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

Quantitative Image Quality Metrics of the Low-Dose 2D/3D Slot Scanner Compared to Two Conventional Digital Radiography X-ray Imaging Systems

The aim of this study was to determine the quantitative image quality metrics of the low-dose 2D/3D EOS slot scanner X-ray imaging system (LDSS) compared with conventional digital radiography (DR) X-ray imaging systems. The effective detective quantum efficiency (eDQE) and effective noise quantum equivalent (eNEQ) were measured using chest and knee protocols.

METHODS

A Nationwide Evaluation of X-ray Trends (NEXT) of a chest adult phantom and a PolyMethylmethacrylate (PMMA) phantom were used for the chest and knee protocols, respectively. Quantitative image quality metrics, including effective normalised noise power spectrum (eNNPS), effective modulation transfer function (eMTF), eDQE and eNEQ of the LDSS and DR imaging systems were assessed and compared.

RESULTS

In the chest acquisition, the LDSS imaging system achieved significantly higher eNEQ and eDQE than the DR imaging systems at lower and higher spatial frequencies (0.001 ≤ p ≤ 0.044). For the knee acquisition, the LDSS imaging system also achieved significantly higher eNEQ and eDQE than the DR imaging systems at lower and higher spatial frequencies (0.001 ≤ p ≤ 0.002). However, there was no significant difference in eNEQ and eDQE between DR systems 1 and 2 at lower and higher spatial frequencies (0.10 < p < 1.00) for either chest or knee protocols.

CONCLUSION

The LDSS imaging system performed well compared to the DR systems. Thus, we have demonstrated that the LDSS imaging system has the potential to be used for clinical diagnostic purposes.

Characterization of a GaAs photon-counting detector for mammography

Purpose: The purpose of this study was to evaluate the potential of a prototype gallium arsenide (GaAs) photon-counting detector (PCD) for imaging of the breast. Approach: First, the contrast-to-noise ratio (CNR) using different aluminum/poly(methyl methacrylate) (PMMA) phantoms of different thicknesses were measured. Second, microcalcification detection accuracy using a receiver operating characteristic study with three observers reading an ensemble of images was measured. Finally, the feasibility of using a GaAs system with two energy bins for contrast-enhanced mammography was investigated. Results: For the first two studies, the GaAs detector was compared with a commercial mammography system. The CNR was estimated by imaging 18-, 36-, and 110 - μ m -thick aluminum targets placed on top of 6 cm of PMMA plates and was found to be similar or better over a range of exposures. We observed a similar performance of detecting microcalcifications with the GaAs detector over a range of clinically applicable dose levels with a small increase at lower dose levels. The results also showed that contrast-enhanced spectral mammography using a GaAs PCD is feasible and beneficial. Conclusions: Results from this study suggest that performance with this new detector seems either slightly improved or equivalent to a commercial mammography system that used an energy-integrated detector. No attempt at optimizing exposure techniques for the GaAs detector was performed. Further research is needed to determine optimal acquisition parameters for the GaAs detector and to develop more sophisticated material decomposition algorithms that promise to provide improved quantitative estimates of iodine uptake.

Application of DQE for quantitative assessment of detectors to estimate AEC efficiency in digital mammography

Optimisation of the detector’s exposure parameters settings for image quality and patient dose is an important task in digital mammography. Assessment of a digital detector’s performance can be done objectively and without operator bias by determining the Detective Quantum Efficiency (DQE). The authors of this article aim to prove that the performance of the AEC system can be objectively portrayed through DQE. The results were examined for influence of KAD changes on DQE values and to determine if it was possible to obtain similar DQE values for different exposures. While analysing the effect of the operation of the AEC system described with DQE, the doses received by women during mammography examinations were considered, as well.

The AEC system’s exposure control mechanism cannot guarantee the same DQE value for different object thicknesses. When the object thickness increases, the AEC system should increase the KAD value to obtain the same DQE value. The result of increasing KAD would be the increase of mean glandular dose for some women. However, assuming that DQE is a good indicator of image quality, introducing the proposed changes to the AEC system’s operation would result in the same image quality for all breast thicknesses.

This approach to DQE use for AEC system evaluation is independent of the image processing procedure and can be the basis for changes to system calibration done by the manufacturer’s technical support team.

