A comparison of the performance of digital mammography systems

Monte-Carlo study of contrast-enhanced spectral mammography with cadmium telluride photon-counting x-ray detectors

BACKGROUND

Contrast-enhanced spectral mammography (CESM) with photon-counting x-ray detectors (PCDs) can be used to improve the classification of breast cancers as benign or malignant. Commercially-available PCD-based mammography systems use silicon-based PCDs. Cadmium-telluride (CdTe) PCDs may provide a practical advantage over silicon-based PCDs because they can be implemented as large-area detectors that are more easily adaptable to existing mammography systems.

PURPOSE

The purpose of this work is to optimize CESM implemented with CdTe PCDs and to investigate the influence of the number of energy bins, electronic noise level, pixel size, and anode material on image quality.

METHODS

We developed a Monte Carlo model of the energy-bin-dependent modulation transfer functions (MTFs) and noise power spectra, including spatioenergetic noise correlations. We validated model predictions using a CdTe PCD with analog charge summing for charge-sharing suppression. Using the ideal-observer detectability, we optimized CESM for the task of detecting a 7-mm-diameter iodine nodule embedded in a breast with 50% glandularity. We optimized the tube voltage, beam filtration, and the location of energy thresholds for 50 and 100- μ $\mu$ m pixels, tungsten and molybdenum anodes, and two electronic noise levels. One of the electronic noise levels was that of the experimental system; the other was half that of the experimental system. Optimization was performed for CdTe PCDs with two or three energy bins. We also estimated the impact of anatomic noise due to background parenchymal enhancement and computed the minimum detectable iodine area density in the presence of quantum and anatomic noise.

RESULTS

Model predictions of the MTFs and noise power spectra agreed well with experiment. For optimized systems, adding a third energy bin increased quantum noise levels and reduced detectability by ∼55% compared to two-bin approaches that simply suppress contrast between fibroglandular and adipose tissue. Decreasing the electronic noise standard deviation from 3.4 to 1.7 keV increased iodine detectability by ∼5% and ∼30% for two-bin imaging and three-bin imaging, respectively. After optimizing for tube voltage, beam filtration, and the location of energy thresholds, there was ∼a 3% difference in iodine detectability between molybdenum and tungsten anodes for two-bin imaging, but for three-bin imaging, molybdenum anodes provided up to 14% increase in detectability relative to tungsten anodes. Anatomic noise decreased iodine detectability by 15% to 40%, with greater impact for lower electronic noise settings and larger pixel sizes.

CONCLUSIONS

For CESM implemented with CdTe PCDs, (1) quantitatively-accurate three-material decompositions using three energy bins are associated with substantial increases in quantum noise relative to two-energy-bin approaches that simply suppress contrast between fibroglandular and adipose tissues; (2) tungsten and molybdenum anodes can provide nearly equal iodine detectability for two-bin imaging, but molybdenum provides a modest detectability advantage for three-bin imaging provided that all other technique parameters are optimized; (3) reducing pixel sizes from 100 to 50  μ $\mu$ m can reduce detectability by up to 20% due to charge sharing; (4) anatomic noise due to background parenchymal enhancement is estimated to have a substantial impact on lesion visibility, reducing detectability by approximately 30%.

Simulation Analysis on the Performance of a Circular-Edge Technique in Measurements of the Modulation Transfer Function

The modulation transfer function (MTF) plays an important role in characterizing medical imaging systems. For such characterization, the circular-edge technique has become a prevalent task-based methodology. When determining the MTF with complicated task-based measurements, error factors must be well understood to properly interpret the results. In this context, the aim of this work was to study the changes in measurement performance in the analysis of the MTF using a circular edge. To eliminate the systematic error related to the measurement and suitably manage the error factors, images were generated by Monte Carlo simulation. Further, a performance comparison with the conventional method was conducted; in addition, the influence of the edge size and contrast and the setting error of the center coordinates were investigated. The difference from the true value and the standard deviation relative to the average value were applied to the index as the accuracy and precision, respectively. The results demonstrated that the smaller the circular object used and the lower the contrast, the grater the deterioration in the measurement performance. Furthermore, this study clarified the underestimating of the MTF in proportion to the square of the distance with respect to the setting error of the center position, which is important for the synthesis of the edge profile. Evaluations in the backgrounds wherein there are multiple factors affecting the results are complex, and the system users must properly judge the validity of the characterization results. These findings provide meaningful insight in the context of MTF measurement techniques.

Target-filter combination effects on breast tissue characterization using mammographic X-rays: A Monte Carlo simulation study

BACKGROUND

Characterization of normal and malignant breast tissues using X-ray scattering techniques has shown promising results and applications.

OBJECTIVE

To examine possibility of characterizing normal and malignant breast tissues using the scattered photon distribution of polyenergetic beams of 30 kV X-rays.

METHODS

A Monte Carlo simulation is upgraded so that it is capable of simulating input mammographic X-ray spectra from different target-filter combinations, tracing photon transport, and producing the distribution of scattered photons. The target-filter combinations include Mo-Mo, Mo-Al, Mo-Rh, Rh-Rh, Rh-Al, W-Rh, and W-Al. Analysis of obtained scattered photon distribution is carried out by comparing the ratio of count under the peak in the momentum transfer region from 0 to 1.55 nm-1, to that in the region from 1.6 to 9.1 nm-1 (covering the regions of scattering from fat and soft tissue, respectively) for breast samples with different percentages of normal tissue (0-100%).

