Bahaa Ghammraoui

A novel physical anthropomorphic breast phantom for 2D and 3D x‐ray imaging

Purpose: Physical phantoms are central to the evaluation of 2D and 3D breast‐imaging systems. Currently, available physical phantoms have limitations including unrealistic uniform background structure, large expense, or excessive fabrication time. The purpose of this work is to outline a method for rapidly creating realistic, inexpensive physical anthropomorphic phantoms for use in full‐field digital mammography (FFDM) and digital breast tomosynthesis (DBT). Methods: The phantom was first modeled using analytical expressions and then discretized into voxels of a specified size. The interior of the breast was divided into glandular and adipose tissue classes using Voronoi segmentation, and additional structures like blood vessels, chest muscle, and ligaments were added. The physical phantom was then fabricated from the virtual model in a slice by slice fashion through inkjet printing, using parchment paper and a radiopaque ink containing 33% (I33%) or 25% (I25%) iohexol by volume. Three types of parchment paper (P1, P2, and P3) were examined. The phantom materials were characterized in terms of their effective linear attenuation coefficients (μeff) using full‐field digital mammography (FFDM) and their energy‐dependent linear attenuation coefficients (μ(E)) using a spectroscopic energy discriminating detector system. The printing method was further validated on the basis of accuracy, print consistency, and the reproducibility of ink batches. Results: The μeff of two types of parchment paper were close to that of adipose tissue, with μeff = 0.61 ± 0.05 cm−1 for P1, 0.61 ± 0.04 cm−1 for P2, and 0.57 ± 0.03 cm−1 for adipose tissue. The addition of the iodinated ink increased the effective attenuation to that of glandular tissue, with μeff = 0.89 ± 0.06 cm−1 for P1 + I25% and 0.94 ± 0.06 cm−1 for P1 + I33% compared to 0.90 ± 0.03 cm−1 for glandular tissue. Spectroscopic measurements showed a good match between the parchment paper and reference values for adipose and glandular tissues across photon energies. Good accuracy was found between the model and the printed phantom by comparing a FFDM of the virtual model simulated through Monte Carlo with a real FFDM of the fully printed phantom. High consistency was found over multiple prints, with 3% variability in mean ink signal across various samples. Reproducibility of ink consistency was very high with <1% variation signal from multiple batches of ink. Imaging of the phantom using FFDM and DBT systems showed promising utility for 2D and 3D imaging. Conclusions: A novel, realistic breast phantom can be created using an analytically defined breast model and readily available materials. The work provides a method to fabricate any virtual phantom in a manner that is accurate, inexpensive, easily accessible, and can be made with different materials or breast models.

Maximum-likelihood estimation of scatter components algorithm for x-ray coherent scatter computed tomography of the breast

Coherent scatter computed tomography (CSCT) is a reconstructive x-ray imaging technique that yields the spatially resolved coherent-scatter cross section of the investigated object revealing structural information of tissue under investigation. In the original CSCT proposals the reconstruction of images from coherently scattered x-rays is done at each scattering angle separately using analytic reconstruction. In this work we develop a maximum likelihood estimation of scatter components algorithm (ML-ESCA) that iteratively reconstructs images using a few material component basis functions from coherent scatter projection data. The proposed algorithm combines the measured scatter data at different angles into one reconstruction equation with only a few component images. Also, it accounts for data acquisition statistics and physics, modeling effects such as polychromatic energy spectrum and detector response function. We test the algorithm with simulated projection data obtained with a pencil beam setup using a new version of MC-GPU code, a Graphical Processing Unit version of PENELOPE Monte Carlo particle transport simulation code, that incorporates an improved model of x-ray coherent scattering using experimentally measured molecular interference functions. The results obtained for breast imaging phantoms using adipose and glandular tissue cross sections show that the new algorithm can separate imaging data into basic adipose and water components at radiation doses comparable with Breast Computed Tomography. Simulation results also show the potential for imaging microcalcifications. Overall, the component images obtained with ML-ESCA algorithm have a less noisy appearance than the images obtained with the conventional filtered back projection algorithm for each individual scattering angle. An optimization study for x-ray energy range selection for breast CSCT is also presented.

