Jerry A. Thomas

Combination of digital mammography with semi-automated 3D breast ultrasound

This paper describes work aimed at combining 3D ultrasound with full-field digital mammography via a semi-automatic prototype ultrasound scanning mechanism attached to the digital mammography system gantry. Initial efforts to obtain high x-ray and ultrasound image quality through a compression paddle are proving successful. Registration between the x-ray mammogram and ultrasound image volumes is quite promising when the breast is stably compressed. This prototype system takes advantage of many synergies between the co-registered digital mammography and pulse-echo ultrasound image data used for breast cancer detection and diagnosis. In addition, innovative combinations of advanced US and X-ray applications are being implemented and tested along with the basic modes. The basic and advanced applications are those that should provide relatively independent information about the breast tissues. Advanced applications include x-ray tomosynthesis, for 3D delineation of mammographic structures, and non-linear elasticity and 3D color flow imaging by ultrasound, for mechanical and physiological information unavailable from conventional, non-contrast x-ray and ultrasound imaging.

Digital mammography: Comparison of adaptive and nonadaptive CAD methods for mass detection

RATIONALE AND OBJECTIVES The authors compared the performance of adaptive and nonadaptive computer-aided diagnostic (CAD) methods for breast mass detection with digital mammography. MATERIALS AND METHODS Both adaptive and nonadaptive modular CAD methods employed recent advances in multiresolution and mutiorientation wavelet transforms for improved feature extraction. The nonadaptive method uses fixed parameters for the image preprocessing modules. The adaptive method, a new class of algorithms, adapts to image content by selecting parameters for the image preprocessing modules within a parameter range. Comparison of the two methods was performed for each individual CAD module with a region-of-interest (ROI) database containing all mass types and normal tissue. RESULTS Receiver operating characteristic (ROC) analysis clearly demonstrated an improvement in performance for the three adaptive modules and a significant overall difference between the two methods. The average ROC area index (Az) values were 0.86 and 0.95 for the nonadaptive and adaptive methods, respectively. The corresponding P value is .0145. For a previously reported database of full mammographic images containing 50 abnormal cases with all mass types and 50 normal images, the adaptive CAD method had a sensitivity of 96% (1.71 false-positive results per image) compared with 89% (1.91 false-positive results per image) for the nonadaptive CAD method. CONCLUSION The adaptive CAD method demonstrated better performance. A study is in progress to determine the generalizability of the adaptive CAD method by applying it to larger retrospective image databases with different film digitizers.

Mercuric iodide medical imagers for low exposure radiography and fluoroscopy

Photoconductive polycrystalline mercuric iodide deposited on flat panel thin film transistor (TFT) arrays is being developed for direct digital X-ray detectors that can perform both radiographic and fluoroscopic medical imaging. The mercuric iodide is either vacuum deposited by Physical Vapor Deposition (PVD) or coated onto the array by a wet Particle-In-Binder (PIB) process. The PVD deposition technology has been scaled up to the 20 cm x 25 cm size required in common medical imaging applications. A TFT array with a pixel pitch of 127 microns is used for these imagers. Arrays of 10 cm x 10 cm size have been used to evaluate performance of mercuric iodide imagers. Radiographic and fluoroscopic images of diagnostic quality at up to 15 pulses per second were demonstrated. As we previously reported, the resolution is limited to the TFT array Nyquist frequency of ~3.9 lp/mm (127 micron pixel pitch). Detective Quantum Efficiency (DQE) has been measured as a function of spatial frequency for these imagers. The DQE is lower than the theoretically calculated value due to some additional noise sources of the electronics and the array. We will retest the DQE after eliminating these noise sources. Reliability and stress testing was also began for polycrystalline mercuric iodide PVD and PIB detectors. These are simplified detectors based upon a stripe electrode or circular electrode structure. The detectors were stressed under various voltage bias, temperature and time conditions. The effects of the stress tests on the detector dark current and sensitivity were determined.