RESULTS

Mo-Mo target-filter combination shows a high linear dependence of the count under peak ratio on the percentage of normal tissue in breast samples (R2 = 0.9513). Despite slightly less linear than Mo-Mo, target-filter combinations other than Rh-Rh, W-Rh, and W-Al produce high linear responses (R2 > 0.9)CONCLUSION:Mo-Mo target-filter combination would probably be the most relevant in characterizing normal and malignant breast tissues from their scattered photon distribution.

The detective quantum efficiency of cadmium telluride photon-counting x-ray detectors in breast imaging applications

PURPOSE

In breast imaging applications, cadmium telluride (CdTe) photon counting x-ray detectors (PCDs) may reduce radiation dose and enable single-shot multi-energy x-ray imaging. The purpose of this work is to determine the upper limits of the detective quantum efficiency (DQE) of CdTe PCDs for x-ray mammography and to compare them with the published DQEs of energy-integrating detectors (EIDs) and other PCDs.

METHODS

We calibrated and validated a Monte Carlo (MC) model of the DQE of CdTe PCDs using an XCounter CdTe PCD. Our model accounted for charge sharing, electronic noise, and charge summation logic. We used a 28 kVp Mo/Mo spectrum hardened by 3.9 cm of Lucite to optimize the detector thickness and energy threshold for pixel sizes of 50, 85, and 100 μ m with and without inter-pixel charge summation logic. The figure of merit used for optimization was the integral of the DQE, which is equivalent to the detectability index for a delta function task function, which represents a high-frequency task.

RESULTS

For an electronic noise level equal to that of the XCounter, the optimal DQE(0) without charge summing was 0.74. Charge summing for charge-sharing correction reduced DQE(0) by 14% due to an increase in electronic noise. Reducing the electronic noise to ∼0.5 keV per pixel in combination with charge summing resulted in DQE(0) ≈ 0.78 for 85  μ m pixels, which is approximately equal to that of a-Se and slot-scanning silicon-strip PCDs. At higher spatial frequencies, and for matched pixel sizes, the DQE was inferior to that of a-Se EIDs and superior to that of slot-scanning silicon-strip PCDs in the scan direction but inferior in the slit direction.

CONCLUSIONS

(1) CdTe PCDs have the potential to provide a zero-frequency DQE equal to that of a-Se EIDs and slot-scanning silicon-strip PCDs, but this will require electronic noise levels ∼0.5 keV per pixel. (2) At mid-to-high spatial frequencies the DQE of CdTe PCDs may be (a) inferior to that of a-Se EIDs and slot-scanning silicon-strip PCDs in the slit direction, and (b) superior to slot-scanning silicon-strip PCDs in the scan direction.

Determination of DQE as a quantitative assessment of detectors in digital mammography: Measurements and calculation in practice

Introduction: Advances in digital detector technology and methods of image presentation in digital mammography now offer the possibility of implementing mathematical assessment methods to quantitative image analysis. The aim of this work was to develop new software to simplify the application of the existing international standard for DQE in digital mammography and show in detail how it can be applied, using a Siemens Mammomat Inspiration as a model.

Material and methods: Consistent with the IEC standard a 2 mm Al filter at the tube exit and images in DICOM format as raw data, without applying any additional post-processing were used. Measurements were performed for W/Rh anode/filter combination and different tube voltage values (26 ÷ 34 kV) without any anti-scatter grid. To verify new software doses ranging from 20-600 µGy were used in measurements. Exposure (air kerma) was measured using a calibrated radiation meter (Piranha Black 457, RTI Electronics AB, Sweden). MTF was determined, using an edge test device constructed specifically for this work.

Results: It has been demonstrated that with the new software the DQE can be measured with the accuracy required by the international standard IEC 62220-1-2. DQE has been presented as a function of spatial frequency for W/Rh anode/filter combination and different tube voltage.

Conclusions: New software was used successfully to analyze image quality parameters for the Siemens Mammomat Inspiration detector. This was done on the basis of an internationally accepted methodology. In the next step, mammographs with different detector types can be compared.

Effect of beam quality and readout direction in the edge profile on the modulation transfer function of photostimulable phosphor systems via the edge method

Purpose: The objective of this study was to investigate the effects of (i) the difference in the beam qualities on the presampled modulation transfer function (MTF) using the edge method and (ii) the readout direction of the edge profile for the photostimulable phosphor (PSP) system. Approach: The International Electrotechnical Commission (IEC) defined a technique using the "radiation qualities based on a phantom made up of an aluminum added filter" (RQA). A general radiographic system with a tube voltage of 50 kV and 9.7 mm of additional aluminum filtration was used to conform the x-ray to the IEC-specified beam quality definition RQA3. Additionally, we employed two different beams with tube voltages of 60 and 70 kV using a dental x-ray unit. The MTF was measured in the readout direction from low-to-high exposure regions and vice versa with respect to the scanning and subscanning directions of the PSP system. Results: The difference in the 50%MTF value for all directions between 60 and 70 kV averaged less than 0.05 . The 50%MTF of RQA3 was on average 0.2 lower than the value for 60 kV for each direction. For all beam qualities, no difference was observed between the MTFs measured in the readout direction from the low-to-high exposure regions and vice versa. Conclusions: The MTFs, measured using the dental x-ray unit, were unaffected by the tube voltage, and they were slightly higher than those measured using the RQA3. Furthermore, the MTF was unaffected by the differences in the readout directions of the edge profile.

