specimens.

METHODS

Mammograms of 57 fresh operative breast specimens were analysed by 10 readers. Exposures were made with identical position and compression with three mammographic systems (Fuji 100CR, 50CR and SFM). Images were anonymised and readers blinded to the CR system used. A five-point comparative scoring system (-2 to +2) was used to assess seven quality criteria and overall diagnostic value. Statistical analysis was subsequently performed of reader ratings (n = 16,925).

RESULTS

For most quality criteria, both CR systems were rated as equivalent to or better than SFM. The CR systems were significantly better at demonstrating skin edge and background tissue (p < 1 × 10(-5)). Microcalcification was best demonstrated on the CR50 system (p < 1 × 10(-5)). The overall diagnostic value of both CR systems was rated as being as good as or better than SFM (p < 1 × 10(-5)).

CONCLUSION

In this clinical setting, the overall diagnostic performance of both CR systems was as good as or better than SFM, with the CR50 system performing better than the CR100.

Dual-energy digital mammography for calcification imaging: noise reduction techniques

We have previously developed a dual-energy digital mammography (DEDM) technique for calcification imaging under full-field imaging conditions using a commercially available flat-panel based digital mammography system. Although dual-energy (DE) imaging could suppress the obscuration of calcifications by tissue-structure background, it also increases the intrinsic noise in the DE images. Here we report on the effects of three different noise reduction techniques on DE calcification images: a simple smoothing (boxcar) filter applied to the DE image, a median filter applied to the HE image prior to the computation of the DE image and an adaptation of the Kalender's correlated-noise reduction (KNR) technique for DEDM. We compared the different noise reduction techniques by evaluating their effects on DE calcification images of a 5 cm thick breast-tissue-equivalent slab with continuously varying glandular-tissue ratio superimposed with calcium carbonate crystals of various sizes that simulate calcifications. Evaluations of different noise reducing techniques were performed by comparison of the root-mean-square signal in background regions (no calcifications present) of the DE calcification images and the contrast-to-noise ratios (CNR) of the calcifications in the DE calcification images. Amongst the different noise reduction techniques evaluated in this study, the KNR method was found to be most effective in reducing the image noise and increasing the calcification visibility (or CNR), closely followed by the HE median filter technique. Although the simple smoothing (boxcar) filter reduced the noise, it did not improve calcification visibility. The visible calcification threshold size with DEDM over smoothly varying background at screening mammography doses, assuming a CNR threshold of 4, was estimated to be around 250 microm with both the HE median filter and the KNR techniques. The quality of DE images with noise reduction techniques based on phantom studies were verified with DE images of an animal-tissue phantom that consisted of calcifications superimposed over more realistic tissue structures.

Suitability of new anode materials in mammography: Dose and subject contrast considerations using Monte Carlo simulation

Mammography is the technique with the highest sensitivity and specificity, for the early detection of nonpalpable lesions associated with breast cancer. As screening mammography refers to asymptomatic women, the task of optimization between the image quality and the radiation dose is critical. A way toward optimization could be the introduction of new anode materials. A method for producing the x-ray spectra of different anode/filter combinations is proposed. The performance of several mammographic spectra, produced by both existing and theoretical anode materials, is evaluated, with respect to their dose and subject contrast characteristics, using a Monte Carlo simulation. The mammographic performance is evaluated utilizing a properly designed mathematical phantom with embedded inhomogeneities, irradiated with different spectra, based on combinations of conventional and new (Ru, Ag) anode materials, with several filters (Mo, Rh, Ru, Ag, Nb, Al). An earlier developed and validated Monte Carlo model, for deriving both image and dose characteristics in mammography, was utilized and overall performance results were derived in terms of subject contrast to dose ratio and squared subject contrast to dose ratio. Results demonstrate that soft spectra, mainly produced from Mo, Rh, and Ru anodes and filtered with k-edge filters, provide increased subject contrast for inhomogeneities of both small size, simulating microcalcifications and low density, simulating masses. The harder spectra (W and Ag anode) come short in the discrimination task but demonstrate improved performance when considering the dose delivered to the breast tissue. As far as the overall performance is concerned, new theoretical spectra demonstrate a noticeable good performance that is similar, and in some cases better compared to commonly used systems, stressing the possibility of introducing new materials in mammographic practice as a possible contribution to its optimization task. In the overall optimization task in terms of subject contrast to dose ratio, tube voltage was found to have a minor effect, while with respect to the filter material, a lesion specific performance was noticed, with Al filtered spectra showing improved characteristics in case of the inhomogeneities simulating microcalcifications, while softer k-edge filtered spectra are more suitable for the discrimination of inhomogeneities simulating masses.

Receiver operating characteristic analysis for the detection of simulated microcalcifications on mammograms using hardcopy images

The aim of this study was to compare mammography systems based on three different detectors--a conventional screen-film (SF) combination, an a-Si/CsI flat-panel (FP)-based detector, and a charge-coupled device (CCD)-based x-ray phosphor-based detector--for their performance in detecting simulated microcalcifications (MCs). 112-150 microm calcium carbonate grains were used to simulate MCs and were overlapped with a slab phantom of simulated 50% adipose/50% glandular breast tissue-equivalent material referred to as the uniform background. For the tissue structure background, 200-250 microm calcium carbonate grains were used and overlapped with an anthropomorphic breast phantom. All MC phantom images were acquired with and without magnification (1.8 X). The hardcopy images were reviewed by five mammographers. A five-point confidence level rating was used to score each detection task. Receiver operating characteristic (ROC) analysis was performed, and the areas under the ROC curves (A(z)s) were used to compare the performances of the three mammography systems under various conditions. The results showed that, with a uniform background and contact images, the FP-based system performed significantly better than the SF and the CCD-based systems. For magnified images with a uniform background, the SF and the FP-based systems performed equally well and significantly better than the CCD-based system. With tissue structure background and contact images, the SF system performed significantly better than the FP and the CCD-based systems. With magnified images and a tissue structure background, the SF and the CCD-based systems performed equally well and significantly better than the FP-based system. In the detection of MCs in the fibroglandular and the heterogeneously dense regions, no significant differences were found except that the SF system performed significantly better than the CCD-based system in the fibroglandular regions for the contact images.

Comparison of two detector systems for cone beam CT small animal imaging - a preliminary study

To compare two detector systems - one based on the charge-coupled device (CCD) and image amplifier, the other based on a-Si/CsI flat panel, for cone beam computed-tomography (CT) imaging of small animals.A high resolution, high framing rate detector system for the cone beam CT imaging of small animals was developed. The system consists of a 2048x3072x12 bit CCD optically coupled to an image amplifier and an x-ray phosphor screen. The CCD has an intrinsic pixel size of 12 mum but the effective pixel size can be adjusted through the magnification adjustment of the optical coupling systems. The system is used in conjunction with an x-ray source and a rotating stage for holding and rotating the scanned object in the cone beam CT imaging experiments. The advantages of the system include but are not limited to the ability to adjust the effective pixel size and to achieve extremely high spatial resolution and temporal resolution. However, the need to use optical coupling compromises the detective quanta efficiency (DQE) of the system. In this paper, the imaging characteristics of the system were presented and compared with those of an a-Si/CsI flat-panel detector system.

Image quality measurements and metrics in full field digital mammography: an overview

This paper gives an overview of test procedures developed to assess the performance of full field digital mammography systems. We make a distinction between tests of the individual components of the imaging chain and global system tests. Most tests are not yet fully standardised. Where possible, we illustrate the test methodologies on a selenium flat-panel system.