Experimentally determined spectral optimization for dedicated breast computed tomography

Technical note: Characterization, validation, and spectral optimization of a dedicated breast CT system for contrast-enhanced imaging

BACKGROUND

The development of a new imaging modality, such as 4D dynamic contrast-enhanced dedicated breast CT (4D DCE-bCT), requires optimization of the acquisition technique, particularly within the 2D contrast-enhanced imaging modality. Given the extensive parameter space, cascade-systems analysis is commonly used for such optimization.

PURPOSE

To implement and validate a parallel-cascaded model for bCT, focusing on optimizing and characterizing system performance in the projection domain to enhance the quality of input data for image reconstruction.

METHODS

A parallel-cascaded system model of a state-of-the-art bCT system was developed and model predictions of the presampled modulation transfer function (MTF) and the normalized noise power spectrum (NNPS) were compared with empirical data collected in the projection domain. Validation was performed using the default settings of 49 kV with 1.5 mm aluminum filter and at 65 kV and 0.257 mm copper filter. A 10 mm aluminum plate was added to replicate the breast attenuation. Air kerma at the isocenter was measured at different tube current levels. Discrepancies between the measured projection domain metrics and model-predicted values were quantified using percentage error and coefficient of variation (CoV) for MTF and NNPS, respectively. The optimal filtration was for a 5 mm iodine disk detection task at 49, 55, 60, and 65 kV. The detectability index was calculated for the default aluminum filtration and for copper thicknesses ranging from 0.05 to 0.4 mm.

RESULTS

At 49 kV, MTF errors were +5.1% and -5.1% at 1 and 2 cycles/mm, respectively; NNPS CoV was 5.3% (min = 3.7%; max = 8.5%). At 65 kV, MTF errors were -0.8% and -3.2%; NNPS CoV was 13.1% (min = 11.4%; max = 16.9%). Air kerma output was linear, with 11.67 µGy/mA (R2 = 0.993) and 19.14 µGy/mA (R2 = 0.996) at 49 and 65 kV, respectively. For iodine detection, a 0.25 mm-thick copper filter at 65 kV was found optimal, outperforming the default technique by 90%.

CONCLUSION

The model accurately predicts bCT system performance, specifically in the projection domain, under varied imaging conditions, potentially contributing to the enhancement of 2D contrast-enhanced imaging in 4D DCE-bCT.

Cone-beam breast CT using an offset detector: effect of detector offset and image reconstruction algorithm

Objective.A dedicated cone-beam breast computed tomography (BCT) using a high-resolution, low-noise detector operating in offset-detector geometry has been developed. This study investigates the effects of varying detector offsets and image reconstruction algorithms to determine the appropriate combination of detector offset and reconstruction algorithm.Approach.Projection datasets (300 projections in 360°) of 30 breasts containing calcified lesions that were acquired using a prototype cone-beam BCT system comprising a 40 × 30 cm flat-panel detector with 1024 × 768 detector pixels were reconstructed using Feldkamp-Davis-Kress (FDK) algorithm and served as the reference. The projection datasets were retrospectively truncated to emulate cone-beam datasets with sinograms of 768×768 and 640×768 detector pixels, corresponding to 5 cm and 7.5 cm lateral offsets, respectively. These datasets were reconstructed using the FDK algorithm with appropriate weights and an ASD-POCS-based Fast, total variation-Regularized, Iterative, Statistical reconstruction Technique (FRIST), resulting in a total of 4 offset-detector reconstructions (2 detector offsets × 2 reconstruction methods). Signal difference-to-noise ratio (SDNR), variance, and full-width at half-maximum (FWHM) of calcifications in two orthogonal directions were determined from all reconstructions. All quantitative measurements were performed on images in units of linear attenuation coefficient (1/cm).Results.The FWHM of calcifications did not differ (P > 0.262) among reconstruction algorithms and detector formats, implying comparable spatial resolution. For a chosen detector offset, the FRIST algorithm outperformed FDK in terms of variance and SDNR (P < 0.0001). For a given reconstruction method, the 5 cm offset provided better results.Significance.This study indicates the feasibility of using the compressed sensing-based, FRIST algorithm to reconstruct sinograms from offset-detectors. Among the reconstruction methods and detector offsets studied, FRIST reconstructions corresponding to a 30 cm × 30 cm with 5 cm lateral offset, achieved the best performance. A clinical prototype using such an offset geometry has been developed and installed for clinical trials.

A residual dense network assisted sparse view reconstruction for breast computed tomography

To develop and investigate a deep learning approach that uses sparse-view acquisition in dedicated breast computed tomography for radiation dose reduction, we propose a framework that combines 3D sparse-view cone-beam acquisition with a multi-slice residual dense network (MS-RDN) reconstruction. Projection datasets (300 views, full-scan) from 34 women were reconstructed using the FDK algorithm and served as reference. Sparse-view (100 views, full-scan) projection data were reconstructed using the FDK algorithm. The proposed MS-RDN uses the sparse-view and reference FDK reconstructions as input and label, respectively. Our MS-RDN evaluated with respect to fully sampled FDK reference yields superior performance, quantitatively and visually, compared to conventional compressed sensing methods and state-of-the-art deep learning based methods. The proposed deep learning driven framework can potentially enable low dose breast CT imaging.