On the relevance of modulation transfer function measurements in digital mammography quality control

Purpose: The relevance of presampling modulation transfer function (MTF) measurements in digital mammography (DM) quality control (QC) is examined. Two studies are presented: a case study on the impact of a reduction in MTF on the technical image quality score and analysis of the robustness of routine QC MTF measurements. Approach: In the first study, two needle computed radiography (CR) plates with identical sensitivities were used with differences in the 50% point of the MTF ( f MTF 0.5 ) larger than the limiting value in the European guidelines ( > 10 % change between successive measurements). Technical image quality was assessed via threshold gold thickness of the CDMAM phantom and threshold microcalcification diameter of the L1 structured phantom. For the second study, presampling MTF results from 595 half-yearly QC tests of 55 DM systems (16 types, six manufacturers) were analyzed for changes from the baseline value and changes in f MTF 0.5 between successive tests. Results: A reduction of 20% in f MTF 0.5 of the two CR plates was observed. There was a tendency to a lower score for task-based metrics, but none were significant. Averaging over 55 systems, the absolute relative change in f MTF 0.5 between consecutive tests (with 95% confidence interval) was 3% (2.5% to 3.4%). Analysis of the maximum relative change from baseline revealed changes of up to - 10 % for one a-Se based system and - 15 % for a group of CsI-based systems. Conclusions: A limit of 10% is a relevant action level for investigation. If exceeded, then the impact on performance has to be verified with extra metrics.

On the Response of a Micro Non-Destructive Testing X-ray Detector

Certain imaging performance metrics are examined for a state-of-the-art 20 μm pixel pitch CMOS sensor (RadEye HR), coupled to a Gd₂O₂S:Tb scintillator screen. The signal transfer property (STP), the modulation transfer function (MTF), the normalized noise power spectrum (NNPS) and the detective quantum efficiency (DQE) were estimated according to the IEC 62220-1-1:2015 standard. The detector exhibits excellent linearity (coefficient of determination of the STP linear regression fit, R² was 0.9978), while its DQE peaks at 33% and reaches 10% at a spatial frequency of 3 cycles/mm, for the measured with a Piranha RTI dosimeter (coefficient of variation CV = 0.03%) exposure value of 28.1 μGy DAK (detector Air Kerma). The resolution capabilities of the X-ray detector under investigation were compared to other commercial CMOS sensors, and were found in every case higher, except from the previous RadEye HR model (CMOS-Gd₂O₂S:Tb screen pair with 22.5 μm pixel pitch) version which had slightly better MTF. The present digital imager is designed for industrial inspection applications, nonetheless its applicability to medical imaging, as well as dual-energy is considered and certain approaches are discussed in this respect.

EXPOSURE DOSE INDEX BASED ON NOISE FACTOR ANALYSIS IN DIGITAL MAMMOGRAPHY: VERIFICATION USING DIRECT-TYPE FLAT-PANEL DETECTOR SYSTEM

In this study, the development of a reasonable index of optimized exposure dose is attempted. Using a direct-type flat-panel system, noise factors contained in the image are analyzed based on the relative standard deviation method, and it is verified that the proposed index conforms with the appropriate standards regarding minimum exposure dose. The findings indicate that Poisson noise is dominant in the general clinical dose range; this noise fraction formed 90% of the total noise in the system considered in this study. Considering the results of previous surveys, it is estimated that the point at which the content rate of the Poisson noise starts to decrease can be considered as the lower limit, below which the dose cannot be reduced further without compromising on image quality. As the 'index' obtained by this method can be easily measured, it is useful as a quantitative indicator for dose determination and optimization.

Objective assessment of task performance: a comparison of two FFDM detectors using an anthropomorphic breast phantom

Current digital mammography systems primarily employ one of two types of detectors: indirect conversion, typically using a cesium-iodine scintillator integrated with an amorphous silicon photodiode matrix, or direct conversion, using a photoconductive layer of amorphous selenium (a-Se) combined with thin-film transistor array. The goal of this study was to evaluate a methodology for objectively assessing image quality to compare human observer task performance in detecting microcalcification clusters and extended mass-like lesions achieved with different detector types. The proposed assessment methodology uses a novel anthropomorphic breast phantom fabricated with ink-jet printing. In addition to human observer detection performance, standard linear metrics such as modulation transfer function, noise power spectrum, and detective quantum efficiency (DQE) were also measured to assess image quality. An Analogic Anrad AXS-2430 a-Se detector used in a commercial FFDM/DBT system and a Teledyne Dalsa Xineos-2329 with CMOS pixel readout were evaluated and compared. The DQE of each detector was similar over a range of exposures. Similar task performance in detecting microcalcifications and masses was observed between the two detectors over a range of clinically applicable dose levels, with some perplexing differences in the detection of microcalcifications at the lowest dose measurement. The evaluation approach presented seems promising as a new technique for objective assessment of breast imaging technology.

