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

Uncertainty estimation and statistical comparative methodology for mammography x-ray energy spectra

Numerical models are an alternative to measurements of x-ray energy spectra when validated by comparative methods that assess the similarity of experimental and calculated spectra. In this work, we compared x-ray energy spectra using several methodologies and determined the methodology with highest statistical power among them. Experiments and Monte Carlo (MC) simulations were used to generate a set of 65 experimental and simulated x-ray mammography spectra pairs typically used in mammography applications. They were generated using Tungsten and Molybdenum targets and Molybdenum and Rhodium filters. The x-ray beams were transmitted through breast tissue equivalent material (bTEM) plates with different glandularities and thicknesses, and the transmitted beam was detected using solid-state x-ray spectrometry with a Cadmium Telluride (CdTe) diode. The MC simulations used the PENELOPE code. Additional uncertainties, beyond that from counting, were propagated using the MC method. Quantitative comparative methods based on the [Formula: see text] statistics, the first and second half-value layers, the mean energy, the effective energy, and the non-parametric u-test were applied and their specificity (true negative rate) was assessed. The polyenergetic normalized glandular dose (DgNp) to a 6 cm breast of 50/50 glandularity was derived from the spectra. In this work, the [Formula: see text] statistics attained the highest score; therefore, it is the most indicated metric for the x-ray energy spectra comparative evaluations. The contribution of the additional uncertainties was important, being responsible for up to 98% of the spectra total uncertainty and shifting the mean of the evaluated [Formula: see text] to 1.2(1), compatible with its expected value. The use of non-parametric test is discouraged by our results, since it failed to distinguish spectra pairs that resulted in up to 72% discrepant DgNp.

X-ray spectra and doses

Using the Monte Carlo method the x-ray spectrum produced by 150keV electrons colliding with W, Rh and Mo targets were calculated. The x-ray spectra were calculated to 20, 50, and 100cm from the focal point. In order to analyze the effect of the filter, calculations were carried out with and without filter. The spectra were used to estimate the Kerma in air, the Ambient dose equivalent, and the Personal dose equivalent. The spectra were integrated in energy to obtain the total photon fluences. Calculated spectra depend on the type of target having the continuous spectrum due to bremsstrahlung and the characteristics x-rays. The Al filter eliminates the low-energy photons; however no effect is noticed when the photon energy is larger than 40keV. The largest effect of dose reduction due to the filter was noticed to 20cm for the Kerma in air.

Direct measurement of mammographic X-ray spectra with a digital CdTe detection system

In this work we present a detection system, based on a CdTe detector and an innovative digital pulse processing (DPP) system, for high-rate X-ray spectroscopy in mammography (1-30 keV). The DPP system performs a height and shape analysis of the detector pulses, sampled and digitized by a 14-bit, 100 MHz ADC. We show the results of the characterization of the detection system both at low and high photon counting rates by using monoenergetic X-ray sources and a nonclinical X-ray tube. The detection system exhibits excellent performance up to 830 kcps with an energy resolution of 4.5% FWHM at 22.1 keV. Direct measurements of clinical molybdenum X-ray spectra were carried out by using a pinhole collimator and a custom alignment device. A comparison with the attenuation curves and the half value layer values, obtained from the measured and simulated spectra, from an ionization chamber and from a solid state dosimeter, also shows the accuracy of the measurements. These results make the proposed detection system a very attractive tool for both laboratory research, calibration of dosimeters and advanced quality controls in mammography.

Monte Carlo simulation of breast imaging using synchrotron radiation

PURPOSE

Synchrotron radiation (SR), being the brightest artificial source of x-rays with a very promising geometry, has raised the scientific expectations that it could be used for breast imaging with optimized results. The "in situ" evaluation of this technique is difficult to perform, mostly due to the limited available SR facilities worldwide. In this study, a simulation model for SR breast imaging was developed, based on Monte Carlo simulation techniques, and validated using data acquired in the SYRMEP beamline of the Elettra facility in Trieste, Italy. Furthermore, primary results concerning the performance of SR were derived.