Mercuric iodide and lead iodide x-ray detectors for radiographic and fluoroscopic medical imaging

Mercuric iodide (HgI2) and lead iodide (PbI2) have been under development for several years as direct converter layers in digital x-ray imaging. Previous reports have covered the basic electrical and physical characteristics of these and several other materials. We earlier reported on 5cm x 5cm and 10cm x 10cm size imagers, direct digital radiography X-ray detectors, based on photoconductive polycrystalline mercuric iodide deposited on a flat panel thin film transistor (TFT) array, as having great potential for use in medical imaging, NDT, and security applications. This paper, presents results and comparison of both lead iodide and mercuric iodide imagers scaled up to 20cm x 25cm sizes. Both the mercuric iodide and lead iodide direct conversion layers are vacuum deposited onto TFT array by Physical Vapor Deposition (PVD). This process has been successfully scaled up to 20cm x 25cm -- the size required in common medical imaging applications. A TFT array with a pixel pitch of 127 microns was used for this imager. In addition to increasing detector size, more sophisticated, non-TFT based small area detectors were developed in order to improve analysis methods of the mercuric and lead iodide photoconductors. These small area detectors were evaluated in radiographic mode, continuous fluoroscopic mode and pulsed fluoroscopic mode. Mercuric iodide coating thickness ranging between 140 microns and 300 microns and lead iodide coating thickness ranging between 100 microns and 180 microns were tested using beams with energies between 40 kVp and 100 kVp, utilizing exposure ranges typical for both fluoroscopic and radiographic imaging. Diagnostic quality radiographic and fluoroscopic images have been generated at up to 15 frames per second. Mercuric iodide image lag appears adequate for fluoroscopic imaging. The longer image lag characteristics of lead iodide make it only suitable for radiographic imaging. For both material the MTF is determined primarily by the aperture and pitch of the TFT array (Nyquist frequency of ~3.93 mm-1 (127 micron pixel pitch).

A quantitative description of the percentage of breast density measurement using full field digital mammography

RATIONALE AND OBJECTIVES Breast density is a significant breast cancer risk factor that is measured from mammograms. However, uncertainty remains in both understanding its underlying physical properties as it relates to the breast and determining the optimal method for its measurement. A quantitative description of the information captured by the standard operator-assisted percentage of breast density (PD) measure was developed using full-field digital mammography (FFDM) images that were calibrated to adjust for interimage acquisition technique differences. MATERIALS AND METHODS The information captured by the standard PD measure was quantified by developing a similar measure of breast density (PD(c)) from calibrated mammograms automatically by applying a static threshold to each image. The specific threshold was estimated by first sampling the probability distributions for breast tissue in calibrated mammograms. A percent glandular (PG) measure of breast density was also derived from calibrated mammograms. The PD, PD(c), and PG breast density measures were compared using both linear correlation (R) and quartile odds ratio measures derived from a matched case-control study. RESULTS The standard PD measure is an estimate of the number of pixel values above a fixed idealized x-ray attenuation fraction. There was significant correlation (P < .0001) between the PD(c)-PD (r = 0.78), PD(c)-PG (r = 0.87), and PD-PG (r = 0.71) measures of breast density. Risk estimates associated with the lowest to highest quartiles for the PD(c) measure (odds ratio [OR]: 1.0 ref., 3.4, 3.6, and 5.6), and the standard PD measure (OR 1.0 ref., 2.9, 4.8, and 5.1) were similar and greater than that of the calibrated PG measure (OR 1.0 ref., 2.0, 2.4, and 2.4). CONCLUSIONS The information captured by the standard PD measure was quantified as it relates to calibrated mammograms and used to develop an automated method for measuring breast density. These findings represent an initial step for developing an automated measure built on an established calibration platform. A fully developed automated measure may be useful for both research- and clinical-based risk applications.

Effect of Room Illuminance on Monitor Black Level Luminance and Monitor Calibration

In this article we demonstrate the effect of room illuminance and surrounding monitor black level luminance on image quality for soft copy interpretation. Luminance values of a 10% central target and image quality evaluations and observer performance using a contrast-detail mammography (CDMAM) phantom demonstrate these effects. Our results indicate that high room illuminance has a more damaging effect on image quality when the surrounding monitor luminance is 0% to 5% of the maximum monitor luminance. The effect of room illuminance is less obvious when the surrounding monitor luminance is 20% of the maximum.