Automated daily quality control analysis for mammography in a multi-unit imaging center

BACKGROUND

The high requirements for mammography image quality necessitate a systematic quality assurance process. Digital imaging allows automation of the image quality analysis, which can potentially improve repeatability and objectivity compared to a visual evaluation made by the users.

PURPOSE

To develop an automatic image quality analysis software for daily mammography quality control in a multi-unit imaging center.

MATERIAL AND METHODS

An automated image quality analysis software using the discrete wavelet transform and multiresolution analysis was developed for the American College of Radiology accreditation phantom. The software was validated by analyzing 60 randomly selected phantom images from six mammography systems and 20 phantom images with different dose levels from one mammography system. The results were compared to a visual analysis made by four reviewers. Additionally, long-term image quality trends of a full-field digital mammography system and a computed radiography mammography system were investigated.

RESULTS

The automated software produced feature detection levels comparable to visual analysis. The agreement was good in the case of fibers, while the software detected somewhat more microcalcifications and characteristic masses. Long-term follow-up via a quality assurance web portal demonstrated the feasibility of using the software for monitoring the performance of mammography systems in a multi-unit imaging center.

CONCLUSION

Automated image quality analysis enables monitoring the performance of digital mammography systems in an efficient, centralized manner.

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.

Physical image properties of a complementary metal-oxide-semiconductor imager for mammography systems

We acquired a direct-type flat panel detector (FPD) developed for mammography systems and investigated its physical image properties, as its characteristics may affect future mammography in the clinic. The pixel size of the detector is 50 µm, the smallest size used in clinical mammography. Amorphous selenium (a-Se) film is used in direct-type FPDs. Due to its inferior temperature properties, the temperature of the imaging room should be set to approximately 25 °C. A novel a-Se film with superior heat resistance has been developed by the HAMAMATSU photonics KK Electron Tube Division that is suitable for high electric field driving. However, the associated trade-offs in image properties are unknown. The purposes of the current study were to investigate whether the detector maintains a high image quality in the presence of a high electric field, and to evaluate the image properties. The signal readout mechanism incorporates a complementary metal-oxide-semiconductor with superior noise properties. We measured the input-output characteristics, resolution, noise properties, and detection quantum efficiency, and investigated the effects of the exposure of the a-Se film to different applied voltages under standard mammography conditions prescribed by the International Electrotechnical Commission. The resolution and noise properties associated with the direct-type FPD were not affected by differences in applied voltage. The CMOS imager had a higher resolution than conventional systems with an equivalent pixel size. It also had a high detective quantum efficiency value. Thus, this detector may be useful in mammography.

Measurement of effective detective quantum efficiency for a photon counting scanning mammography system and comparison with two flat panel full-field digital mammography systems

Effective detective quantum efficiency (eDQE) describes the resolution and noise properties of an imaging system along with scatter and primary transmission, all measured under clinically appropriate conditions. Effective dose efficiency (eDE) is the eDQE normalised to mean glandular dose and has been proposed as a useful metric for the optimisation of clinical imaging systems. The aim of this study was to develop a methodology for measuring eDQE and eDE on a Philips microdose mammography (MDM) L30 photon counting scanning system, and to compare performance with two conventional flat panel systems. A custom made lead-blocker was manufactured to enable the accurate determination of dose measurements, and modulation transfer functions were determined free-in-air at heights of 2, 4 and 6 cm above the breast support platform. eDQE were calculated for a Philips MDM L30, Hologic Dimensions and Siemens Inspiration digital mammography system for 2, 4 and 6 cm thick poly(methyl methacrylate) (PMMA). The beam qualities (target/filter and kilovoltage) assessed were those selected by the automatic exposure control, and anti-scatter grids were used where available. Measurements of eDQE demonstrate significant differences in performance between the slit- and scan-directions for the photon counting imaging system. MTF has been shown to be the limiting factor in the scan-direction, which results in a rapid fall in eDQE at mid-to-high spatial frequencies. A comparison with two flat panel mammography systems demonstrates that this may limit image quality for small details, such as micro-calcifications, which correlates with a more conventional image quality assessment with the CDMAM phantom. eDE has shown the scanning photon counting system offers superior performance for low spatial frequencies, which will be important for the detection of large low contrast masses. Both eDQE and eDE are proposed as useful metrics that should enable optimisation of the Philips MDM L30.

Position paper: recommendations for a digital mammography quality assurance program V4.0

