A. Sarnelli

Evaluation of the minimum iodine concentration for contrast-enhanced subtraction mammography

Early manifestation of breast cancer is often very subtle and is displayed in a complex and variable pattern of normal anatomy that may obscure the disease. The use of dual-energy techniques, that can remove the structural noise, and contrast media, that enhance the region surrounding the tumour, could help us to improve the detectability of the lesions. The aim of this work is to investigate the use of an iodine-based contrast medium in mammography with two different double exposure techniques: K-edge subtraction mammography and temporal subtraction mammography. Both techniques have been investigated by using an ideal source, like monochromatic beams produced at a synchrotron radiation facility and a clinical digital mammography system. A dedicated three-component phantom containing cavities filled with different iodine concentrations has been developed and used for measurements. For each technique, information about the minimum iodine concentration, which provides a significant enhancement of the detectability of the pathology by minimizing the risk due to high dose and high concentration of contrast medium, has been obtained. In particular, for cavities of 5 and 8 mm in diameter filled with iodine solutions, the minimum concentration needed to obtain a contrast-to-noise ratio of 5 with a mean glandular dose of 2 mGy has been calculated. The minimum concentrations estimated with monochromatic beams and K-edge subtraction mammography are 0.9 mg ml(-1) and 1.34 mg ml(-1) for the biggest and smallest details, respectively, while for temporal subtraction mammography they are 0.84 mg ml(-1) and 1.31 mg ml(-1). With the conventional clinical system the minimum concentrations for the K-edge subtraction mammography are 4.13 mg ml(-1) (8 mm diameter) and 5.75 mg ml(-1) (5 mm diameter), while for the temporal subtraction mammography they are 1.01 mg ml(-1) (8 mm diameter) and 1.57 mg ml(-1) (5 mm diameter).

K-edge digital subtraction imaging based on a dichromatic and compact x-ray source

This work proposes a compact dichromatic imaging system for the application of the K-edge digital subtraction technique based on a conventional x-ray tube and a monochromator system. A quasi-monochromatic x-ray beam at the energy of iodine K-edge is produced by Bragg diffraction on a mosaic crystal. Two thin adjacent beams with energies that bracket the K-edge discontinuity are obtained from the diffracted beam by means of a proper collimation system. They are then detected using an array of Si detectors. A home-made phantom is used to study the image quality as a function of iodine concentration. Signal and signal-to-noise ratio analysis has also been performed. The results are compared with theoretical expectations.

Contrast cancellation technique applied to digital x-ray imaging using silicon strip detectors.

Dual-energy mammographic imaging experimental tests have been performed using a compact dichromatic imaging system based on a conventional x-ray tube, a mosaic crystal, and a 384-strip silicon detector equipped with full-custom electronics with single photon counting capability. For simulating mammal tissue, a three-component phantom, made of Plexiglass, polyethylene, and water, has been used. Images have been collected with three different pairs of x-ray energies: 16-32 keV, 18-36 keV, and 20-40 keV. A Monte Carlo simulation of the experiment has also been carried out using the MCNP-4C transport code. The Alvarez-Macovski algorithm has been applied both to experimental and simulated data to remove the contrast between two of the phantom materials so as to enhance the visibility of the third one.

Quantitative analysis of the effect of energy separation in k-edge digital subtraction imaging.

The aim of the work is to quantitatively compare the effect of the energy separation in the k-edge digital subtraction imaging technique. Images of a custom-made, iodine filled (k-edge = 33.17 keV) test object have been acquired with monochromatic x-ray beams (energy spread <0.1 keV) at the ID17 biomedical beamline of the ESRF. Image acquisition has been performed using two energy separations, namely 0.65 keV (32.85 keV and 33.5 keV, respectively) and 4.4 keV (31.2 keV and 35.6 keV, respectively), using beams of energies on either side of the iodine k-edge. Signal and signal-to-noise ratio (SNR) analysis has been performed as a function of DeltaE and the contrast medium concentrations. The results show that the SNR values measured for DeltaE < 1 keV are only slightly higher than those measured for DeltaE = 4.4 keV. This preliminary study shows that monochromaticity and the energy separation obtained with quasi monochromatic beams from conventional x-ray sources might be suitable for this imaging technique.

Results about imaging with silicon strips for Angiography and Mammography

We present results obtained with a single photon counting system consisting of 384 silicon microstrips of 100 micron pitch equipped with 6 RX64 ASICs. The ASIC includes a charge preamplifier, a shaper, a discriminator and a 20‐bit counter for each of its 64 channels. The energy resolution of the system has been measured in the range from 8 keV to 32 keV using fluorescence X‐ray lines from several targets, using either an Am‐241 source or an X‐ray tube. Then, the efficiency of the system has been determined using the specially developed quasi‐monochromatic X‐ray beams in the energy range 18–36 KeV. Good efficiency has been obtained in the edge‐on configuration, which is more suitable for the intended applications. The spatial resolution of the system has been verified using a special microfocus X‐ray tube equipped with capillaries. Finally, images of angiographic and mammographic test objects have been obtained with dual energy X‐ray beams and have then been processed with the dual energy subtraction techn...