Physical characterization of a novel wireless DRX Plus 3543C using both a carbon nano tube (CNT) mobile x-ray system and a traditional x-ray system

This work aims to characterize the novel DRX Plus 3543C detector in terms of detective quantum efficiency (DQE) using both a mobile x-ray system called Carestream DRX Revolution Nano and a traditional x-ray system (Carestream DRX Evolution). We used the commercial system DRX Revolution Nano, equipped with a new x-ray source based on CNT technology and field emission (FE) as the electron emitter (cathode). An innovative aspect of this device is its intrinsic selection of the focal spot size. We tested the system using three IEC-specified beam qualities (RQA3, 5 and 7) in terms of modulation transfer function (MTF), normalized noise power spectra (NNPS) and DQE as defined in the IEC 62220-1-1:2015. We compared the results obtained using DRX Revolution Nano and DRX Evolution with correlation and with Bland-Altman plots to study their agreement. RQA3 MTF is slightly lower than the RQA5 and 7 curves between 0.5 and 2.5 cycles mm^-1. We measured MTF values of about 0.6 at 1 lp mm^-1 and about 0.28 lp mm^-1 at 2 lp mm^-1. The NNPS curves show a decreasing trend with the energy regarding the DRX Revolution Nano. On the other hand, the DRX Evolution NNPS curve at RQA3 is greater than the one at RQA5, but the one at RQA5 is less than the one at RQA7. The DQE(0) ranged between about 0.82 (DRX Evolution at RQA3) and 0.54 (DRX Evolution at RQA7). As expected, the squared Pearson's correlation coefficients between the two x-ray tubes were always in an optimal agreement, and Bland-Altman plots confirmed a substantial equivalence between the two physical characterizations of the wireless detector. In conclusion, we can show that the dynamic focal selection of the system equipped with CNT does not play a substantial role in image quality compared to a traditional system in terms of physical characterisation of the detector in our measurement conditions.

Optimizing image quality using automatic exposure control based on the signal-difference-to-noise ratio: a phantom study

This study proposes to adjust the sensitivity of automatic exposure control (AEC) for achieving consistent image quality over a range of subject thicknesses in abdominal radiography simulations. The relation between image quality and subject thickness was investigated using a digital radiography system with 10-, 15-, 20-, and 25-cm-thick acrylic phantom. Simple pixel signal-to-noise ratio (SNR) was measured to check the default AEC accuracy for each thickness, and image quality was evaluated using the signal-difference-to-noise ratio (SDNR) with an additional acrylic plate and bone-equivalent material. Based on the figure of merit theory, dose ratios to obtain constant image quality regardless of the subject thickness were calculated from SDNR results. The AEC setup was manually modified using this dose ratio, and visibility was examined using a CDRAD 2.0 contrast-detail analysis phantom. Moreover, the entrance surface dose (ESD) was estimated as an index of exposure dose using exposure parameters. The default AEC setup provided a constant simple pixel SNR for each subject thickness with a high accuracy. SDNRs decreased with an increase in the subject thickness. The calculated dose ratios relative to the results for 20 cm thickness were 0.424, 0.647, and 1.43 for 10, 15 and 25 cm, respectively, and a > 25% decrease in ESD was observed for smaller patients. CDRAD analysis using the modified AEC setup showed almost identical visibility for each thickness. Adjusting the sensitivity of AEC according to subject thickness can contribute toward the optimization of the exposure condition.

Imaging and Dosimetric Study on Direct Flat-Panel Detector-Based Digital Mammography System

INTRODUCTION

Image quality of digital mammography system is generally defined by three primary physical parameters, namely, contrast, resolution, and noise. Quantification of these metrics can be done by measuring objective image quality parameters defined as contrast-to-noise ratio (CNR), modulation transfer function (MTF), and noise power spectra (NPS).

MATERIALS AND METHODS

In the present study, various imaging metrics such as CNR, contrast detail resolution, MTF, and NPS were evaluated for a direct flat-panel detector-based digital mammography system following the European Guidelines. Furthermore, system performance relating to both image quality and doses were evaluated using figure of merit (FOM) in terms of CNR2/mean glandular dose (MGD) under automatic exposure control (AEC) and clinically used OPDOSE operating mode.

RESULTS AND CONCLUSION

Under AEC mode, FOM values for the 4.5 cm thick BARC polymethyl methacrylate (PMMA) phantom were found to be 15.02, 15.88, and 19.82 at Mo/Mo, Mo/Rh, and W/Rh target/filter (T/F), respectively. Under OPDOSE mode, FOM values were found to 65.32, 11.80, and 1.14 for the BARC PMMA phantom thickness of 2, 4.5, and 8 cm, respectively. Under OPDOSE mode, the calculated MGD values for three Computerized Imaging Reference Systems slab phantoms having total thickness of 7 cm were observed to be 3.03, 2.32, and 1.75 mGy with glandular/adipose tissue compositions of 70/30, 50/50, and 30/70, respectively, whereas for the 2-8-cm thick BARC PMMA phantom, the calculated MGDs were found to be in the range of 0.57-3.32 mGy. All the calculated MGDs values were found to be lower than the acceptable level of dose limits provided in European Guidelines.

