Antonio Sarno

Towards breast tomography with synchrotron radiation at Elettra: First images

The aim of the SYRMA-CT collaboration is to set-up the first clinical trial of phase-contrast breast CT with synchrotron radiation (SR). In order to combine high image quality and low delivered dose a number of innovative elements are merged: a CdTe single photon counting detector, state-of-the-art CT reconstruction and phase retrieval algorithms. To facilitate an accurate exam optimization, a Monte Carlo model was developed for dose calculation using GEANT4. In this study, high isotropic spatial resolution (120 μm)(3) CT scans of objects with dimensions and attenuation similar to a human breast were acquired, delivering mean glandular doses in the range of those delivered in clinical breast CT (5-25 mGy). Due to the spatial coherence of the SR beam and the long distance between sample and detector, the images contain, not only absorption, but also phase information from the samples. The application of a phase-retrieval procedure increases the contrast-to-noise ratio of the tomographic images, while the contrast remains almost constant. After applying the simultaneous algebraic reconstruction technique to low-dose phase-retrieved data sets (about 5 mGy) with a reduced number of projections, the spatial resolution was found to be equal to filtered back projection utilizing a four fold higher dose, while the contrast-to-noise ratio was reduced by 30%. These first results indicate the feasibility of clinical breast CT with SR.

Imaging performance of phase-contrast breast computed tomography with synchrotron radiation and a CdTe photon-counting detector

PURPOSE Within the SYRMA-CT collaboration based at the ELETTRA synchrotron radiation (SR) facility the authors investigated the imaging performance of the phase-contrast computed tomography (CT) system dedicated to monochromatic in vivo 3D imaging of the female breast, for breast cancer diagnosis. METHODS Test objects were imaged at 38keV using monochromatic SR and a high-resolution CdTe photon-counting detector. Signal and noise performance were evaluated using modulation transfer function (MTF) and noise power spectrum. The analysis was performed on the images obtained with the application of a phase retrieval algorithm as well as on those obtained without phase retrieval. The contrast to noise ratio (CNR) and the capability of detecting test microcalcification clusters and soft masses were investigated. RESULTS For a voxel size of (60μm)(3), images without phase retrieval showed higher spatial resolution (6.7mm(-1) at 10% MTF) than corresponding images with phase retrieval (2.5mm(-1)). Phase retrieval produced a reduction of the noise level and an increase of the CNR by more than one order of magnitude, compared to raw phase-contrast images. Microcalcifications with a diameter down to 130μm could be detected in both types of images. CONCLUSIONS The investigation on test objects indicates that breast CT with a monochromatic SR source is technically feasible in terms of spatial resolution, image noise and contrast, for in vivo 3D imaging with a dose comparable to that of two-view mammography. Images obtained with the phase retrieval algorithm showed the best performance in the trade-off between spatial resolution and image noise.

Glandular dose in breast computed tomography with synchrotron radiation

The purpose of this work is to provide an evaluation of the mean glandular dose (MGD) for breast computed tomography (CT) with synchrotron radiation in an axial scanning configuration with a partial or total organ volume irradiation, for the in vivo program of breast CT ongoing at the ELETTRA facility (Trieste, Italy). A Geant4 Monte Carlo code was implemented, simulating the photon irradiation from a synchrotron radiation source in the energetic range from 8 to 50 keV with 1 keV intervals, to evaluate the MGD. The code was validated with literature data, in terms of mammographic normalized glandular dose coefficients (DgN) and with ad hoc experimental data, in terms of computed tomography dose index (CTDI). Simulated cylindrical phantoms of different sizes (diameter at phantom base 8, 10, 12, 14 or 16 cm, axial length 1.5 times the radius) and glandular fraction by weight (0%, 14.3%, 25%, 50%, 75% and 100%) were implemented into the code. The validation of the code shows an excellent agreement both with previously published work and in terms of DgN and CDTI measurements. The implemented simulations show a dependence of the glandular dose estimate on the vertical dimension of the irradiated zone when a partial organ irradiation was implemented. Specific normalized coefficients for calculating the MGD to the whole breast or to the single irradiated slice were reported.

