Angelo Taibi

Dual-energy tissue cancellation in mammography with quasi-monochromatic x-rays

Dual-energy radiography has not evolved into a routine clinical examination yet due to intrinsic limitations of both dual-kVp imaging and single-exposure imaging with conventional x-ray sources. The recent introduction of novel quasi-monochromatic x-ray sources and detectors could lead to interesting improvements, especially in mammography where the complex structure of healthy tissues often masks the detectability of lesions. A dual-energy radiography technique based on a tissue cancellation algorithm has been developed for mammography, with the aim of maximizing the low intrinsic contrast of pathologic tissues while being able to minimize or cancel the contrast between glandular and fat tissues. Several images of a plastic test object containing various tissue equivalent inserts were acquired in the energy range 17-36 keV using a quasi-monochromatic x-ray source and a scintillator-coated CCD detector. Images acquired at high and low energies were nonlinearly combined to generate two energy-independent basis images. Suitable linear combinations of these two basis images result in the elimination of the contrast of a given material with respect to another. This makes it possible to selectively cancel certain details in the processed image.

Updating of form factor tabulations for coherent scattering of photons in tissues.

An updating of photon transport modelling in tissues is carried out by including the effect of molecular interference in the coherent (Rayleigh) scattering. To this end, the present tabulations--which permit us to obtain the linear differential scattering coefficient of compounds from a simple weighted sum of the elemental components--are integrated by adding files for a limited set of molecular interference functions. This set originates from a four-component model which is found to be capable of reproducing human tissues in situations involving bony and soft tissues. The proposed procedure overcomes, in the computation, the hindrance that the dependence on molecular interference effects leads every tissue to have its own diffraction pattern, which is not easily obtained by means of measurements or calculations.

An ultrasound model to calculate the brain blood outflow through collateral vessels: a pilot study

BackgroundThe quantification of the flow returning from the head through the cervical veins and the collaterals of the internal jugular vein (IJV), is becoming of prominent interest in clinical practice. We developed a novel model to calculate the cerebral venous return, normalized to the arterial inflow, in the different segments of the IJV.MethodsWe assessed, by established Echo Colour Doppler (ECD) methodology, the head inflow (HBinF) defined as the sum of common carotids and vertebral arteries, as well as the cerebral flow (CBF) defined as the sum of internal carotid and vertebral arteries. We also assessed the head outflow (HBoutF) defined as the sum of the measurements at the junction of the IJV and the vertebral veins. In addition, we also calculated the collateral flow index (CFI) by estimating the flow which re-enters directly into the superior vena cava as the amount of blood extrapolated by the difference between the HBinF and the HBoutF. We preliminarily tested the model by comparing ten healthy controls (HC) with ten patients affected by chronic cerebral spinal venous insufficiency (CCSVI), a condition characterized by some blockages in the IJV which are bypassed by collateral circulation.ResultsIn HC the HBinF was 956+-105ml/min, whereas the HBoutF was > 90% of the HBinF, leading to a final CFI value of 1%. The last result shows that a very small amount of blood is drained by the collaterals. In upright we confirmed a reduction of the outflow through the IJV which increased CFI to 9%. When we applied the model to CCSVI, the HBinF was not significantly different from controls. In supine, the flow of CCSVI patients in the IJV junction was significantly lower (p < 0.001) while the correspondent CFI value significantly increased (61%, p < 0.0002).ConclusionsOur preliminary application of the novel model in the clinical setting suggests the pivotal role of the collateral network in draining the blood into the superior vena cava under CCSVI condition.

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).