In 2001 the ACPSEM published a position paper on quality assurance in screen film mammography which was subsequently adopted as a basis for the quality assurance programs of both the Royal Australian and New Zealand College of Radiologists (RANZCR) and of BreastScreen Australia. Since then the clinical implementation of digital mammography has been realised and it has become evident that existing screen-film protocols were not appropriate to assure the required image quality needed for reliable diagnosis or to address the new dose implications resulting from digital technology. In addition, the advantages and responsibilities inherent in teleradiology are most critical in mammography and also need to be addressed. The current document is the result of a review of current overseas practice and local experience in these areas. At this time the technology of digital imaging is undergoing significant development and there is still a lack of full international consensus about some of the detailed quality control (QC) tests that should be included in quality assurance (QA) programs. This document describes the current status in digital mammography QA and recommends test procedures that may be suitable in the Australasian environment. For completeness, this document also includes a review of the QA programs required for the various types of digital biopsy units used in mammography. In the future, international harmonisation of digital quality assurance in mammography and changes in the technology may require a review of this document. Version 2.0 represented the first of these updates and key changes related to image quality evaluation, ghost image evaluation and interpretation of signal to noise ratio measurements. In Version 3.0 some significant changes, made in light of further experience gained in testing digital mammography equipment were introduced. In Version 4.0, further changes have been made, most notably digital breast tomosynthesis (DBT) testing and QC have been addressed. Some additional testing for conventional projection imaging has been added in order that sites may have the capability to undertake dose surveys to confirm compliance with diagnostic reference levels (DRLs) that may be established at the National or State level. A key recommendation is that dosimetry calculations are now to be undertaken using the methodology of Dance et al. Some minor changes to existing facility QC tests have been made to ensure the suggested procedures align with those most recently adopted by the Royal Australian and New Zealand College of Radiologists and BreastScreen Australia. Future updates of this document may be provided as deemed necessary in electronic format on the ACPSEM's website ( https://www.acpsem.org.au/whatacpsemdoes/standards-position-papers and see also http://www.ranzcr.edu.au/quality-a-safety/radiology/practice-quality-activities/mqap ).

Performance evaluation of a retrofit digital detector-based mammography system

A retrofit flat panel detector was integrated with a GE DMR+ analog mammography system and characterized using detective quantum efficiency (DQE). Technical system performance was evaluated using the European Guidelines protocol, followed by a limited evaluation of clinical image quality for 20 cases using image quality criteria in the European Guidelines. Optimal anode/filter selections were established using signal difference-to-noise ratio measurements. Only small differences in peak DQE were seen between the three anode/filter settings, with an average value of 0.53. For poly(methyl methacrylate) (PMMA) thicknesses above 60 mm, the Rh/Rh setting was the optimal anode/filter setting. The system required a mean glandular dose of 0.54 mGy at 30 kV Rh/Rh to reach the Acceptable gold thickness limit for 0.1 mm details. Imaging performance of the retrofit unit with the GE DMR+ is notably better than of powder based computed radiography systems and is comparable to current flat panel FFDM systems.

Mammographic density measurements are not affected by mammography system

Mammographic density (MD) is a significant risk factor for breast cancer and has been shown to reduce the sensitivity of mammography screening. Knowledge of a woman's density can be used to predict her risk of developing breast cancer and personalize her imaging pathway. However, measurement of breast density has proven to be troublesome with wide variations in density recorded using radiologists' visual Breast Imaging Reporting and Data System (BIRADS). Several automated methods for assessing breast density have been proposed, each with their own source of measurement error. The use of differing mammographic imaging systems further complicates MD measurement, especially for the same women imaged over time. The purpose of this study was to investigate whether having a mammogram on differing manufacturer's equipment affects a woman's MD measurement. Raw mammographic images were acquired on two mammography imaging systems (General Electric and Hologic) one year apart and processed using VolparaDensity™ to obtain the Volpara Density Grade (VDG) and average volumetric breast density percentage (AvBD%). Visual BIRADS scores were also obtained from 20 expert readers. BIRADS scores for both systems showed strong positive correlation ([Formula: see text]; [Formula: see text]), while the VDG ([Formula: see text]; [Formula: see text]) and AvBD% ([Formula: see text]; [Formula: see text]) showed stronger positive correlations. Substantial agreement was shown between the systems for BIRADS ([Formula: see text]; [Formula: see text]), however, the systems demonstrated an almost perfect agreement for VDG ([Formula: see text]; [Formula: see text]).

Image simulation and a model of noise power spectra across a range of mammographic beam qualities

PURPOSE

The aim of this work is to create a model to predict the noise power spectra (NPS) for a range of mammographic radiographic factors. The noise model was necessary to degrade images acquired on one system to match the image quality of different systems for a range of beam qualities.

METHODS

Five detectors and x-ray systems [Hologic Selenia (ASEh), Carestream computed radiography CR900 (CRc), GE Essential (CSI), Carestream NIP (NIPc), and Siemens Inspiration (ASEs)] were characterized for this study. The signal transfer property was measured as the pixel value against absorbed energy per unit area (E) at a reference beam quality of 28 kV, Mo/Mo or 29 kV, W/Rh with 45 mm polymethyl methacrylate (PMMA) at the tube head. The contributions of the three noise sources (electronic, quantum, and structure) to the NPS were calculated by fitting a quadratic at each spatial frequency of the NPS against E. A quantum noise correction factor which was dependent on beam quality was quantified using a set of images acquired over a range of radiographic factors with different thicknesses of PMMA. The noise model was tested for images acquired at 26 kV, Mo/Mo with 20 mm PMMA and 34 kV, Mo/Rh with 70 mm PMMA for three detectors (ASEh, CRc, and CSI) over a range of exposures. The NPS were modeled with and without the noise correction factor and compared with the measured NPS. A previous method for adapting an image to appear as if acquired on a different system was modified to allow the reference beam quality to be different from the beam quality of the image. The method was validated by adapting the ASEh flat field images with two thicknesses of PMMA (20 and 70 mm) to appear with the imaging characteristics of the CSI and CRc systems.