Including the effect of molecular interference in the coherent x-ray scattering modeling in MC-GPU and PENELOPE for the study of novel breast imaging modalities

Purpose: To present upgraded versions of MC-GPU and PenEASY Imaging, two open-source Monte Carlo codes for the simulation of radiographic projections and CT. The codes have been extended with the aim of studying breast imaging modalities that rely on the accurate modeling of coherent x-ray scatter. Methods: The simulation codes were extended to account for the effect of molecular interference in coherent scattering using experimentally measured molecular interference functions. The validity of the new model was tested experimentally using the Energy Dispersive X-Ray Diffraction (EDXRD) technique with a polychromatic x-ray source and an energy-resolved Germanium detector at a fixed scattering angle. Experiments and simulations of a full field digital mammography system with and without a 1D focused antiscatter grid were conducted for additional validation. The modified MC-GPU code was also used to examine the possibility of characterizing breast cancer within a mathematical breast phantom using the EDXRD technique. Results: The measured EDXRD spectra were correctly reproduced by the simulation with the modified code while the previous code using the Independent Atomic Approximation led to large errors in the predicted diffraction spectra. There was good agreement between the simulated and measured rejection factor for the 1D focused antiscatter grid with both models. The simulation study in a whole breast showed that the x-ray scattering profiles of adipose, fibrosis, cancer and benign tissues are differentiable. Conclusion: MC-GPU and PENELOPE were successfully extended and validated for accurate modeling of coherent x-ray scatter. The EDXRD technique with pencil-cone geometry in a whole breast was investigated by a simulation study and it was concluded that this technique has potential to characterize breast cancer lesions.

Non-invasive classification of breast microcalcifications using x-ray coherent scatter computed tomography.

We investigate the use of energy dispersive x-ray coherent scatter computed tomography (ED-CSCT) as a non-invasive diagnostic method to differentiate between type I and type II breast calcifications. This approach is sensitive to the differences of composition and internal crystal structure of different types of microcalcifications. The study is carried out by simulating a CSCT system with a scanning pencil beam, considering a polychromatic x-ray source and an energy-resolving photon counting detector. In a first step, the multidimensional angle and energy distributed CSCT data is reduced to the projection-space distributions of only a few components, corresponding to the expected target composition: adipose, glandular tissue, weddellite (calcium oxalate) for type I calcifications, and hydroxyapatite for type II calcifications. The maximum-likelihood estimation of scatter components algorithm used, operating in the projection space, takes into account the polychromatic source, the detector response function and the energy dependent attenuation. In the second step, component images are reconstructed from the corresponding estimated component projections using filtered backprojection. In a preliminary step the coherent scatter differential cross sections for hydroxyapatite and weddellite minerals were determined experimentally. The classification of type I or II calcifications is done using the relative contrasts of their components as the criterion. Simulation tests were carried out for different doses and energy resolutions for multiple realizations. The results were analyzed using relative/receiver operating characteristic methodology and show good discrimination ability at medium and higher doses. The noninvasive CSCT technique shows potential to further improve the breast diagnostic accuracy and reduce the number of breast biopsies.

Monte Carlo X-ray transport simulation of small-angle X-ray scattering instruments using measured sample cross sections

Small-angle X-ray scattering (SAXS) has recently been proposed as a novel noninvasive in vivo molecular imaging technique to characterize molecular interactions deep within the body using high-contrast probes. This article describes a detailed Monte Carlo X-ray transport simulation technique that utilizes user-provided cross sections to describe X-ray interaction in virtual samples and explore SAXS instrument design choices. The accuracy of the simulation code is validated with sample material cross sections derived from analytical models and empirical measurements of a homogeneous spherical gold nanoparticle (GNP) monomer, a dimer and heterogeneous mixtures of the two in aqueous solution. Analytical and measured scattering profiles from these samples were converted to cross sections using an absolute water standard. Our Monte Carlo estimates of the fraction of dimers from analytically derived and empirically derived cross sections are strongly correlated, with less than 1.5 and 16% error, respectively, to the expected concentration of monomer and dimer species. In addition, a variety of monoenergetic X-ray beams were simulated to investigate coherent scattering versus radiation dose for a range of sample sizes. For GNP spheres in aqueous solution, the energy range that produces the most coherent scattering at the detector per deposited energy was between 31 and 49 keV for a sample thickness of 1 mm to 10 cm. The method described here for the detailed simulation of SAXS using measured and modeled cross sections will enable instrumentation optimization for in vivo molecular imaging applications.