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.

Technical characterization of five x-ray detectors for paediatric radiography applications

Physical image quality of five x-ray detectors used in the paediatric imaging department is characterized with the aim of establishing the range/scope of imaging performance provided by these detectors for neonatal imaging. Two computed radiography (CR) detectors (MD4.0 powder imaging plate (PIP) and HD5.0 needle imaging plate (NIP), Agfa HealthCare NV, B-2640 Mortsel, Belgium) and three flat panel detectors (FPD) (the Agfa DX-D35C and DX-D45C and the DRX-2530C (Carestream Health Inc., Rochester, NY 14608, USA)) were assessed. Physical image quality was characterized using the detector metrics given by the International Electrotechnical Commission (IEC 62220-1) to measure modulation transfer function (MTF), the noise power spectrum (NPS) and the detective quantum efficiency (DQE) using the IEC-specified beam qualities of RQA3 and RQA5. The DQE was evaluated at the normal operating detector air kerma (DAK) level, defined at 2.5 µGy for all detectors, and at factors of 1/3.2 and 3.2 times the normal level. MTF curves for the different detectors were similar at both RQA3 and RQA5 energies; the average spatial frequency for the 50% point (MTF0.5) at RQA3 was 1.26 mm^-1, with a range from 1.20 mm^-1 to 1.37 mm^-1. The DQE of the NIP CR compared to the PIP CR was notably greater and similar to that for the FPD devices. At RQA3, average DQE for the FPD and NIP (at 0.5 mm^-1; 2.5 µGy) was 0.57 compared to 0.26 for the PIP CR. At the RQA5 energy, the DRX-2530C and the DX-D45C had the highest DQE (~0.6 at 0.5 mm^-1; 2.5 µGy). Noise separation analysis using the polynomial model showed higher electronic noise for the DX-D35C and DRX-2530C detectors; this explains the reduced DQE seen at 0.7 µGy/image. The NIP CR detector offers notably improved DQE performance compared to the PIP CR system and a value similar to the DQE for FPD devices at the RQA3 energy.

Impact of compressed breast thickness and dose on lesion detectability in digital mammography: FROC study with simulated lesions in real mammograms

PURPOSE

The aim of this work was twofold: (1) to examine whether, with standard automatic exposure control (AEC) settings that maintain pixel values in the detector constant, lesion detectability in clinical images decreases as a function of breast thickness and (2) to verify whether a new AEC setup can increase lesion detectability at larger breast thicknesses.

METHODS

Screening patient images, acquired on two identical digital mammography systems, were collected over a period of 2 yr. Mammograms were acquired under standard AEC conditions (part 1) and subsequently with a new AEC setup (part 2), programmed to use the standard AEC settings for compressed breast thicknesses ≤49 mm, while a relative dose increase was applied above this thickness. The images were divided into four thickness groups: T1 ≤ 29 mm, T2 = 30-49 mm, T3 = 50-69 mm, and T4 ≥ 70 mm, with each thickness group containing 130 randomly selected craniocaudal lesion-free images. Two measures of density were obtained for every image: a BI-RADS score and a map of volumetric breast density created with a software application (VolparaDensity, Matakina, NZ). This information was used to select subsets of four images, containing one image from each thickness group, matched to a (global) BI-RADS score and containing a region with the same (local) volpara volumetric density value. One selected lesion (a microcalcification cluster or a mass) was simulated into each of the four images. This process was repeated so that, for a given thickness group, half the images contained a single lesion and half were lesion-free. The lesion templates created and inserted in groups T3 and T4 for the first part of the study were then inserted into the images of thickness groups T3 and T4 acquired with higher dose settings. Finally, all images were visualized using the ViewDEX software and scored by four radiologists performing a free search study. A statistical jackknife-alternative free-response receiver operating characteristic analysis was applied.

RESULTS

For part 1, the alternative free-response receiver operating characteristic curves for the four readers were 0.80, 0.65, 0.55 and 0.56 in going from T1 to T4, indicating a decrease in detectability with increasing breast thickness. P-values and the 95% confidence interval showed no significant difference for the T3-T4 comparison (p = 0.78) while all the other differences were significant (p < 0.05). Separate analysis of microcalcification clusters presented the same results while for mass detection, the only significant difference came when comparing T1 to the other thickness groups. Comparing the scores of part 1 and part 2, results for the T3 group acquired with the new AEC setup and T3 group at standard AEC doses were significantly different (p = 0.0004), indicating improved detection. For this group a subanalysis for microcalcification detection gave the same results while no significant difference was found for mass detection.