Effects of kV, filtration, dose, and object size on soft tissue and iodine contrast in dedicated breast CT

PURPOSE

Clinical use of dedicated breast computed tomography (bCT) requires relatively short scan times necessitating systems with high frame rates. This in turn impacts the x-ray tube operating range. We characterize the effects of tube voltage, beam filtration, dose, and object size on contrast and noise properties related to soft tissue and iodine contrast agents as a way to optimize imaging protocols for soft tissue and iodine contrast at high frame rates.

METHODS

This study design uses the signal-difference-to-noise ratio (SDNR), noise-equivalent quanta (NEQ), and detectability (d´) as measures of imaging performance for a prototype breast CT scanner that utilizes a pulsed x-ray tube (with a 4 ms pulse width) at 43.5 fps acquisition rate. We assess a range of kV, filtration, breast phantom size, and mean glandular dose (MGD). Performance measures are estimated from images of adipose-equivalent breast phantoms machined to have a representative size and shape of small, medium, and large breasts. Water (glandular tissue equivalent) and iodine contrast (5 mg/ml) were used to fill two cylindrical wells in the phantoms.

RESULTS

Air kerma levels required for obtaining an MGD of 6 mGy ranged from 7.1 to 9.1 mGy and are reported across all kV, filtration, and breast phantom sizes. However, at 50 kV, the thick filters (0.3 mm of Cu or Gd) exceeded the maximum available mA of the x-ray generator, and hence, these conditions were excluded from subsequent analysis. There was a strong positive association between measurements of SDNR and d' (R²  > 0.97) within the range of parameters investigated in this work. A significant decrease in soft tissue SDNR was observed for increasing phantom size and increasing kV with a maximum SDNR at 50 kV with 0.2 mm Cu or 0.2 mm Gd filtration. For iodine contrast SDNR, a significant decrease was observed with increasing phantom size, but a decrease in SDNR for increasing kV was only observed for 70 kV (50 and 60 kV were not significantly different). Thicker Gd filtration (0.3 mm Gd) resulted in a significant increase in iodine SDNR and decrease in soft tissue SDNR but requires significantly more tube current to deliver the same MGD.

CONCLUSIONS

The choice of 60 kV with 0.2 mm Gd filtration provides a good trade-off for maximizing both soft tissue and iodine contrast. This scanning technique takes advantage of the ~50 keV Gd k-edge to produce contrast and can be achieved within operating range of the x-ray generator used in this work. Imaging at 60 kV allows for a greater range in dose delivered to the large breast sizes when uniform image quality is desired across all breast sizes. While imaging performance metrics (i.e., detectability index and SDNR) were shown to be strongly correlated, the methodologies presented in this work for the estimation of NEQ (and subsequently d') provides a meaningful description of the spatial resolution and noise characteristics of this prototype bCT system across a range of beam quality, dose, and object sizes.

3D-printed breast phantom for multi-purpose and multi-modality imaging

Background

Breast imaging technology plays an important role in breast cancer planning and treatment. Recently, three-dimensional (3D) printing technology has become a trending issue in phantom constructions for medical applications, with its advantages of being customizable and cost-efficient. However, there is no current practice in the field of multi-purpose breast phantom for quality control (QC) in multi-modalities imaging. The purpose of this study was to fabricate a multi-purpose breast phantom with tissue-equivalent materials via a 3D printing technique for QC in multi-modalities imaging.

Methods

We used polyvinyl chloride (PVC) based materials and a 3D printing technique to construct a breast phantom. The phantom incorporates structures imaged in the female breast such as microcalcifications, fiber lesions, and tumors with different sizes. Moreover, the phantom was used to assess the sensitivity of lesion detection, depth resolution, and detectability thresholds with different imaging modalities. Phantom tissue equivalent properties were determined using computed tomography (CT) attenuation [Hounsfield unit (HU)] and magnetic resonance imaging (MRI) relaxation times.

Results

The 3D-printed breast phantom had an average background value of 36.2 HU, which is close to that of glandular breast tissue (40 HU). T1 and T2 relaxation times had an average relaxation time of 206.81±17.50 and 20.22±5.74 ms, respectively. Mammographic imaging had improved detection of microcalcification compared with ultrasound and MRI with multiple sequences [T1WI, T2WI and short inversion time inversion recovery (STIR)]. Soft-tissue lesion detection and cylindrical tumor contrast were superior with mammography and MRI compared to ultrasound. Hemispherical tumor detection was similar regardless of the imaging modality used.

Conclusions

We developed a multi-purpose breast phantom using a 3D printing technique and determined its value for multi-modal breast imaging studies.