Feasibility of estimating volumetric breast density from mammographic x‐ray spectra using a cadmium telluride photon‐counting detector

PURPOSE Mammographic density of glandular breast tissue has a masking effect that can reduce lesion detection accuracy and is also a strong risk factor for breast cancer. Therefore, accurate quantitative estimation of breast density is clinically important. In this study, we investigate experimentally the feasibility of quantifying volumetric breast density with spectral mammography using a CdTe-based photon-counting detector. METHODS To demonstrate proof-of-principle, this study was carried out using the single pixel Amptek XR-100T-CdTe detector. The total number of x rays recorded by the detector from a single pencil-beam projection through 50%/50% of adipose/glandular mass fraction-equivalent phantoms was measured. Material decomposition assuming two, four, and eight energy bins was then applied to characterize the inspected phantom into adipose and glandular using log-likelihood estimation, taking into account the polychromatic source, the detector response function, and the energy-dependent attenuation. RESULTS Measurement tests were carried out for different doses, kVp settings, and different breast sizes. For dose of 1 mGy and above, the percent relative root mean square (RMS) errors of the estimated breast density was measured below 7% for all three phantom studies. It was also observed that some decrease in RMS errors was achieved using eight energy bins. For 3 and 4 cm thick phantoms, performance at 40 and 45 kVp showed similar performance. However, it was observed that 45 kVp showed better performance for a phantom thickness of 6 cm at low dose levels due to increased statistical variation at lower photon count levels with 40 kVp. CONCLUSION The results of the current study suggest that photon-counting spectral mammography systems using CdTe detectors have the potential to be used for accurate quantification of volumetric breast density on a pixel-to-pixel basis, with an RMS error of less than 7%.

Investigating the feasibility of classifying breast microcalcifications using photon‐counting spectral mammography: A simulation study

Purpose A dual‐energy material decomposition method using photon‐counting spectral mammography was investigated as a non‐invasive diagnostic approach to differentiate between Type I calcifications, consisting of calcium oxalate dihydrate or weddellite compounds that are more often associated with benign lesions, and Type II calcifications containing hydroxyapatite that are predominantly associated with malignant tumors. Methods The study was carried out by numerical simulation to assess the feasibility of the proposed approach. A pencil‐beam geometry was modeled, and the total number of x‐rays transported through a breast embedded with microcalcifications of different types and sizes were simulated by a one‐pixel detector. Material decomposition using two energy bins was then applied to characterize the simulated calcifications into hydroxyapatite and weddellite using maximum‐likelihood estimation, taking into account the polychromatic source, and the energy dependent attenuation. Simulation tests were carried out for different dose levels, energy windows and calcification sizes for multiple noise realizations. Results The results were analyzed using receiver operating characteristic (ROC) analysis. Classification between Type I and Type II calcifications achieved by analyzing a single microcalcification showed moderate accuracy. However, simultaneously analyzing several calcifications within the cluster provided area under the ROC curve of greater than 99% for radiation dose greater than 4.8 mGy mean glandular dose. Conclusion Simulation results indicated that photon‐counting spectral mammography with dual energy material decomposition has the potential to be used as a non‐invasive method for discrimination between Type I and Type II microcalcifications that can potentially improve early breast cancer diagnosis and reduce the number of negative breast biopsies. Additional studies using breast specimens and clinical data should be performed to further explore the feasibility of this approach.