RESULTS

The quantum noise correction factor rises with higher beam qualities, except for CR systems at high spatial frequencies, where a flat response was found against mean photon energy. This is due to the dominance of secondary quantum noise in CR. The use of the quantum noise correction factor reduced the difference from the model to the real NPS to generally within 4%. The use of the quantum noise correction improved the conversion of ASEh image to CRc image but had no difference for the conversion to CSI images.

CONCLUSIONS

A practical method for estimating the NPS at any dose and over a range of beam qualities for mammography has been demonstrated. The noise model was incorporated into a methodology for converting an image to appear as if acquired on a different detector. The method can now be extended to work for a wide range of beam qualities and can be applied to the conversion of mammograms.

Figure of image quality and information capacity in digital mammography

Objectives. In this work, a simple technique to assess the image quality characteristics of the postprocessed image is developed and an easy to use figure of image quality (FIQ) is introduced. This FIQ characterizes images in terms of resolution and noise. In addition information capacity, defined within the context of Shannon's information theory, was used as an overall image quality index. Materials and Methods. A digital mammographic image was postprocessed with three digital filters. Resolution and noise were calculated via the Modulation Transfer Function (MTF), the coefficient of variation, and the figure of image quality. In addition, frequency dependent parameters such as the noise power spectrum (NPS) and noise equivalent quanta (NEQ) were estimated and used to assess information capacity. Results. FIQs for the “raw image” data and the image processed with the “sharpen edges” filter were found 907.3 and 1906.1, correspondingly. The information capacity values were 60.86 × 10³ and 78.96 × 10³ bits/mm². Conclusion. It was found that, after the application of the postprocessing techniques (even commercial nondedicated software) on the raw digital mammograms, MTF, NPS, and NEQ are improved for medium to high spatial frequencies leading to resolving smaller structures in the final image.

[Radiation dose evaluation in a photon-counting digital mammography unit]

The purpose of our study was to evaluate radiation dose and beam quality in photon-counting digital mammography (PCDM) and compare them with those in a full-field digital mammography (FFDM) unit. Dose variation in the X-ray tube axis direction, aluminum half-value layer, average glandular and skin doses, and contrast-to-noise ratio (CNR) were evaluated for the PCDM and FFDM units. In PCDM, the dose variation in the X-ray tube axis direction was greater than that in FFDM. At a tube voltage of 28 kV, the first half-value layers were 0.407 mmAl for PCDM, 0.357 mmAl for FFDM with a molybdenum target and molybdenum filter (Mo/Mo), and 0.579 mmAl for FFDM with a tungsten target and rhodium filter (W/Rh). The average glandular doses with 45-mm-equivalent breast thickness were 0.723 mGy for the PCDM, 1.55 mGy for the FFDM with Mo/Mo in low-dose mode, and 0.835 mGy for the FFDM with W/Rh in low-dose mode. In PCDM, the skin dose was equivalent to or lower than that in FFDM. The CNR was 2.65±0.04, 2.35±0.04, and 2.52±0.03 for the PCDM, FFDM with Mo/Mo, and that with W/Rh, respectively. The CNR for PCDM was significantly higher than that for FFDM (p<0.001). It is therefore possible to reduce the radiation dose to the patient by using a PCDM unit while maintaining a significantly higher CNR than with the FFDM unit.

Effective detective quantum efficiency for two mammography systems: measurement and comparison against established metrics

PURPOSE

The aim of this paper was to illustrate the value of the new metric effective detective quantum efficiency (eDQE) in relation to more established measures in the optimization process of two digital mammography systems. The following metrics were included for comparison against eDQE: detective quantum efficiency (DQE) of the detector, signal difference to noise ratio (SdNR), and detectability index (d') calculated using a standard nonprewhitened observer with eye filter.

METHODS

The two systems investigated were the Siemens MAMMOMAT Inspiration and the Hologic Selenia Dimensions. The presampling modulation transfer function (MTF) required for the eDQE was measured using two geometries: a geometry containing scattered radiation and a low scatter geometry. The eDQE, SdNR, and d' were measured for poly(methyl methacrylate) (PMMA) thicknesses of 20, 40, 60, and 70 mm, with and without the antiscatter grid and for a selection of clinically relevant target/filter (T/F) combinations. Figures of merit (FOMs) were then formed from SdNR and d' using the mean glandular dose as the factor to express detriment. Detector DQE was measured at energies covering the range of typical clinically used spectra.

RESULTS

The MTF measured in the presence of scattered radiation showed a large drop at low spatial frequency compared to the low scatter method and led to a corresponding reduction in eDQE. The eDQE for the Siemens system at 1 mm(-1) ranged between 0.15 and 0.27, depending on T/F and grid setting. For the Hologic system, eDQE at 1 mm(-1) varied from 0.15 to 0.32, again depending on T/F and grid setting. The eDQE results for both systems showed that the grid increased the system efficiency for PMMA thicknesses of 40 mm and above but showed only small sensitivity to T/F setting. While results of the SdNR and d' based FOMs confirmed the eDQE grid position results, they were also more specific in terms of T/F selection. For the Siemens system at 20 mm PMMA, the FOMs indicated Mo/Mo (grid out) as optimal while W/Rh (grid in) was the optimal configuration at 40, 60, and 70 mm PMMA. For the Hologic, the FOMs pointed to W/Rh (grid in) at 20 and 40 mm of PMMA while W/Ag (grid in) gave the highest FOM at 60 and 70 mm PMMA. Finally, DQE at 1 mm(-1) averaged for the four beam qualities studied was 0.44 ± 0.02 and 0.55 ± 0.03 for the Siemens and Hologic detectors, respectively, indicating only a small influence of energy on detector DQE.