Digital system based on a bichromatic x-ray source and a single-photon counting device: a single-exposure dual-energy mammography approach

In this work we exploit the advantages of using a bi-chromatic X-rays source coupled with a single photon counting pixel detector to perform a feasibility study for dual energy mammography. This technique allows enhancing the contrast between different breast tissues by composing two images acquired at two different energies. The high and low energy images have been acquired by a single X-ray shot. The bi-chromatic beam has been produced per diffraction of polychromatic photons by a monochromator crystal. The imaging system is based on a single photon counting silicon pixel detector. The data read-out is performed by a VLSI Integrated Circuit bump-bonded to the sensor. The energy threshold of each electronics channel can be individually trimmed. We set the threshold of one pixel below 16 keV while the threshold of the neighboring pixel between 16 and 32 keV. With a single exposure the information from both energies is recorded. After separation between low and high threshold pixels, we obtained two independent images. We acquired radiographs of phantoms made of three different materials. Appling a dual energy algorithm, we obtained synthesized images where any of the three materials is removed from the radiograph, enhancing the contrast between the two remaining.

Effect of x-ray energy dispersion in digital subtraction imaging at the iodine K-edge--A Monte Carlo study

The effect of the energy dispersion of a quasi-monochromatic x-ray beam on the performance of a dual-energy x-ray imaging system is studied by means of Monte Carlo simulations using MCNPX (Monte Carlo N-Particle eXtended) version 2.6.0. In particular, the case of subtraction imaging at the iodine K-edge, suitable for angiographic imaging application, is investigated. The average energies of the two beams bracketing the iodine K-edge are set to the values of 31.2 and 35.6 keV corresponding to the ones obtained with a compact source based on a conventional x-ray tube and a mosaic crystal monochromator. The energy dispersion of the two beams is varied between 0 and 10 keV of full width at half-maximum (FWHM). The signal and signal-to-noise ratio produced in the simulated images by iodine-filled cavities (simulating patient vessels) drilled in a PMMA phantom are studied as a function of the x-ray energy dispersion. The obtained results show that, for the considered energy separation of 4.4 keV, no dramatic deterioration of the image quality is observed with increasing x-ray energy dispersion up to a FWHM of about 2.35 keV. The case of different beam energies is also investigated by means of fast simulations of the phantom absorption.

Dichromatic source for the application of dual-energy tissue cancellation in mammography

A novel x-ray source, providing dichromatic beams for the application of dual-energy radiography, has been assembled and studied. The system works via Bragg diffraction, by monochromatizing the beam produced by a conventional W-anode x-ray tube with a mosaic crystal monochromator. The source generates a laminar beam (10 cm-high and 0.8 cm-wide), composed by two spatially superimposed quasi-monochromatic beams. The characteristics of the radiation field in terms of energy resolution and fluence have been reported, for three pairs of energies. A study of the spectra attenuated by several phantoms of breast equivalent tissue of different thicknesses shows that the optimal energy of the dichromatic beam for dual energy mammography application ranges between 18/36 keV and 18.6/37.2 keV and may be set as a function of the thickness or density of investigated tissue.

A silicon microstrip system equipped with the RX64DTH ASIC for dual energy mammography

We present results obtained with a single photon counting system of 384 silicon microstrips (100 micron pitch) equipped with six RX64DTH ASICs including charge preamplifier, shaper, two discriminators and two 20-bit counters for each channel. The energy resolution of the system was determined to be of 0.72 keV (rms) with a spread of threshold setting of 0.32 keV for the whole 384-channel module (at energies of 29-33 keV), indicating its excellent potential for dual-energy imaging. Images of a mammographic test object made of PMMA, polyethylene and water were taken in scanning mode (strips parallel to incoming X-rays) under the dual energy X-ray beams. Images were subsequently processed with the dual energy subtraction technique (Alvarez and Macovski, 1976). Experimental results agree well with MCNP simulations of the mammographic phantom and demonstrate the capability of our system to obtain contrast cancellation between two kinds of materials, thereby enhancing the visibility of small features in the third material.

Comparative study of in-vivo image improvement and dose reduction with dual energy angiography

The imaging capabilities of the dual energy angiography (DEA) based on the Bragg diffraction on a pyrolitic graphite target and CCD detectors coupled with fiber optic plate with scintillator (FOS) was evaluated using an experimental setup built for phantoms and small animals. The scanning system was built with a new X-ray source, which produces two thin parallel quasi-monochromatic beams starting from a conventional X-ray tube; these beams have peak energies centered before and after the iodine K-edge energy respectively. The polychromatic X-ray beam is monochromatized by Bragg diffraction on a pyrolitic graphite crystal and splitted in two thin parallel beams. The beams go through the phantom and are detected with a CCD coupled with FOS detector. The image results as difference between the remaining intensities of two beams. In this work, we will report results obtained in terms of sensitivity, image quality and dose reduction in comparison with standard angiographic apparatus. In particular, the capability to visualize small vessels will be discussed.