CONCLUSIONS

These data using clinical images confirm results found in simple QA tests for many mammography systems that detectability falls as breast thickness increases. Results obtained with the AEC setup for constant detectability above 49 mm showed an increase in lesion detection with compressed breast thickness, bringing detectability of lesions to the same level.

Towards standardization of x-ray beam filters in digital mammography and digital breast tomosynthesis: Monte Carlo simulations and analytical modelling

In digital breast tomosynthesis and digital mammography, the x-ray beam filter material and thickness vary between systems. Replacing K-edge filters with Al was investigated with the intent to reduce exposure duration and to simplify system design. Tungsten target x-ray spectra were simulated with K-edge filters (50 µm Rh; 50 µm Ag) and Al filters of varying thickness. Monte Carlo simulations were conducted to quantify the x-ray scatter from various filters alone, scatter-to-primary ratio (SPR) with compressed breasts, and to determine the radiation dose to the breast. These data were used to analytically compute the signal-difference-to-noise ratio (SDNR) at unit (1 mGy) mean glandular dose (MGD) for W/Rh and W/Ag spectra. At SDNR matched between K-edge and Al filtered spectra, the reductions in exposure duration and MGD were quantified for three strategies: (i) fixed Al thickness and matched tube potential in kilovolts (kV); (ii) fixed Al thickness and varying the kV to match the half-value layer (HVL) between Al and K-edge filtered spectra; and, (iii) matched kV and varying the Al thickness to match the HVL between Al and K-edge filtered spectra. Monte Carlo simulations indicate that the SPR with and without the breast were not different between Al and K-edge filters. Modelling for fixed Al thickness (700 µm) and kV matched to K-edge filtered spectra, identical SDNR was achieved with 37-57% reduction in exposure duration and with 2-20% reduction in MGD, depending on breast thickness. Modelling for fixed Al thickness (700 µm) and HVL matched by increasing the kV over (0,4) range, identical SDNR was achieved with 62-65% decrease in exposure duration and with 2-24% reduction in MGD, depending on breast thickness. For kV and HVL matched to K-edge filtered spectra by varying Al filter thickness over (700, 880) µm range, identical SDNR was achieved with 23-56% reduction in exposure duration and 2-20% reduction in MGD, depending on breast thickness. These simulations indicate that increased fluence with Al filter of fixed or variable thickness substantially decreases exposure duration while providing for similar image quality with moderate reduction in MGD.

Optimization of contrast-enhanced breast imaging: Analysis using a cascaded linear system model

PURPOSE

Contrast-enhanced (CE) breast imaging involves the injection contrast agents (i.e., iodine) to increase conspicuity of malignant lesions. CE imaging may be used in conjunction with digital mammography (DM) or digital breast tomosynthesis (DBT) and has shown promise in improving diagnostic specificity. Both CE-DM and CE-DBT techniques require optimization as clinical diagnostic tools. Physical factors including x-ray spectra, subtraction technique, and the signal from iodine contrast, must be considered to provide the greatest object detectability and image quality. We developed a cascaded linear system model (CLSM) for the optimization of CE-DM and CE-DBT employing dual energy (DE) subtraction or temporal (TE) subtraction.

METHODS

We have previously developed a CLSM for DBT implemented with an a-Se flat panel imager (FPI) and filtered backprojection (FBP) reconstruction algorithm. The model is used to track image quality metrics - modulation transfer function (MTF) and noise power spectrum (NPS) - at each stage of the imaging chain. In this study, the CLSM is extended for CE breast imaging. The effect of x-ray spectrum (varied by changing tube potential and the filter) and DE and TE subtraction techniques on breast structural noise was measured was studied and included as a deterministic source of noise in the CLSM. From the two-dimensional (2D) and three-dimensional (3D) MTF and NPS, the ideal observer signal-to-noise ratio (SNR), also known as the detectability index (d'), may be calculated. Using d' as a FOM, we discuss the optimization of CE imaging for the task of iodinated contrast object detection within structured backgrounds.

RESULTS

Increasing x-ray energy was determined to decrease the magnitude of structural noise and not its correlation. By performing DE subtraction, the magnitude of the structural noise was further reduced at the expense of increased stochastic (quantum and electronic) noise. TE subtraction exhibited essentially no residual structural noise at the expense of increased quantum noise, even over that of the DE case. For DE subtraction, optimization of dose weighting to the HE view (f_h ) results in the minimization of quantum noise. Both subtraction weighting factor (w_Sub ) and the iodine contrast signal were dependent on the LE and HE x-ray spectra. To best detect a 5 mm Gaussian lesion with 5 mg/ml of iodine within a 4 cm thick breast, it was found that the high energy (HE) view should be acquired with a tube potential of 47 kVp (W/Ti spectrum) and the low energy (LE) view with a potential of 23 kVp (W/Rh spectrum). Due to the complete removal of structural noise, TE subtraction produced much higher d' than DE subtraction both as a function of mean glandular dose and iodine concentration.