CONCLUSIONS

Both the DQE and eDQE data showed only a small sensitivity to T/F setting for these two systems. The eDQE showed clear preferences in terms of scatter reduction, being highest for the grid-in geometry for PMMA thicknesses of 40 mm and above. The SdNR and d' based figures of merit, which contain additional weighting for contrast and dose, pointed to specific T/F settings for both systems.

Effect of readout direction in the edge profile on the modulation transfer function of computed radiographic systems by use of the edge method

We investigated the effect of the readout direction of the edge profile obtained by the edge method on the presampled modulation transfer function (MTF) in various computed radiographic (CR) systems. There were no differences in the MTFs derived from two edge profiles in the sub-scanning direction of four CR systems used in this study. On the other hand, the MTFs measured at a readout direction from the low (edge) to the high (direct exposure) exposure region were higher than those measured at a readout direction from the high to the low exposure region in the laser-beam scanning direction for three of the four CR systems. Although this phenomenon depends on the CR system, it is important to understand and indicate both MTFs at the two edge profiles in the laser-beam scanning direction for accurate assessment of the resolution property.

Breast composition measurement with a cadmium-zinc-telluride based spectral computed tomography system

PURPOSE

To investigate the feasibility of breast tissue composition in terms of water, lipid, and protein with a cadmium-zinc-telluride (CZT) based computed tomography (CT) system to help better characterize suspicious lesions.

METHODS

Simulations and experimental studies were performed using a spectral CT system equipped with a CZT-based photon-counting detector with energy resolution. Simulations of the figure-of-merit (FOM), the signal-to-noise ratio (SNR) of the dual energy image with respect to the square root of mean glandular dose (MGD), were performed to find the optimal configuration of the experimental acquisition parameters. A calibration phantom 3.175 cm in diameter was constructed from polyoxymethylene plastic with cylindrical holes that were filled with water and oil. Similarly, sized samples of pure adipose and pure lean bovine tissues were used for the three-material decomposition. Tissue composition results computed from the images were compared to the chemical analysis data of the tissue samples.

RESULTS

The beam energy was selected to be 100 kVp with a splitting energy of 40 keV. The tissue samples were successfully decomposed into water, lipid, and protein contents. The RMS error of the volumetric percentage for the three-material decomposition, as compared to data from the chemical analysis, was estimated to be approximately 5.7%.

CONCLUSIONS

The results of this study suggest that the CZT-based photon-counting detector may be employed in the CT system to quantify the water, lipid, and protein mass densities in tissue with a relatively good agreement.

Physical evaluation of a needle photostimulable phosphor based CR mammography system

PURPOSE

Needle phosphor based computed radiography (CR) systems promise improved image quality compared to powder phosphor based CR units for x-ray screening mammography. This paper compares the imaging performance of needle CR cassettes, powder based CR cassettes and a well established amorphous selenium (a-Se) based flat panel based mammography system, using consistent beam qualities.

METHODS

Detector performance was assessed using modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE). Mammography system performance was assessed against levels from the European Guidelines, including threshold gold thickness (c-d), relative signal difference to noise (SdNR) and mean glandular dose, for automatic exposure control settings suggested by the manufacturers. The needle based Agfa HM5.0 CR detector was compared against the single sided readout Agfa MM3.0R and dual sided readout Fuji Profect CS powder CR plates using a 28 kV Mo/Rh spectrum, while a 28 kV W/Rh spectrum was used to compare the Agfa HM5.0 against the Siemens MAMMOMAT Inspiration a-Se based system.

RESULTS

MTF at 5 mm(-1) was 0.16 and 0.24 for the needle CR detector in the fast and slow scan directions, respectively, indicating a slight improvement (∼20%) over the two powder CR systems but remained 50% lower than the result at 5 mm(-1) for the a-Se detector (∼0.55). Structured screen noise was lower for the needle phosphor compared to the powder plates. CR system gain, estimated from the measured absorption fraction and NNPS results, was 6.3 for the (single sided) needle phosphor and 5.1 and 7.2 for the single sided and dual sided powder phosphor systems. Peak DQE at ∼100 μGy was 0.47 for the needle system compared to peak DQE figures of 0.33 and 0.46 for the single sided readout powder plates and dual sided readout plates. The high frequency DQE (at 5 mm(-1)) was 0.19 for the needle CR plates, a factor of approximately 3 greater than for the powder CR plates. At 28 kV W/Rh, 2 mm Al, peak DQE for the needle CR system was 0.45 against a value of 0.50 for the a-Se detector. The needle CR detector reached the Acceptable limit for 0.1 mm details in the European Guidelines at a mean glandular dose (MGD) of approximately 1.31 mGy imaged at 28 kV Mo/Rh, compared to figures of 2.19 and 1.43 mGy for the single sided and dual sided readout powder CR systems. The a-Se detector could reach the limit at 0.65 mGy using a 28 kV W/Rh spectrum, while the needle CR system required 1.09 mGy for the same spectrum.