Low-Dose Contrast-Enhanced Breast CT Using Spectral Shaping Filters: An Experimental Study

Iodinated contrast-enhanced X-ray imaging of the breast has been studied with various modalities, including full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and dedicated breast CT. Contrast imaging with breast CT has a number of advantages over FFDM and DBT, including the lack of breast compression, and generation of fully isotropic 3-D reconstructions. Nonetheless, for breast CT to be considered as a viable tool for routine clinical use, it would be desirable to reduce radiation dose. One approach for dose reduction in breast CT is spectral shaping using X-ray filters. In this paper, two high atomic number filter materials are studied, namely, gadolinium (Gd) and erbium (Er), and compared with Al and Cu filters currently used in breast CT systems. Task-based performance is assessed by imaging a cylindrical poly(methyl methacrylate) phantom with iodine inserts on a benchtop breast CT system that emulates clinical breast CT. To evaluate detectability, a channelized hoteling observer (CHO) is used with sums of Laguerre-Gauss channels. It was observed that spectral shaping using Er and Gd filters substantially increased the dose efficiency (defined as signal-to-noise ratio of the CHO divided by mean glandular dose) as compared with kilovolt peak and filter settings used in commercial and prototype breast CT systems. These experimental phantom study results are encouraging for reducing dose of breast CT, however, further evaluation involving patients is needed.

Investigation of x-ray spectra for iodinated contrast-enhanced dedicated breast CT

Screening for breast cancer with mammography has been very successful, resulting in part to a reduction of breast cancer mortality by approximately 39% since 1990. However, mammography still has limitations in performance, especially for women with dense breast tissue. Iodinated contrast-enhanced, dedicated breast CT (BCT) has been proposed to improve lesion analysis and the accuracy of diagnostic workup for patients suspected of having breast cancer. A mathematical analysis to explore the use of various x-ray filters for iodinated contrast-enhanced BCT is presented. To assess task-based performance, the ideal linear observer signal-to-noise ratio (SNR) is used as a figure-of-merit under the assumptions of a linear, shift-invariant imaging system. To estimate signal and noise propagation through the BCT detector, a parallel-cascade model was used. The lesion model was embedded into a structured background and included a realistic level of iodine uptake. SNR was computed for 84,000 different exposure settings by varying the kV setting, x-ray filter materials and thickness, breast size, and composition and radiation dose. It is shown that some x-ray filter material/thickness combinations can provide up to 75% improvement in the linear ideal observer SNR over a conventionally used x-ray filter for BCT. This improvement in SNR can be traded off for substantial reductions in mean glandular dose.

Temporal subtraction contrast-enhanced dedicated breast CT

The development of a framework of deformable image registration and segmentation for the purpose of temporal subtraction contrast-enhanced breast CT is described. An iterative histogram-based two-means clustering method was used for the segmentation. Dedicated breast CT images were segmented into background (air), adipose, fibroglandular and skin components. Fibroglandular tissue was classified as either normal or contrast-enhanced then divided into tiers for the purpose of categorizing degrees of contrast enhancement. A variant of the Demons deformable registration algorithm, intensity difference adaptive Demons (IDAD), was developed to correct for the large deformation forces that stemmed from contrast enhancement. In this application, the accuracy of the proposed method was evaluated in both mathematically-simulated and physically-acquired phantom images. Clinical usage and accuracy of the temporal subtraction framework was demonstrated using contrast-enhanced breast CT datasets from five patients. Registration performance was quantified using normalized cross correlation (NCC), symmetric uncertainty coefficient, normalized mutual information (NMI), mean square error (MSE) and target registration error (TRE). The proposed method outperformed conventional affine and other Demons variations in contrast enhanced breast CT image registration. In simulation studies, IDAD exhibited improvement in MSE (0-16%), NCC (0-6%), NMI (0-13%) and TRE (0-34%) compared to the conventional Demons approaches, depending on the size and intensity of the enhancing lesion. As lesion size and contrast enhancement levels increased, so did the improvement. The drop in the correlation between the pre- and post-contrast images for the largest enhancement levels in phantom studies is less than 1.2% (150 Hounsfield units). Registration error, measured by TRE, shows only submillimeter mismatches between the concordant anatomical target points in all patient studies. The algorithm was implemented using a parallel processing architecture resulting in rapid execution time for the iterative segmentation and intensity-adaptive registration techniques. Characterization of contrast-enhanced lesions is improved using temporal subtraction contrast-enhanced dedicated breast CT. Adaptation of Demons registration forces as a function of contrast-enhancement levels provided a means to accurately align breast tissue in pre- and post-contrast image acquisitions, improving subtraction results. Spatial subtraction of the aligned images yields useful diagnostic information with respect to enhanced lesion morphology and uptake.

Bowtie filters for dedicated breast CT: theory and computational implementation

PURPOSE

To design bowtie filters with improved properties for dedicated breast CT to improve image quality and reduce dose to the patient.