METHODS

The developed model includes the exact setup of the SR beamline, considering that the x-ray source is located at almost 23 m from the slit, while the photon energy was considered to originate from a very narrow Gaussian spectrum. Breast phantoms, made of Perspex and filled with air cavities, were irradiated with energies in the range of 16-28 keV. The model included a Gd(2)O(2)S detector with the same characteristics as the one available in the SYRMEP beamline. Following the development and validation of the model, experiments were performed in order to evaluate the contrast resolution of SR. A phantom made of adipose tissue and filled with inhomogeneities of several compositions and sizes was designed and utilized to simulate the irradiation under conventional mammography and SR conditions.

RESULTS

The validation results of the model showed an excellent agreement with the experimental data, with the correlation for contrast being 0.996. Significant differences only appeared at the edges of the phantom, where phase effects occur. The initial evaluation experiments revealed that SR shows very good performance in terms of the image quality indices utilized, namely subject contrast and contrast to noise ratio. The response of subject contrast to energy is monotonic; however, this does not stand for contrast to noise ratio, since there is a range of optimal performance for SR (18-21 keV). In comparison to conventional mammography, SR shows improved subject contrast for energies lower than the mean energy of each spectrum.

CONCLUSIONS

The comparison of the results of the two models, conventional and SR, proved that SR exhibits better performance in the majority of cases. The proposed simulation model offers the possibility to perform exhaustive search to evaluate the performance of SR in clinical applications such as breast imaging.

Optimization of x-ray spectra in digital mammography through Monte Carlo simulations

In this work, a Monte Carlo code was used to investigate the performance of different x-ray spectra in digital mammography, through a figure of merit (FOM), defined as FOM = CNR²/(¯)D(g), with CNR being the contrast-to-noise ratio in image and [Formula: see text] being the average glandular dose. The FOM was studied for breasts with different thicknesses t (2 cm ≤ t ≤ 8 cm) and glandular contents (25%, 50% and 75% glandularity). The anode/filter combinations evaluated were those traditionally employed in mammography (Mo/Mo, Mo/Rh, Rh/Rh), and a W anode combined with Al or K-edge filters (Zr, Mo, Rh, Pd, Ag, Cd, Sn), for tube potentials between 22 and 34 kVp. Results show that the W anode combined with K-edge filters provides higher values of FOM for all breast thicknesses investigated. Nevertheless, the most suitable filter and tube potential depend on the breast thickness, and for t ≥ 6 cm, they also depend on breast glandularity. Particularly for thick and dense breasts, a W anode combined with K-edge filters can greatly improve the digital technique, with the values of FOM up to 200% greater than that obtained with the anode/filter combinations and tube potentials traditionally employed in mammography. For breasts with t < 4 cm, a general good performance was obtained with the W anode combined with 60 μm of the Mo filter at 24-25 kVp, while 60 μm of the Pd filter provided a general good performance at 24-26 kVp for t = 4 cm, and at 28-30 and 29-31 kVp for t = 6 and 8 cm, respectively.

Monte Carlo simulator of realistic x-ray beam for diagnostic applications

PURPOSE

Monte Carlo simulation is a very useful tool for radiotherapy and diagnostic radiology. Yet even with the latest PCs, simulation of photon spectra emitted by an x-ray tube is a time-consuming task, potentially reducing the possibility to obtain relevant data such as dose evaluations, simulation of geometric settings, or monitor detector efficiency. This study developed and validated a method to generate random numbers for realistic beams in terms of photon spectrum and intensity to simulate x-ray tubes via Monte Carlo algorithms.

METHODS

Starting from literature data, the most common semiempirical models of bremsstrahlung are analyzed and implemented, adjusting their formulation to describe a large irradiation area (i.e., large field of view) and to take account of the heel effect as in common practice during patient examinations.

RESULTS

Simulation results show that Birch and Marshall's model is the fastest and most accurate for the aims of this work. Correction of the geometric size of the beam and validation of the intensity variation (heel effect) yielded excellent results with differences between experimental and simulated data of less than 6%.

CONCLUSIONS

The results of validation and execution time showed that the tube simulator calculates the x-ray photons quickly and efficiently and is perfectly capable of considering all the phenomena occurring in a real beam (total filtration, focal spot size, and heel effect), so it can be used in a wide range of applications such as industry, medical physics, or quality assurance.