A Monte Carlo study of monoenergetic and polyenergetic normalized glandular dose (DgN) coefficients in mammography

We investigated the influence of model assumptions in GEANT4 Monte Carlo (MC) simulations for the calculation of monoenergetic and polyenergetic normalized glandular dose coefficients (DgN) in mammography, focussing on the effect of the skin thickness and composition, of the role of compression paddles and of the bremsstrahlung processes. We showed that selecting a skin thickness of 4 mm instead of 1.45 mm produced DgN values with deviations from 9% to 32% for x-ray spectra routinely adopted in mammography. Consideration of the bremsstrahlung radiation had a weak influence on monoenergetic DgN. Simulations (in the range 8-40 kVp) which included consideration of bremsstrahlung radiation, a skin thickness of 1.45 mm and a 2 mm thick compression paddles produced polyenergetic DgN coefficients up to 19% higher than corresponding literature data. Adding a 2 mm thick adipose layer between the skin layer and the radiosensitive portion of the breast produces polyenergetic DgN values up to 15% higher than those routinely adopted. These findings provide a quantitative estimate of the influence of model parameters on the calculation of the mean glandular dose in mammography.

Cone-beam micro computed tomography dedicated to the breast.

We developed a scanner for micro computed tomography dedicated to the breast (BµCT) with a high resolution flat-panel detector and a microfocus X-ray tube. We evaluated the system spatial resolution via the 3D modulation transfer function (MTF). In addition to conventional absorption-based X-ray imaging, such a prototype showed capabilities for propagation-based phase-contrast and related edge enhancement effects in 3D imaging. The system limiting spatial resolution is 6.2mm-1 (MTF at 10%) in the vertical direction and 3.8mm-1 in the radial direction, values which compare favorably with the spatial resolution reached by mini focus breast CT scanners of other groups. The BµCT scanner was able to detect both microcalcification clusters and masses in an anthropomorphic breast phantom at a dose comparable to that of two-view mammography. The use of a breast holder is proposed in order to have 1-2min long scan times without breast motion artifacts.

Energy dependent calibration of XR-QA2 radiochromic film with monochromatic and polychromatic x-ray beams.

PURPOSE This work investigates the energy response and dose-response curve determinations for XR-QA2 radiochromic film dosimetry system used for synchrotron radiation work and for quality assurance in diagnostic radiology, in the range of effective energies 18-46.5 keV. METHODS Pieces of XR-QA2 films were irradiated, in a plane transverse to the beam axis, with a monochromatic beam of energy in the range 18-40 keV at the ELETTRA synchrotron radiation facility (Trieste, Italy) and with a polychromatic beam from a laboratory x-ray tube operated at 80, 100, and 120 kV. The film calibration curve was expressed as air kerma (measured free-in-air with an ionization chamber) versus the net optical reflectance change (netΔR) derived from the red channel of the RGB scanned film image. Four functional relationships (rational, linear exponential, power, and logarithm) were tested to evaluate the best curve for fitting the calibration data. The adequacy of the various fitting functions was tested by using the uncertainty analysis and by assessing the average of the absolute air kerma error calculated as the difference between calculated and delivered air kerma. The sensitivity of the film was evaluated as the ratio of the change in net reflectance to the corresponding air kerma. RESULTS The sensitivity of XR-QA2 films increased in the energy range 18-39 keV, with a maximum variation of about 170%, and decreased in the energy range 38-46.5 keV. The present results confirmed and extended previous findings by this and other groups, as regards the dose response of the radiochromic film XR-QA2 to monochromatic and polychromatic x-ray beams, respectively. CONCLUSIONS The XR-QA2 radiochromic film response showed a strong dependence on beam energy for both monochromatic and polychromatic beams in the range of half value layer values from 0.55 to 6.1 mm Al and corresponding effective energies from 18 to 46.5 keV. In this range, the film response varied by 170%, from a minimum sensitivity of 0.0127 to a maximum sensitivity of 0.0219 at 10 mGy air kerma in air. The more suitable function for air kerma calibration of the XR-QA2 radiochromic film was the power function. A significant batch-to-batch variation, up to 55%, in film response at 120 kV (46.5 keV effective energy) was observed in comparison with published data.