METHODS

The authors present three different bowtie filters designed for a cylindrical 14-cm diameter phantom with a uniform composition of 40/60 breast tissue, which vary in their design objectives and performance improvements. Bowtie design #1 is based on single material spectral matching and produces nearly uniform spectral shape for radiation incident upon the detector. Bowtie design #2 uses the idea of basis material decomposition to produce the same spectral shape and intensity at the detector, using two different materials. Bowtie design #3 eliminates the beam hardening effect in the reconstructed image by adjusting the bowtie filter thickness so that the effective attenuation coefficient for every ray is the same. All three designs are obtained using analytical computational methods and linear attenuation coefficients. Thus, the designs do not take into account the effects of scatter. The authors considered this to be a reasonable approach to the filter design problem since the use of Monte Carlo methods would have been computationally intensive. The filter profiles for a cone-angle of 0° were used for the entire length of each filter because the differences between those profiles and the correct cone-beam profiles for the cone angles in our system are very small, and the constant profiles allowed construction of the filters with the facilities available to us. For evaluation of the filters, we used Monte Carlo simulation techniques and the full cone-beam geometry. Images were generated with and without each bowtie filter to analyze the effect on dose distribution, noise uniformity, and contrast-to-noise ratio (CNR) homogeneity. Line profiles through the reconstructed images generated from the simulated projection images were also used as validation for the filter designs.

RESULTS

Examples of the three designs are presented. Initial verification of performance of the designs was done using analytical computations of HVL, intensity, and effective attenuation coefficient behind the phantom as a function of fan-angle with a cone-angle of 0°. The performance of the designs depends only weakly on incident spectrum and tissue composition. For all designs, the dynamic range requirement on the detector was reduced compared to the no-bowtie-filter case. Further verification of the filter designs was achieved through analysis of reconstructed images from simulations. Simulation data also showed that the use of our bowtie filters can reduce peripheral dose to the breast by 61% and provide uniform noise and CNR distributions. The bowtie filter design concepts validated in this work were then used to create a computational realization of a 3D anthropomorphic bowtie filter capable of achieving a constant effective attenuation coefficient behind the entire field-of-view of an anthropomorphic breast phantom.

CONCLUSIONS

Three different bowtie filter designs that vary in performance improvements were described and evaluated using computational and simulation techniques. Results indicate that the designs are robust against variations in breast diameter, breast composition, and tube voltage, and that the use of these filters can reduce patient dose and improve image quality compared to the no-bowtie-filter case.

Evolution of spatial resolution in breast CT at UC Davis

PURPOSE

Dedicated breast computed tomography (bCT) technology for the purpose of breast cancer screening has been a focus of research at UC Davis since the late 1990s. Previous studies have shown that improvement in spatial resolution characteristics of this modality correlates with greater microcalcification detection, a factor considered a potential limitation of bCT. The aim of this study is to improve spatial resolution as characterized by the modulation transfer function (MTF) via changes in the scanner hardware components and operational schema.

METHODS

Four prototypes of pendant-geometry, cone-beam breast CT scanners were designed and developed spanning three generations of design evolution. To improve the system MTF in each bCT generation, modifications were made to the imaging components (x-ray tube and flat-panel detector), system geometry (source-to-isocenter and detector distance), and image acquisition parameters (technique factors, number of projections, system synchronization scheme, and gantry rotational speed).

RESULTS

Characterization of different generations of bCT systems shows these modifications resulted in a 188% improvement of the limiting MTF properties from the first to second generation and an additional 110% from the second to third. The intrinsic resolution degradation in the azimuthal direction observed in the first generation was corrected by changing the acquisition from continuous to pulsed x-ray acquisition. Utilizing a high resolution detector in the third generation, along with modifications made in system geometry and scan protocol, resulted in a 125% improvement in limiting resolution. An additional 39% improvement was obtained by changing the detector binning mode from 2 × 2 to 1 × 1.

CONCLUSIONS

These results underscore the advancement in spatial resolution characteristics of breast CT technology. The combined use of a pulsed x-ray system, higher resolution flat-panel detector and changing the scanner geometry and image acquisition logic resulted in a significant fourfold improvement in MTF.

Bowtie filters for dedicated breast CT: Analysis of bowtie filter material selection

PURPOSE

For a given bowtie filter design, both the selection of material and the physical design control the energy fluence, and consequently the dose distribution, in the object. Using three previously described bowtie filter designs, the goal of this work is to demonstrate the effect that different materials have on the bowtie filter performance measures.

METHODS

Three bowtie filter designs that compensate for one or more aspects of the beam-modifying effects due to the differences in path length in a projection have been designed. The nature of the designs allows for their realization using a variety of materials. The designs were based on a phantom, 14 cm in diameter, composed of 40% fibroglandular and 60% adipose tissue. Bowtie design #1 is based on single material spectral matching and produces nearly uniform spectral shape for radiation incident upon the detector. Bowtie design #2 uses the idea of basis-material decomposition to produce the same spectral shape and intensity at the detector, using two different materials. With bowtie design #3, it is possible to eliminate the beam hardening effect in the reconstructed image by adjusting the bowtie filter thickness so that the effective attenuation coefficient for every ray is the same. Seven different materials were chosen to represent a range of chemical compositions and densities. After calculation of construction parameters for each bowtie filter design, a bowtie filter was created using each of these materials (assuming reasonable construction parameters were obtained), resulting in a total of 26 bowtie filters modeled analytically and in the penelope Monte Carlo simulation environment. Using the analytical model of each bowtie filter, design profiles were obtained and energy fluence as a function of fan-angle was calculated. Projection images with and without each bowtie filter design were also generated using penelope and reconstructed using FBP. Parameters such as dose distribution, noise uniformity, and scatter were investigated.