CONCLUSIONS

Imaging performance for the needle CR phosphor technology, characterized using MTF and DQE and threshold gold thickness demonstrated a clear improvement compared to both single and dual sided reading powder phosphor based CR systems.

[Physical image properties of digital radiography systems in low dose range]

We measured physical image properties of a flat panel detector (FPD) system and a computed radiography (CR) system, targeting to a low dose range (reference dose: 2.58×10(-7) C/kg: to 1/20 dose). Input-output properties, pre-sampled modulation transfer functions (pre-sampled MTFs), and normalized noise power spectra for an FPD system equipped with a CsI scintillator (FPDcsi) and a CR system with an imaging plate coated with storage phosphor (CR) were measured at the low dose range for radiation quality of RQA3 (≍50 skV) and RQA5 (≍70 kV), and detective quantum efficiencies (DQEs) were calculated. In addition, in order to validate the DQE results, component fractions of Poisson and multiplicative and additive noise were analyzed using relative standard deviation analysis. The DQE values of FPDcsi were decreased with dose decrease, and contrarily to these, those of CR were increased. At the 1/10 and 1/20 doses for RQA3, the DQEs of FPDcsi and CR became almost the same. From the results of RSD analysis, it was proved that the main cause of DQE deterioration on FPDcsi are non-negligible additive (electronic) noise, and the DQE improvement on CR was caused by both of significant multiplicative (structure) noise and very low electronic noise. The DQE results were validated by comparing burger phantom images of each dose and radiation quality.

A 24 keV liquid-metal-jet x-ray source for biomedical applications

We present a high-brightness 24-keV electron-impact microfocus x-ray source based on continuous operation of a heated liquid-indium/gallium-jet anode. The 30-70 W electron beam is magnetically focused onto the jet, producing a circular 7-13 μm full width half maximum x-ray spot. The measured spectral brightness at the 24.2 keV In K(α) line is 3 × 10(9) photons∕(s × mm(2) × mrad(2) × 0.1% BW) at 30 W electron-beam power. The high photon energy compared to existing liquid-metal-jet sources increases the penetration depth and allows imaging of thicker samples. The applicability of the source in the biomedical field is demonstrated by high-resolution imaging of a mammography phantom and a phase-contrast angiography phantom.

Comparison of full field digital (FFD) and computed radiography (CR) mammography systems in Greece

The purpose of this study is to evaluate and compare the performance of 52 full field digital (FFD) and computed radiography (CR) mammography systems checked by the Greek Atomic Energy Commission with respect to dose and image quality. Entrance surface air kerma (ESAK) was measured and average glandular dose (AGD) was calculated according to the European protocol on dosimetry in mammography. The exposures were performed using the clinical protocol of each laboratory. The image quality was assessed by the total score of resolved phantom structures incorporated in an American College of Radiology accreditation phantom. The mean ESAK values for FFD and CR systems were 4.59 ± 1.93 and 5.0 ± 1.78 mGy, respectively, whereas the AGD yielded a mean value of 1.06 ± 0.36 mGy for the FFD and 1.04 ± 0.35 mGy for the CR systems. Considering image quality, FFD systems indicated a mean total score of 13.04 ± 0.89, whereas CR systems a mean total score of 11.54 ± 1.06.

Detectors for the future of X-ray imaging

In recent decades, developments in detectors for X-ray imaging have improved dose efficiency. This has been accomplished with for example, structured scintillators such as columnar CsI, or with direct detectors where the X rays are converted to electric charge carriers in a semiconductor. Scattered radiation remains a major noise source, and fairly inefficient anti-scatter grids are still a gold standard. Hence, any future development should include improved scatter rejection. In recent years, photon-counting detectors have generated significant interest by several companies as well as academic research groups. This method eliminates electronic noise, which is an advantage in low-dose applications. Moreover, energy-sensitive photon-counting detectors allow for further improvements by optimising the signal-to-quantum-noise ratio, anatomical background subtraction or quantitative analysis of object constituents. This paper reviews state-of-the-art photon-counting detectors, scatter control and their application in diagnostic X-ray medical imaging. In particular, spectral imaging with photon-counting detectors, pitfalls such as charge sharing and high rates and various proposals for mitigation are discussed.

The effect of radiation dose reduction on clinical image quality in chest radiography of premature neonates using a dual-side readout technique computed radiography system

The purpose of the present study was to investigate if the exposure could be reduced from the clinical setting (resulting in an effective dose of 8 microSv for a neonate of weight 0.7 kg and height 25 cm at a tube voltage of 90 kV) without negatively influencing the image quality for a dual-side readout technique computed radiography (CR) system in chest radiography of premature neonates. Chest radiographs of premature neonates were acquired with the double-side readout technique CR system. The images underwent simulated dose reduction in steps of 20 % to represent five different radiation dose levels. Four image quality criteria, related to the visibility of important anatomical structures, were used in a visual grading study where five experienced radiologists rated how well the criteria were fulfilled for all images. When reducing the radiation dose, a decrease in image quality could be observed already at the 80 % dose level for all the structures. The results indicate that a decrease in exposure from the clinically used setting affects the image quality negatively for the CR system.