Effective radiation attenuation calibration for breast density: compression thickness influences and correction

BackgroundCalibrating mammograms to produce a standardized breast density measurement for breast cancer risk analysis requires an accurate spatial measure of the compressed breast thickness. Thickness inaccuracies due to the nominal system readout value and compression paddle orientation induce unacceptable errors in the calibration.MethodA thickness correction was developed and evaluated using a fully specified two-component surrogate breast model. A previously developed calibration approach based on effective radiation attenuation coefficient measurements was used in the analysis. Water and oil were used to construct phantoms to replicate the deformable properties of the breast. Phantoms consisting of measured proportions of water and oil were used to estimate calibration errors without correction, evaluate the thickness correction, and investigate the reproducibility of the various calibration representations under compression thickness variations.ResultsThe average thickness uncertainty due to compression paddle warp was characterized to within 0.5 mm. The relative calibration error was reduced to 7% from 48-68% with the correction. The normalized effective radiation attenuation coefficient (planar) representation was reproducible under intra-sample compression thickness variations compared with calibrated volume measures.ConclusionIncorporating this thickness correction into the rigid breast tissue equivalent calibration method should improve the calibration accuracy of mammograms for risk assessments using the reproducible planar calibration measure.

High-speed large-angle mammography tomosynthesis system

A new mammography tomosynthesis prototype system that acquires 21 projection images over a 60 degree angular range in approximately 8 seconds has been developed and characterized. Fast imaging sequences are facilitated by a high power tube and generator for faster delivery of the x-ray exposure and a high speed detector read-out. An enhanced a-Si/CsI flat panel digital detector provides greater DQE at low exposure, enabling tomo image sequence acquisitions at total patient dose levels between 150% and 200% of the dose of a standard mammographic view. For clinical scenarios where a single MLO tomographic acquisition per breast may replace the standard CC and MLO views, total tomosynthesis breast dose is comparable to or below the dose in standard mammography. The system supports co-registered acquisition of x-ray tomosynthesis and 3-D ultrasound data sets by incorporating an ultrasound transducer scanning system that flips into position above the compression paddle for the ultrasound exam. Initial images acquired with the system are presented.

Effective x-ray attenuation coefficient measurements from two full field digital mammography systems for data calibration applications

BackgroundBreast density is a significant breast cancer risk factor. Currently, there is no standard method for measuring this important factor. Work presented here represents an essential component of an ongoing project that seeks to determine the appropriate method for calibrating (standardizing) mammography image data to account for the x-ray image acquisition influences. Longer term goals of this project are to make accurate breast density measurements in support of risk studies.MethodsLogarithmic response calibration curves and effective x-ray attenuation coefficients were measured from two full field digital mammography (FFDM) systems with breast tissue equivalent phantom imaging and compared. Normalization methods were studied to assess the possibility of reducing the amount of calibration data collection. The percent glandular calibration map functional form was investigated. Spatial variations in the calibration data were used to assess the uncertainty in the calibration application by applying error propagation analyses.ResultsLogarithmic response curves are well approximated as linear. Measured effective x-ray attenuation coefficients are characteristic quantities independent of the imaging system and are in agreement with those predicted numerically. Calibration data collection can be reduced by applying a simple normalization technique. The calibration map is well approximated as linear. Intrasystem calibration variation was on the order of four percent, which was approximately half of the intersystem variation.ConclusionFFDM systems provide a quantitative output, and the calibration quantities presented here may be used for data acquired on similar FFDM systems.

Improved properties of PbI2 x-ray imagers with tighter process control and using positive bias voltage

Vapor deposited lead iodide films show a wide range of physical attributes dependant upon fabrication conditions. High density is most readily achieved with films less than 100 μm. Thicker films, with lessening density, often show lower response (gain) as charge collection becomes less efficient. Lack of consistency in density throughout a deposition invariably leads to non-uniform electronic properties, which is challenging to both model and predict. To overcome this, tighter control of deposition parameters is required during the slow growth process (<10 μm/hour). Lead iodide films are characterized in forms of planar devices deposited onto conductive glass and active pixel arrays deposited onto a-Si TFT arrays1. Electronic properties (e.g. leakage current, gain) show little variation that can be traced to substrate choice. Films generally provide less than 100 pA/mm2 leakage current as they show saturation in gain (at approximate fields of 1 V/μm). We recently modified our readout electronics to accept positive bias. Using positive bias on the top electrode provides better charge collection for the lower mobility electrons and (despite process variability) better quality films can provide sensitivities greater than 6 μC/R*cm2, with only partial x-ray absorption, and show less than 20 pA/mm2 dark current.