RESULTS

Analytical calculations with and without each bowtie filter show that some materials for a given design produce bowtie filters that are too large for implementation in breast CT scanners or too small to accurately manufacture. Results also demonstrate the ability to manipulate the energy fluence distribution (dynamic range) by using different materials, or different combinations of materials, for a given bowtie filter design. This feature is especially advantageous when using photon counting detector technology. Monte Carlo simulation results from penelope show that all studied material choices for bowtie design #2 achieve nearly uniform dose distribution, noise uniformity index less than 5%, and nearly uniform scatter-to-primary ratio. These same features can also be obtained using certain materials with bowtie designs #1 and #3.

CONCLUSIONS

With the three bowtie filter designs used in this work, the selection of material is an important design consideration. An appropriate material choice can improve image quality, dose uniformity, and dynamic range.

Characterization of scatter magnitude and distribution in dedicated breast computed tomography with bowtie filters

Scatter contamination of projection images in cone-beam computed tomography (CT) degrades the image quality. The use of bowtie filters in dedicated breast CT can decrease this scatter contribution. Three bowtie filter designs that compensate for one or more aspects of the beam-modifying effects due to differences in path length in a projection were studied. These designs have been investigated in terms of their ability to reduce the scatter contamination in projection images acquired in a dedicated breast CT geometry. The scatter magnitude was measured as the scatter-to-primary ratio (SPR) using experimental and Monte Carlo techniques for various breast phantom diameters and tube voltages. The results show that a 55% reduction in the center SPR value could be obtained with the bowtie filter designs. On average, the bowtie filters reduced the center SPR by approximately 18% over all breast diameters. The distribution of the scatter was calculated at a range of different locations to produce scatter distribution maps for all three bowtie filter designs. With the inclusion of the bowtie filters, the scatter distribution was more uniform for all breast diameters. The results of this study will be useful in designing scatter correction methods and understanding the benefits of bowtie filters in dedicated breast CT.

Cone beam breast CT with a high pitch (75 μm), thick (500 μm) scintillator CMOS flat panel detector: visibility of simulated microcalcifications

PURPOSE

To measure and investigate the improvement of microcalcification (MC) visibility in cone beam breast CT with a high pitch (75 μm), thick (500 μm) scintillator CMOS/CsI flat panel detector (Dexela 2923, Perkin Elmer).

METHODS

Aluminum wires and calcium carbonate grains of various sizes were embedded in a paraffin cylinder to simulate imaging of calcifications in a breast. Phantoms were imaged with a benchtop experimental cone beam CT system at various exposure levels. In addition to the Dexela detector, a high pitch (50 μm), thin (150 μm) scintillator CMOS/CsI flat panel detector (C7921CA-09, Hamamatsu Corporation, Hamamatsu City, Japan) and a widely used low pitch (194 μm), thick (600 μm) scintillator aSi/CsI flat panel detector (PaxScan 4030CB, Varian Medical Systems) were also used in scanning for comparison. The images were independently reviewed by six readers (imaging physicists). The MC visibility was quantified as the fraction of visible MCs and measured as a function of the estimated mean glandular dose (MGD) level for various MC sizes and detectors. The modulation transfer functions (MTFs) and detective quantum efficiencies (DQEs) were also measured and compared for the three detectors used.

RESULTS

The authors have demonstrated that the use of a high pitch (75 μm) CMOS detector coupled with a thick (500 μm) CsI scintillator helped make the smaller 150-160, 160-180, and 180-200 μm MC groups more visible at MGDs up to 10.8, 9, and 10.8 mGy, respectively. It also made the larger 200-212 and 212-224 μm MC groups more visible at MGDs up to 7.2 mGy. No performance improvement was observed for 224-250 μm or larger size groups. With the higher spatial resolution of the Dexela detector based system, the apparent dimensions and shapes of MCs were more accurately rendered. The results show that with the aforementioned detector, a 73% visibility could be achieved in imaging 160-180 μm MCs as compared to 28% visibility achieved by the low pitch (194 μm) aSi/CsI flat panel detector. The measurements confirm that the Hamamatsu detector has the highest MTF, followed by the Dexel detector, and then the Varian detector. However, the Dexela detector, with its thick (500 μm) CsI scintillator and low noise level, has the highest DQE at all frequencies, followed by the Varian detector, and then the Hamamatsu detector. The findings on the MC visibility correlated well with the differences in MTFs, noise power spectra, and DQEs measured for these three detectors.