CONCLUSIONS

We have shown the effect of increasing x-ray energy as well as projection domain subtraction on breast structural noise. Further, we have exhibited the utility of the CLSM for DE and TE subtraction CE imaging in the optimization of imaging parameters such as x-ray energy, f_h , and w_Sub as well as guiding the understanding of their effects on image contrast and noise.

CHARACTERISING THE EOS SLOT-SCANNING SYSTEM WITH THE EFFECTIVE DETECTIVE QUANTUM EFFICIENCY

As opposed to the standard detective quantum efficiency (DQE), effective DQE (eDQE) is a figure of merit that allows comparing the performances of imaging systems in the presence of scatter rejection devices. The geometry of the EOS™ slot-scanning system is such that the detector is self-collimated and rejects scattered radiation. In this study, the EOS system was characterised using the eDQE in imaging conditions similar to those used in clinical practice: with phantoms of different widths placed in the X-ray beam, for various incident air kerma and tube voltages corresponding to the phantom thickness. Scatter fractions in EOS images were extremely low, around 2 % for all configurations. Maximum eDQE values spanned 9-14.8 % for a large range of air kerma at the detector plane from 0.01 to 1.34 µGy. These figures were obtained with non-optimised EOS setting but still over-performed most of the maximum eDQEs recently assessed for various computed radiology and digital radiology systems with antiscatter grids.

Tailoring automatic exposure control toward constant detectability in digital mammography

PURPOSE

The automatic exposure control (AEC) modes of most full field digital mammography (FFDM) systems are set up to hold pixel value (PV) constant as breast thickness changes. This paper proposes an alternative AEC mode, set up to maintain some minimum detectability level, with the ultimate goal of improving object detectability at larger breast thicknesses.

METHODS

The default "opdose" AEC mode of a Siemens MAMMOMAT Inspiration FFDM system was assessed using poly(methyl methacrylate) (PMMA) of thickness 20, 30, 40, 50, 60, and 70 mm to find the tube voltage and anode/filter combination programmed for each thickness; these beam quality settings were used for the modified AEC mode. Detectability index (d'), in terms of a non-prewhitened model observer with eye filter, was then calculated as a function of tube current-time product (mAs) for each thickness. A modified AEC could then be designed in which detectability never fell below some minimum setting for any thickness in the operating range. In this study, the value was chosen such that the system met the achievable threshold gold thickness (Tt) in the European guidelines for the 0.1 mm diameter disc (i.e., Tt ≤ 1.10 μm gold). The default and modified AEC modes were compared in terms of contrast-detail performance (Tt), calculated detectability (d'), signal-difference-to-noise ratio (SDNR), and mean glandular dose (MGD). The influence of a structured background on object detectability for both AEC modes was examined using a CIRS BR3D phantom. Computer-based CDMAM reading was used for the homogeneous case, while the images with the BR3D background were scored by human observers.

RESULTS

The default opdose AEC mode maintained PV constant as PMMA thickness increased, leading to a reduction in SDNR for the homogeneous background 39% and d' 37% in going from 20 to 70 mm; introduction of the structured BR3D plate changed these figures to 22% (SDNR) and 6% (d'), respectively. Threshold gold thickness (0.1 mm diameter disc) for the default AEC mode in the homogeneous background increased by 62% in going from 20 to 70 mm PMMA thickness; in the structured background, the increase was 39%. Implementation of the modified mode entailed an increase in mAs at PMMA thicknesses >40 mm; the modified AEC held threshold gold thickness constant above 40 mm PMMA with a maximum deviation of 5% in the homogeneous background and 3% in structured background. SDNR was also held constant with a maximum deviation of 4% and 2% for the homogeneous and the structured background, respectively. These results were obtained with an increase of MGD between 15% and 73% going from 40 to 70 mm PMMA thickness.

CONCLUSIONS

This work has proposed and implemented a modified AEC mode, tailored toward constant detectability at larger breast thickness, i.e., above 40 mm PMMA equivalent. The desired improvement in object detectability could be obtained while maintaining MGD within the European guidelines achievable dose limit. (A study designed to verify the performance of the modified mode using more clinically realistic data is currently underway.).