Can electronic zoom replace magnification in mammography? A comparative Monte Carlo study

Magnification, which is considered to be a relatively high "dose cost" mammographic technique, is a complementary examination performed on women exhibiting breast complaints or abnormalities. Particular attention is given to the imaging procedure as the primary aim is to confirm the existence of suspected abnormalities, despite the additional dose. The introduction of post-processing capabilities and the widespread use of digital mammography promoted some controversy in the last decades on whether electronic zoom performed on the derived initial screening mammogram can effectively replace this technique. This study used Monte Carlo simulation methods to derive simulated screening mammograms produced under several exposure conditions, aiming to electronically magnify and compare them to the corresponding magnification mammograms. Comparison was based on quantitative measurements of image quality, namely contrast to noise ratio (CNR) and spatial resolution. Results demonstrated that CNR was higher for geometric magnification compared to the case of electronic zooming. The percentage difference was higher for lesions of smaller radius and achieved 29% for 0.10 mm details. Although spatial resolution is maintained high in the zoomed images, when investigating microcalcifications of 0.05 mm radius or less, only with geometric magnification can they be visualised.

A technique optimization protocol and the potential for dose reduction in digital mammography

Digital mammography requires revisiting techniques that have been optimized for prior screen/film mammography systems. The objective of the study was to determine optimized radiographic technique for a digital mammography system and demonstrate the potential for dose reduction in comparison to the clinically established techniques based on screen- film. An objective figure of merit (FOM) was employed to evaluate a direct-conversion amorphous selenium (a-Se) FFDM system (Siemens Mammomat Novation(DR), Siemens AG Medical Solutions, Erlangen, Germany) and was derived from the quotient of the squared signal-difference-to-noise ratio to mean glandular dose, for various combinations of technique factors and breast phantom configurations including kilovoltage settings (23-35 kVp), target/filter combinations (Mo-Mo and W-Rh), breast-equivalent plastic in various thicknesses (2-8 cm) and densities (100% adipose, 50% adipose/50% glandular, and 100% glandular), and simulated mass and calcification lesions. When using a W-Rh spectrum, the optimized FOM results for the simulated mass and calcification lesions showed highly consistent trends with kVp for each combination of breast density and thickness. The optimized kVp ranged from 26 kVp for 2 cm 100% adipose breasts to 30 kVp for 8 cm 100% glandular breasts. The use of the optimized W-Rh technique compared to standard Mo-Mo techniques provided dose savings ranging from 9% for 2 cm thick, 100% adipose breasts, to 63% for 6 cm thick, 100% glandular breasts, and for breasts with a 50% adipose/50% glandular composition, from 12% for 2 cm thick breasts up to 57% for 8 cm thick breasts.

A novel method for contrast-to-noise ratio (CNR) evaluation of digital mammography detectors

The purpose of this study was to test a new, simple method of evaluating the contrast-to-noise ratio (CNR) over the entire image field of a digital detector and to compare different mammography systems. Images were taken under clinical exposure conditions for a range of simulated breast thicknesses using poly(methyl methacrylate) (PMMA). At each PMMA thickness, a second image which included an additional 0.2-mm Al sheet was also acquired. Image processing software was used to calculate the CNR in multiple regions of interest (ROI) covering the entire area of the detector in order to obtain a 'CNR image'. Five detector types were evaluated, two CsI-alphaSi (GE Healthcare) flat panel systems, one alphaSe (Hologic) flat panel system and a two generations of scanning photon counting digital detectors (Sectra). Flat panel detectors exhibit better CNR uniformity compared with the first-generation scanning photon counting detector in terms of mean pixel value variation. However, significant improvement in CNR uniformity was observed for the next-generation scanning detector. The method proposed produces a map of the CNR and a measurement of uniformity throughout the entire image field of the detector. The application of this method enables quality control measurement of individual detectors and a comparison of detectors using different technologies.