CONCLUSIONS

The authors have demonstrated that the use of the CMOS type Dexela detector with its high pitch (75 μm) and thick (500 μm) CsI scintillator could help improve the MC visibility. However, the improvement depended on the exposure level and the MC size. For imaging larger MCs or scanning at high exposure levels, there was little advantage in using the Dexela detector as compared to the aSi type Varian detector. These findings correlate well with the higher measured DQEs of the Dexela detector, especially at higher frequencies.

Scaling-law for the energy dependence of anatomic power spectrum in dedicated breast CT

PURPOSE

To determine the x-ray photon energy dependence of the anatomic power spectrum of the breast when imaged with dedicated breast computed tomography (CT).

METHODS

A theoretical framework for scaling the empirically determined anatomic power spectrum at one x-ray photon energy to that at any given x-ray photon energy when imaged with dedicated breast CT was developed. Theory predicted that when the anatomic power spectrum is fitted with a power curve of the form k f(-β), where k and β are fit coefficients and f is spatial frequency, the exponent β would be independent of x-ray photon energy (E), and the amplitude k scales with the square of the difference in energy-dependent linear attenuation coefficients of fibroglandular and adipose tissues. Twenty mastectomy specimens based numerical phantoms that were previously imaged with a benchtop flat-panel cone-beam CT system were converted to 3D distribution of glandular weight fraction (f(g)) and were used to verify the theoretical findings. The 3D power spectrum was computed in terms of f(g) and after converting to linear attenuation coefficients at monoenergetic x-ray photon energies of 20-80 keV in 5 keV intervals. The 1D power spectra along the axes were extracted and fitted with a power curve of the form k f(-β). The energy dependence of k and β were analyzed.

RESULTS

For the 20 mastectomy specimen based numerical phantoms used in the study, the exponent β was found to be in the range of 2.34-2.42, depending on the axis of measurement. Numerical simulations agreed with the theoretical predictions that for a power-law anatomic spectrum of the form k f(-β), β was independent of E and k(E) = k(1)[μ(g)(E) - μ(a)(E)](2), where k(1) is a constant, and μ(g)(E) and μ(a)(E) represent the energy-dependent linear attenuation coefficients of fibroglandular and adipose tissues, respectively.

CONCLUSIONS

Numerical simulations confirmed the theoretical predictions that in dedicated breast CT, the spatial frequency dependence of the anatomic power spectrum will be independent of x-ray photon energy, and the amplitude of the anatomic power spectrum scales by the square of difference in linear attenuation coefficients of fibroglandular and adipose tissues.

Dedicated breast CT: geometric design considerations to maximize posterior breast coverage

An Institutional Review Board-approved protocol was used to quantify breast tissue inclusion in 52 women, under conditions simulating both craniocaudal (CC) and mediolateral oblique (MLO) views in mammography, dedicated breast CT in the upright subject position, and dedicated breast CT in the prone subject position. Using skin as a surrogate for the underlying breast tissue, the posterior aspect of the breast that is aligned with the chest-wall edge of the breast support in a screen-film mammography system was marked with the study participants positioned for CC and MLO views. The union of skin marks with the study participants positioned for CC and MLO views was considered to represent chest-wall tissue available for imaging with mammography and served as the reference standard. For breast CT, a prone stereotactic breast biopsy unit and a custom-fabricated barrier were used to simulate conditions during prone and upright breast CT, respectively. For the same breast marked on the mammography system, skin marks were made along the breast periphery that was just anterior to the apertures of the prone biopsy unit and the upright barrier. The differences in skin marks between subject positioning simulating breast CT (prone, upright) and mammography were quantified at six anatomic locations. For each location, at least one study participant had a skin mark from breast CT (prone, upright) posterior to mammography. However for all study participants, there was at least one anatomic location where the skin mark from mammography was posterior to that from breast CT (prone, upright) positioning. The maximum amount by which the skin mark from mammography was posterior to breast CT (prone and upright) over all six locations was quantified for each study participant and pair-wise comparison did not exhibit statistically significant difference between prone and upright breast CT (paired t- test, p = 0.4). Quantitatively, for 95% of the study participants the skin mark from mammography was posterior to breast CT (prone or upright) by at the most 9 mm over all six locations. Based on the study observations, geometric design considerations targeting chest-wall coverage with breast CT equivalent to mammography, wherein part of the x-ray beam images through the swale during breast CT are provided. Assuming subjects can extend their chest in to a swale, the optimal swale-depth required to achieve equivalent coverage with breast CT images as mammograms for 95% of the subjects varies in the range of ~30-50 mm for clinical prototypes and was dependent on the system geometry.

Comprehensive assessment of the slice sensitivity profiles in breast tomosynthesis and breast CT

PURPOSE

This study experimentally evaluated the slice sensitivity profile (SSP) and its relationship between acquisition angle, object size, and cone angle. The sensitivity profile metric was used to characterize a breast tomosynthesis system's resolution in the z-axis. The SSP was also measured on a prototype breast computed tomography (bCT) system.