A prototype of a quasi-monochromatic system for mammography applications

Improvement in image contrast and dose reduction, in mammographic x-ray imaging, can be achieved using narrow energy band x-ray beams in the 16-24 keV range. As part of an Italian Government funded project, a quasi-monochromatic system for mammography applications has been developed. The system is based on a tunable narrow energy band x-ray source operating in the 16-24 keV energy range. The bremsstrahlung beam is monochromatized via Bragg diffraction by a highly oriented pyrolytic graphite mosaic crystal (HOPG). The scanning system provides a large field (18 x 24 cm2) of quasi-monochromatic x-rays with energy resolution ranging from 10% at 18 keV to 17.2% at 24 keV. The system has been characterized in terms of fluence rate and energy resolution. An x-ray tube developed ad hoc allows us to acquire images in a reasonable time to minimize the motion blur. A qualitative analysis has been performed in order to know if the prototype system performances are far from a clinical application, by evaluating the spatial resolution, the field uniformity and the image quality as a function of the quasi-monochromatic beam energy. Dose evaluation has been performed as a function of the energy and compared to a conventional system for mammography. The quasi-monochromatic prototype system can produce comparable image quality at half the dose.

Narrow energy band X-rays via mosaic crystal for mammography application

Abstract Monochromatic X-ray beams are desirable in various fields of diagnostic radiology. We are investigating an imaging system based on a narrow energy band X-ray source for mammography application. The narrow energy band is obtained by making use of a mosaic crystal that reflects X-rays from a conventional X-ray tube via Bragg diffraction. In this paper the characteristics of the system in terms of energy resolution and fluence rate are reported. Small field (1.1 × 3.0 cm 2 ) radiographs of Plexiglas phantoms with a thickness up to 3.6 cm have been obtained with 18, 20 and 22 keV quasi-monochromatic beams. The field size is limited by the crystal size along one dimension and by the desired energy spread along the other one. A digital imaging system has been used to correct for non-uniformity of the X-ray beam.

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.

Does thoracic pump influence the cerebral venous return

We assessed the hemodynamic effects induced by the thoracic pump in the intra- and extracranial veins of the cerebral venous system on healthy volunteers. Activation of the thoracic pump was standardized among subjects by setting the deep inspiration at 70% of individual vital capacity. Peak velocity (PV), time average velocity (TAV), vein area (VA), and flow quantification (Q) were assessed by means of echo color Doppler in supine posture. Deep respiration significantly increases PV, TAV, and Q, but it is limited to the extracranial veins. To the contrary, no significant hemodynamic changes were recorded at the level of the intracranial venous network. Moreover, at rest TAV in the jugular veins was significantly correlated with Q of the intracranial veins. We conclude that the modulation of the atmospheric pressure operated by the thoracic pump significantly modifies the hemodynamics of the jugular veins and of the reservoir of the neck and facial veins, with no effect on the vein network of the intracranial compartment.

MTF evaluation of a phosphor-coated CCD for x-ray imaging

A novel digital x-ray detector has been assembled. The imaging system is based on a phosphor-coated charge-coupled device (CCD) obtained by direct deposition of a gadolinium oxysulphide scintillator onto the detector surface. The modulation transfer function has been measured along the two directions of the digital coordinates with the narrow slit technique. A resolution limit of about 20 line pairs per mm has been obtained for both directions. The high spatial resolution currently demanded in mammography can be achieved with this imaging system.

A novel approach to digital breast tomosynthesis for simultaneous acquisition of 2D and 3D images

ObjectiveThe complexity of anatomical structure within the breast represents the ultimate limit to signal detection on a mammogram. To increase lesion conspicuity Digital Breast Tomosynthesis (DBT) has been recently proposed and several manufacturers are currently performing clinical trials. In this study we investigate the potential of DBT with variable dose distribution by using a phantom in which details of interest are within a heterogeneous background.MethodsTo compare the performance of a commercial digital mammography unit and a DBT prototype, 2D and 3D images of the breast phantom were obtained at similar dose levels.ResultsAs expected, DBT showed superior performance over digital mammography. Although certain details of interest are not detectable with digital mammography, DBT can reveal their signal by reducing the complexity of tissue structures. Additionally, the potential of the central projection in variable dose DBT is similar to the standard projection obtained with digital mammography. Finally, the uniform and variable dose approaches provided almost identical reconstructed slices.ConclusionThis preliminary investigation demonstrates that breast tomosynthesis acquired with variable dose distribution exhibits inherent 3D reconstruction advantages for structure noise removal and provides a 2D projection with a physical image quality close to that of standard mammography.