Monte Carlo evaluation of the relationship between absorbed dose and contrast-to-noise ratio in coherent scatter breast CT

The objective of this work was to evaluate the advantages and shortcomings associated with Coherent Scatter Computed Tomography (CSCT) systems for breast imaging and study possible alternative configurations. The relationship between dose in a breast phantom and a simple surrogate of image quality in pencil-beam and fan-beam CSCT geometries was evaluated via Monte Carlo simulation, and an improved pencil-beam setup was proposed for faster CSCT data acquisition. CSCT projection datasets of a simple breast phantom have been simulated using a new version of the MC-GPU code that includes an improved model of x-ray coherent scattering using experimentally measured molecular interference functions. The breast phantom was composed of an 8 cm diameter cylinder of 50/50 glandular/adipose material and nine rods with different diameters of cancerous, adipose and glandular tissues. The system performance has been assessed in terms of the contrast-to-noise ratio (CNR) in multiple regions of interest within the reconstructed images, for a range of exposure levels. The enhanced pencil-beam setup consisted of multiplexed pencil beams and specific post-processing of the projection data to calculate the scatter intensity coming from each beam separately. At reconstruction spatial resolution of 1×1×1 mm3 and from 1 to 10 mGy of received breast dose, fan-beam geometry showed higher statistical noise and lower CNR than pencil-beam geometry. Conventional CT acquisition had the highest CNR per dose. However, the CNR figure of merit did not combine yet all the information available at different scattering angles in the CSCT, which has potential for increased discrimination of materials with similar attenuation properties. Preliminary evaluation of the multiplexed pencil-beam geometry showed that the scattering profiles simulated with the new approach are similar to those of the single pencil-beam geometry. Conclusion: It has been shown that the GPU-accelerated MC-GPU code is a practical tool to simulate complete CSCT scans with different acquisition geometries and exposure levels. The simulation showed better performance in terms of the received dose and CNR with pencil-beam geometry in comparison to the fan-beam geometry. Finally, we demonstrated that the proposed multiplexed-beam geometry might be useful for faster acquisition of CSCT while providing comparable image quality as the pencil-beam geometry.

A physical breast phantom for 2D and 3D x-ray imaging made through inkjet printing

Physical breast phantoms are used for imaging evaluation studies with 2D and 3D breast x-ray systems, serving as surrogates for human patients. However, there is a presently a limited selection of available phantoms that are realistic, in terms of containing the complex tissue architecture of the human breast. In addition, not all phantoms can be successfully utilized for both 2D and 3D breast imaging. Additionally, many of the phantoms are uniform or unrealistic in appearance, expensive, or difficult to obtain. The purpose of this work was to develop a new method to generate realistic physical breast phantoms using easy to obtain and inexpensive materials. First, analytical modeling was used to design a virtual model, which was then compressed using finite element modeling. Next, the physical phantom was realized through inkjet printing with a standard inkjet printer using parchment paper and specialized inks, formulated using silver nanoparticles and a bismuth salt. The printed phantom sheets were then aligned and held together using a custom designed support plate made of PMMA, and imaged on clinical FFDM and DBT systems. Objects of interest were also placed within the phantom to simulate microcalcifications, pathologies that often occur in the breast. The linear attenuation coefficients of the inks and parchment were compared against tissue equivalent samples and found to be similar to breast tissue. The phantom is promising for use in imaging studies and developing QC protocols.

Reproducing 2D breast mammography images with 3D printed phantoms

Mammography is currently the standard imaging modality used to screen women for breast abnormalities and, as a result, it is a tool of great importance for the early detection of breast cancer. Physical phantoms are commonly used as surrogates of breast tissue to evaluate some aspects of the performance of mammography systems. However, most phantoms do not reproduce the anatomic heterogeneity of real breasts. New fabrication technologies, such as 3D printing, have created the opportunity to build more complex, anatomically realistic breast phantoms that could potentially assist in the evaluation of mammography systems. The primary objective of this work is to present a simple, easily reproducible methodology to design and print 3D objects that replicate the attenuation profile observed in real 2D mammograms. The secondary objective is to evaluate the capabilities and limitations of the competing 3D printing technologies, and characterize the x-ray properties of the different materials they use. Printable phantoms can be created using the open-source code introduced in this work, which processes a raw mammography image to estimate the amount of x-ray attenuation at each pixel, and outputs a triangle mesh object that encodes the observed attenuation map. The conversion from the observed pixel gray value to a column of printed material with equivalent attenuation requires certain assumptions and knowledge of multiple imaging system parameters, such as x-ray energy spectrum, source-to-object distance, compressed breast thickness, and average breast material attenuation. A detailed description of the new software, a characterization of the printed materials using x-ray spectroscopy, and an evaluation of the realism of the sample printed phantoms are presented.