METHODS

The SSP was measured using brass disks placed within adipose tissue-equivalent breast phantoms. The digital tomosynthesis system (Selenia Dimensions, Hologic Corporation, Bedford, MA) acquires projection images over a 15° angular range and the bCT scanner acquires projection images over a 360° angular range. Angular ranges between 15° and 360° were studied by using a subset of the projection images acquired on the bCT scanner. The SSP was determined by measuring a background-corrected mean gray scale value as a function of the z-position (axis normal to the plane of the detector).

RESULTS

The results show that SSP improves when the angular acquisition range is increased and the SSP approaches a delta function for angles greater than 180°. Smaller objects have a narrower SSP and the SSP is not significantly dependent on the cone angle. For a 2.5, 5, 10 mm disk, the full width at half maximum of the SSP was 35, 61, 115 mm, respectively, on the tomosynthesis system (at 15°) and was 0.5 mm for all disk diameters on the bCT scanner (at 360°).

CONCLUSIONS

The SSP is dependent on object size and angular acquisition range. These dependencies are overcome once the angular acquisition range is increased beyond 180°.

Spectral optimization for micro-CT

PURPOSE

To optimize micro-CT protocols with respect to x-ray spectra and thereby reduce radiation dose at unimpaired image quality.

METHODS

Simulations were performed to assess image contrast, noise, and radiation dose for different imaging tasks. The figure of merit used to determine the optimal spectrum was the dose-weighted contrast-to-noise ratio (CNRD). Both optimal photon energy and tube voltage were considered. Three different types of filtration were investigated for polychromatic x-ray spectra: 0.5 mm Al, 3.0 mm Al, and 0.2 mm Cu. Phantoms consisted of water cylinders of 20, 32, and 50 mm in diameter with a central insert of 9 mm which was filled with different contrast materials: an iodine-based contrast medium (CM) to mimic contrast-enhanced (CE) imaging, hydroxyapatite to mimic bone structures, and water with reduced density to mimic soft tissue contrast. Validation measurements were conducted on a commercially available micro-CT scanner using phantoms consisting of water-equivalent plastics. Measurements on a mouse cadaver were performed to assess potential artifacts like beam hardening and to further validate simulation results.

RESULTS

The optimal photon energy for CE imaging was found at 34 keV. For bone imaging, optimal energies were 17, 20, and 23 keV for the 20, 32, and 50 mm phantom, respectively. For density differences, optimal energies varied between 18 and 50 keV for the 20 and 50 mm phantom, respectively. For the 32 mm phantom and density differences, CNRD was found to be constant within 2.5% for the energy range of 21-60 keV. For polychromatic spectra and CMs, optimal settings were 50 kV with 0.2 mm Cu filtration, allowing for a dose reduction of 58% compared to the optimal setting for 0.5 mm Al filtration. For bone imaging, optimal tube voltages were below 35 kV. For soft tissue imaging, optimal tube settings strongly depended on phantom size. For 20 mm, low voltages were preferred. For 32 mm, CNRD was found to be almost independent of tube voltage. For 50 mm, voltages larger than 50 kV were preferred. For all three phantom sizes stronger filtration led to notable dose reduction for soft tissue imaging. Validation measurements were found to match simulations well, with deviations being less than 10%. Mouse measurements confirmed simulation results.

CONCLUSIONS

Optimal photon energies and tube settings strongly depend on both phantom size and imaging task at hand. For in vivo CE imaging and density differences, strong filtration and voltages of 50-65 kV showed good overall results. For soft tissue imaging of animals the size of a rat or larger, voltages higher than 65 kV allow to greatly reduce scan times while maintaining dose efficiency. For imaging of bone structures, usage of only minimum filtration and low tube voltages of 40 kV and below allow exploiting the high contrast of bone at very low energies. Therefore, a combination of two filtrations could prove beneficial for micro-CT: a soft filtration allowing for bone imaging at low voltages, and a variable stronger filtration (e.g., 0.2 mm Cu) for soft tissue and contrast-enhanced imaging.

Development of a patient-specific two-compartment anthropomorphic breast phantom

The purpose of this paper is to develop a technique for the construction of a two-compartment anthropomorphic breast phantom specific to an individual patient's pendant breast anatomy. Three-dimensional breast images were acquired on a prototype dedicated breast computed tomography (bCT) scanner as part of an ongoing IRB-approved clinical trial of bCT. The images from the breast of a patient were segmented into adipose and glandular tissue regions and divided into 1.59 mm thick breast sections to correspond to the thickness of polyethylene stock. A computer-controlled water-jet cutting machine was used to cut the outer breast edge and the internal regions corresponding to glandular tissue from the polyethylene. The stack of polyethylene breast segments was encased in a thermoplastic 'skin' and filled with water. Water-filled spaces modeled glandular tissue structures and the surrounding polyethylene modeled the adipose tissue compartment. Utility of the phantom was demonstrated by inserting 200 µm microcalcifications as well as by measuring point dose deposition during bCT scanning. Affine registration of the original patient images with bCT images of the phantom showed similar tissue distribution. Linear profiles through the registered images demonstrated a mean coefficient of determination (r(2)) between grayscale profiles of 0.881. The exponent of the power law describing the anatomical noise power spectrum was identical in the coronal images of the patient's breast and the phantom. Microcalcifications were visualized in the phantom at bCT scanning. The real-time air kerma rate was measured during bCT scanning and fluctuated with breast anatomy. On average, point dose deposition was 7.1% greater than the mean glandular dose. A technique to generate a two-compartment anthropomorphic breast phantom from bCT images has been demonstrated. The phantom is the first, to our knowledge, to accurately model the uncompressed pendant breast and the glandular tissue distribution for a specific patient. The modular design of the phantom allows for studies of a single breast segment and the entire breast volume. Insertion of other devices, materials and tissues of interest into the phantom provide a robust platform for future breast imaging and dosimetry studies.