Overview of patient dosimetry in diagnostic radiology in the USA for the past 50 years

This review covers the role of medical physics in addressing issues directly related to patient dosimetry in radiography, fluoroscopy, mammography, and CT. The sections on radiography and fluoroscopy radiation doses review the changes that have occurred during the last 50 to 60 years. A number of technological improvements have contributed to both a significant reduction in patient and staff radiation doses and improvements to the image quality during this period of time. There has been a transition from film-screen radiography with hand dip film processing to electronic digital imaging utilizing CR and DR. Similarly, fluoroscopy has progressed by directly viewing image intensifiers in darkened rooms to modern flat panel image receptor systems utilizing pulsed radiation, automated variable filtration, and digitally processed images. Mammography is one of the most highly optimized imaging procedures performed, because it is a repetitive screening procedure that results in annual radiation exposure. Mammography is also the only imaging procedure in the United States in which the radiation dose is regulated by the federal government. Consequently, many medical physicists have studied the dosimetry associated with screen-film and digital mammography. In this review, a brief history of mammography dose assessment by medical physicists is discussed. CT was introduced into clinical practice in the early 1970s, and has grown into one of the most important modalities available for diagnostic imaging. CT dose quantities and measurement techniques are described, and values of radiation dose for different types of scanner are presented. Organ and effective doses to adult patients are surveyed from the earliest single slice scanners, to the latest versions that include up to two x-ray tubes and can incorporate as many as 256 detector channels. An overview is provided of doses received by pediatric patients undergoing CT examinations, as well as methods, and results, of studies performed to assess the radiation absorbed by the conceptus of pregnant patients.

The effect of breast compression on mass conspicuity in digital mammography

This study analyzed how the inherent quality of diagnostic information in digital mammography could be affected by breast compression. A digital mammography system was modeled using a Monte Carlo algorithm based on the Penelope program, which has been successfully used to model several medical imaging systems. First, the Monte Carlo program was validated against previous measurements and simulations. Once validated, the Monte Carlo software modeled a digital mammography system by tracking photons through a voxelized software breast phantom, containing anatomical structures and breast masses, and following photons until they were absorbed by a selenium-based flat-panel detector. Simulations were performed for two compression conditions (standard compression and 12.5% reduced compression) and three photon flux conditions (constant flux, constant detector signal, and constant glandular dose). The results showed that reduced compression led to higher scatter fractions, as expected. For the constant photon flux condition, decreased compression also reduced glandular dose. For constant glandular dose, the SdNR for a 4 cm breast was 0.60 +/- 0.11 and 0.62 +/- 0.11 under standard and reduced compressions, respectively. For the 6 cm case with constant glandular dose, the SdNR was 0.50 +/- 0.11 and 0.49 +/- 0.10 under standard and reduced compressions, respectively. The results suggest that if a particular imaging system can handle an approximately 10% increase in total tube output and 10% decrease in detector signal, breast compression can be reduced by about 12% in terms of breast thickness with little impact on image quality or dose.

Contrast-to-noise ratio in magnification mammography: a Monte Carlo study

Magnification views are a common way to perform a secondary examination when suspicious abnormalities are found in a screening mammogram. The visibility of microcalcifications and breast lesions is restricted by the compromise between the image quality and the absorbed dose. In this study, image quality characteristics in magnification mammography were evaluated based on Monte Carlo techniques. A breast phantom was utilized, simulating a homogeneous mixture of adipose and glandular tissue in various percentages of glandularity, containing inhomogeneities of various sizes and compositions. The effect of the magnification degree, breast glandularity, tube voltage and anode/filter material combination on image quality characteristics was investigated in terms of a contrast-to-noise ratio (CNR). A performance index PI(nu) was introduced in order to study the overall performance of various anode/filter combinations under different exposure parameters. Results demonstrate that CNR is improved with the degree of magnification and degraded as the breast glandularity is increased. Degree of magnification 1.3 offers the best overall performance for most of the anode/filter combinations utilized. Under magnification conditions, the role of dose is demoted against the image quality, as magnification views are secondary, diagnostic examinations and not screening procedures oriented to non-symptomatic women. For decreased image quality weighting, some anode/filter combinations different from Mo/0.030 mmMo can be utilized as they offer a similar performance index. However, if the desired weighting for the image quality is high, the Mo/0.030 mmMo combination has the best overall performance.