PurposeDigital breast tomosynthesis (DBT) has been introduced more than a decade ago. Studies have shown higher breast cancer detection rates and lower recall rates, and it has become an established imaging method in diagnostic settings. However, full-field digital mammography (FFDM) remains the most common imaging modality for screening in many countries, as it delivers high-resolution planar images of the breast. To combine the advantages of DBT with the faster acquisition and the unique in-plane resolution capabilities known from FFDM, a system concept was developed for application in screening and diagnosis.ApproachThe concept comprises an X-ray tube with adaptive focal spot position based on the flying focal spot (FFS) technology and optimized X-ray spectra. This is combined with innovative algorithmic concepts for tomosynthesis reconstruction and synthetic mammograms (SMs).ResultsAn X-ray tube with FFS was incorporated into a DBT system that performs 50-deg wide tomosynthesis scans with 25 projections in 4.85 s. Laboratory evaluations demonstrated significant improvements in the effective modular transfer function (eMTF). The improved eMTF as well as the effectiveness of the algorithmic concepts is shown in images from a clinical evaluation study.ConclusionsThe DBT system concept enables high spatial resolution at short acquisition times. This leads to improved microcalcification visibility, reduced risk of motion artifacts, and shorter breast compression times. It shifts the in-plane resolution of DBT into the high-resolution range of FFDM. The presented technology leap might be a key contributor to facilitating the paradigm shift of replacing FFDM with DBT plus SM.
KEYWORDS: Digital breast tomosynthesis, Mammography, Breast, X-rays, Modulation transfer functions, Imaging systems, Tomosynthesis, Spatial resolution, Breast cancer
Digital breast tomosynthesis (DBT) enables significantly higher cancer detection rates compared to full-field digital mammography (FFDM) without compromising the recall rate. However, regarding microcalcification assessment established tomosynthesis system concepts still tend to be inferior to FFDM. To further boost the clinical role of DBT in breast cancer screening and diagnosis, a system concept was developed that enables fast wide-angle DBT with the unique in-plane resolution capabilities known from FFDM. The concept comprises a novel x-ray tube concept that incorporates an adaptive focal spot position, fast flat-panel detector technology, and innovative algorithmic concepts for image reconstruction. We have built a DBT system that provides tomosynthesis image stacks and synthetic mammograms from 50° tomosynthesis scans realized in less than five seconds. In this contribution, we motivate the design of the system concept, present a physics characterization of its imaging performance, and outline the algorithmic concepts used for image processing. We conclude with illustrating the potential clinical impact by means of clinical case examples from first evaluations in Europe.
Recently introduced multi-layer flat panel detectors (FPDs) enable single acquisition spectral radiography. We perform an in-depth simulation study to investigate different decomposition algorithms under the influence of adipose tissue and scattered radiation using physics-based material decomposition algorithms for the task of bone removal. We examine a matrix-based material decomposition (MBMD) under assumption of monoenergetic X-ray spectra (equivalent to weighted logarithmic subtraction (WLS)), a matrix-based material decomposition with polynomial beam hardening pre-correction (MBMD-PBC) and a projection domain decomposition (PDD). The simulated setup corresponds to an intensive care unit (ICU) anterior posterior (AP) bedside chest examination (contact scan). The limitations of the three algorithms are evaluated using a high-fidelity X-ray simulator with five phantom realizations that differ in terms of added adipose tissue. For each simulated phantom realization, different amounts of scatter correction are considered, ranging from no correction at all to an ideal scatter correction. Unless quantitative imaging is required, the three algorithms are capable of removing bone structures when adipose tissue is present. Bone removal using a multi-layer FPDs in an ICU setup is feasible. However, uncorrected scatter can lead to bone structures becoming visible in the soft tissue image. This indicates the need for accurate scatter estimation and correction algorithms, especially when using quantitative algorithms such as PDD.
Wide–angle digital breast tomosynthesis (DBT) is well known to offer benefits in mass perceptibility compared to narrow–angle DBT due to reduced anatomical overlap. Regarding the perceptibility of micro–calcifications the situation is somehow inverted. On the one hand this can be related to effects during data acquisition and their impact on the system MTF. On the other hand there is a wider spread of calcifications in depth direction in narrow–angle DBT, which distributes calcifications over more slices. This is equivalent to an inherent thicker slice for high spatial frequencies. In this work we want to assume an equivalent quality of raw data and only focus on the effects of different acquisition angles in the reconstruction. We propose an algorithm which creates so–called hybrid thick DBT slices and optimizes the visualization of calcifications while preserving the high mass perceptibility of thin wide–angle DBT slices. The algorithm is purely based on filtered backprojection (FBP) and can be implemented in an efficient manner. For validation simulation studies using the VICTRE (FDA) pipeline are performed. Our results indicate that hybrid thick–slices in wide-angle DBT enable to successfully solve the contrarian imaging tasks of high mass and high calcification perception within one imaging setup.
PURPOSE: To investigate differences in microcalcification detection performance for different acquisition setups in digital breast tomosynthesis (DBT), a convex dose distribution and sparser number of projections compared to the standard set-up was evaluated via a virtual clinical trial (VCT). METHODS AND MATERIALS: Following the Institutional Review Board (IRB) approval and patient consent, mediolateral oblique (MLO) DBT views were acquired at twice the automatic exposure controlled (AEC) dose level; omitting the craniocaudal (CC) view limited the total examination dose. Microcalcification clusters were simulated into the DBT projections and noise was added to simulate lower dose levels. Three set-ups were evaluated: (1) 25 DBT projections acquired with a fixed dose/projection at the clinically used AEC dose level, (2) 25 DBT projections with dose/projection following a convex dose distribution along the scan arc, and (3) 13 DBT projections at higher dose with the total scan dose equal to the AEC dose level and preserving the angular range of 50° (sparse). For the convex set-up, dose/projection started at 0.035 mGy at the extremes and increased to 0.163 mGy for the central projection. A Siemens prototype algorithm was used for reconstruction. An alternative free-response receiver operating characteristic (AFROC) study was conducted with 6 readers to compare the microcalcification detection between the acquisition set-ups. Sixty cropped VOIs of 50x50x(breast thickness) mm3 per set-up were included, of which 50% contained a microcalcification cluster. In addition to localization of the cluster, the readers were asked to count the individual calcifications. The area under the AFROC curve was used to compare the different acquisition set-ups and a paired t-test was used to test significance. RESULTS: The AUCs for the standard, convex and sparse set-up were 0.97±0.01, 0.95±0.02 and 0.89±0.03, respectively, indicating no significant difference between standard and convex set-up (p=0.309), but a significant decrease in detectability was found for the sparse set-up (p=0.001). The number of detected calcifications per cluster was not significantly different between standard and convex set-ups (p=0.049), with 42%±9% and 40%±8%, respectively. The sparse set-up scored lower with a relative number of detected microcalcifications of 34%±11%, but this decrease was not significant (p=0.031). CONCLUSION: A convex dose distribution that increased dose along the scan arc towards the central projections did not increase detectability of microcalcifications in the DBT planes compared to the current AEC set-up. Conversely, a sparse set of projections acquired over the total scan arc decreased microcalcification detectability compared to the variable dose and current clinical set-up.
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