Kilovoltage rotational external beam radiotherapy on a breast computed tomography platform: a feasibility study

PURPOSE

To demonstrate the feasibility of a dedicated breast computed tomography (bCT) platform to deliver rotational kilovoltage (kV) external beam radiotherapy (RT) for partial breast irradiation, whole breast irradiation, and dose painting.

METHODS AND MATERIALS

Rotational kV-external beam RT using the geometry of a prototype bCT platform was evaluated using a Monte Carlo simulator. A point source emitting 178 keV photons (approximating a 320-kVp spectrum with 4-mm copper filtration) was rotated around a 14-cm voxelized polyethylene disk (0.1 cm tall) or cylinder (9 cm tall) to simulate primary and primary plus scattered photon interactions, respectively. Simulations were also performed using voxelized bCT patient images. Beam collimation was varied in the x-y plane (1-14 cm) and in the z-direction (0.1-10 cm). Dose painting for multiple foci, line, and ring distributions was demonstrated using multiple rotations with varying beam collimation. Simulations using the scanner's native hardware (120 kVp filtered by 0.2-mm copper) were validated experimentally.

RESULTS

As the x-y collimator was narrowed, the two-dimensional dose profiles shifted from a cupped profile with a high edge dose to an increasingly peaked central dose distribution with a sharp dose falloff. Using a 1-cm beam, the cylinder edge dose was <7% of the dose deposition at the cylinder center. Simulations using 120-kVp X-rays showed distributions similar to the experimental measurements. A homogeneous dose distribution (<2.5% dose fluctuation) with a 20% decrease in dose deposition at the cylinder edge (i.e., skin sparing) was demonstrated by weighted summation of four dose profiles using different collimation widths. Simulations using patient bCT images demonstrated the potential for treatment planning and image-guided RT.

CONCLUSIONS

Rotational kV-external beam RT for partial breast irradiation, dose painting, and whole breast irradiation with skin sparing is feasible on a bCT platform with the potential for high-resolution image-guided RT.

The simulation of 3D microcalcification clusters in 2D digital mammography and breast tomosynthesis

PURPOSE

This work proposes a new method of building 3D models of microcalcification clusters and describes the validation of their realistic appearance when simulated into 2D digital mammograms and into breast tomosynthesis images.

METHODS

A micro-CT unit was used to scan 23 breast biopsy specimens of microcalcification clusters with malignant and benign characteristics and their 3D reconstructed datasets were segmented to obtain 3D models of microcalcification clusters. These models were then adjusted for the x-ray spectrum used and for the system resolution and simulated into 2D projection images to obtain mammograms after image processing and into tomographic sequences of projection images, which were then reconstructed to form 3D tomosynthesis datasets. Six radiologists were asked to distinguish between 40 real and 40 simulated clusters of microcalcifications in two separate studies on 2D mammography and tomosynthesis datasets. Receiver operating characteristic (ROC) analysis was used to test the ability of each observer to distinguish between simulated and real microcalcification clusters. The kappa statistic was applied to assess how often the individual simulated and real microcalcification clusters had received similar scores ("agreement") on their realistic appearance in both modalities. This analysis was performed for all readers and for the real and the simulated group of microcalcification clusters separately. "Poor" agreement would reflect radiologists' confusion between simulated and real clusters, i.e., lesions not systematically evaluated in both modalities as either simulated or real, and would therefore be interpreted as a success of the present models.

RESULTS

The area under the ROC curve, averaged over the observers, was 0.55 (95% confidence interval [0.44, 0.66]) for the 2D study, and 0.46 (95% confidence interval [0.29, 0.64]) for the tomosynthesis study, indicating no statistically significant difference between real and simulated lesions (p > 0.05). Agreement between allocated lesion scores for 2D mammography and those for the tomosynthesis series was poor.

CONCLUSIONS

The realistic appearance of the 3D models of microcalcification clusters, whether malignant or benign clusters, was confirmed for 2D digital mammography images and the breast tomosynthesis datasets; this database of clusters is suitable for use in future observer performance studies related to the detectability of microcalcification clusters. Such studies include comparing 2D digital mammography to breast tomosynthesis and comparing different reconstruction algorithms.