Imaging study of a phase-sensitive breast-CT system in continuous acquisition mode

The SYRMA-CT project aims to set-up the first clinical trial of phase-contrast breast Computed Tomography with synchrotron radiation at the SYRMEP beamline of Elettra, the Italian synchrotron light source. The challenge in a dedicated breast CT is to match a high spatial resolution with a low dose level. In order to fulfil these requirements, the SYRMA-CT project uses a large area CdTe single photon counting detector (Pixirad-8), simultaneous algebraic reconstruction technique (SART) and phase retrieval pre-processing. This work investigates the imaging performances of the system in a continuous acquisition mode and with a low dose level towards the clinical application. A custom test object and a large surgical sample have been studied.

A Monte Carlo model for mean glandular dose evaluation in spot compression mammography

Purpose To characterize the dependence of normalized glandular dose (DgN) on various breast model and image acquisition parameters during spot compression mammography and other partial breast irradiation conditions, and evaluate alternative previously proposed dose‐related metrics for this breast imaging modality. Methods Using Monte Carlo simulations with both simple homogeneous breast models and patient‐specific breasts, three different dose‐related metrics for spot compression mammography were compared: the standard DgN, the normalized glandular dose to only the directly irradiated portion of the breast (DgNv), and the DgN obtained by the product of the DgN for full field irradiation and the ratio of the mid‐height area of the irradiated breast to the entire breast area (DgNM). How these metrics vary with field‐of‐view size, spot area thickness, x‐ray energy, spot area and position, breast shape and size, and system geometry was characterized for the simple breast model and a comparison of the simple model results to those with patient‐specific breasts was also performed. Results The DgN in spot compression mammography can vary considerably with breast area. However, the difference in breast thickness between the spot compressed area and the uncompressed area does not introduce a variation in DgN. As long as the spot compressed area is completely within the breast area and only the compressed breast portion is directly irradiated, its position and size does not introduce a variation in DgN for the homogeneous breast model. As expected, DgN is lower than DgNv for all partial breast irradiation areas, especially when considering spot compression areas within the clinically used range. DgNM underestimates DgN by 6.7% for a W/Rh spectrum at 28 kVp and for a 9 × 9 cm2 compression paddle. Conclusion As part of the development of a new breast dosimetry model, a task undertaken by the American Association of Physicists in Medicine and the European Federation of Organizations of Medical Physics, these results provide insight on how DgN and two alternative dose metrics behave with various image acquisition and model parameters.

Dose Volume Distribution in Digital Breast Tomosynthesis: A Phantom Study

Monte Carlo (MC) calculations for breast dosimetry in digital breast tomosynthesis (DBT) require experimental validations. We measured the 3-D dose distribution in breast phantoms, using XR-QA2 radiochromic films, compared to dose maps obtained with a previously validated MC code. Film sheets were positioned at the entrance surface, at the bottom surface as well as at four depths between adjacent slabs in the five-slabs 50-mm-thick phantoms simulating a compressed breast. We employed a homogeneous PMMA phantom, for the method validation, and a heterogeneous (BR 50/50) phantom for a preliminary study in a complex breast phantom. Irradiations were made at 40 kV at ±25° and 0° in craniocaudal view. A continuous scan over 15° was carried out for the homogeneous phantom. In the direction of the beam axis the dose decreases down to 12% of the entrance value. In the transverse planes, the dose varies up to 17%; in the heterogeneous phantom, it decreases to 25% in the direction of the beam axis. In transverse planes the maximum dose variations are up to 18% at

Evaluation of the BreastSimulator software platform for breast tomography.

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