Nuno Matela

Optimal photon energy comparison between digital breast tomosynthesis and mammography: A case study

A comparison, in terms of the optimal energy that maximizes the image quality between digital breast tomosynthesis (DBT) and digital mammography (DM) was performed in a MAMMOMAT Inspiration system (Siemens) based on amorphous selenium flat panel detector. In this paper we measured the image quality by the signal difference-to-noise ratio (SDNR), and the patient risk by the mean glandular dose (MGD). Using these quantities we compared the optimal voltage that maximizes the image quality both in breast tomosynthesis and standard mammography acquisition mode. The comparison for the two acquisition modes was performed for a W/Rh anode filter combinations by using a 4.5 cm tissue equivalent mammography phantom. Moreover, in order to check if the used equipment was quantum noise limited, the relation of the relative noise with respect to the detector dose was evaluated. Results showed that in the tomosynthesis acquisition mode the optimal voltage is 28 kV, whereas in standard mammography the optimal voltage is 30 kV. The automatic exposure control (AEC) of the system selects 28 kV as optimal voltage both for DBT and DM. Monte Carlo simulations showed a qualitative agreement with the AEC selection system, since an optimal monochromatic energy of 20 keV was found both for DBT and DM. Moreover, the check about the noise showed that the system is not completely quantum noise limited, and this issue could explain the experimental slight difference in terms of optimal voltage between DBT and DM. According to these results, the use of higher voltage settings is not justified for the improvement of the image quality during a DBT examination.

Estimation of the collective dose in the Portuguese population due to medical procedures in 2010

In a wide range of medical fields, technological advancements have led to an increase in the average collective dose in national populations worldwide. Periodic estimations of the average collective population dose due to medical exposure is, therefore of utmost importance, and is now mandatory in countries within the European Union (article 12 of EURATOM directive 97/43). Presented in this work is a report on the estimation of the collective dose in the Portuguese population due to nuclear medicine diagnostic procedures and the Top 20 diagnostic radiology examinations, which represent the 20 exams that contribute the most to the total collective dose in diagnostic radiology and interventional procedures in Europe. This work involved the collaboration of a multidisciplinary taskforce comprising representatives of all major Portuguese stakeholders (universities, research institutions, public and private healthcare providers, administrative services of the National Healthcare System, scientific and professional associations and private service providers). This allowed us to gather a comprehensive amount of data necessary for a robust estimation of the collective effective dose to the Portuguese population. The methodology used for data collection and dose estimation was based on European Commission recommendations, as this work was performed in the framework of the European wide Dose Datamed II project. This is the first study estimating the collective dose for the population in Portugal, considering such a wide national coverage and range of procedures and consisting of important baseline reference data. The taskforce intends to continue developing periodic collective dose estimations in the future. The estimated annual average effective dose for the Portuguese population was of 0.080±0.017 mSv caput(-1) for nuclear medicine exams and of 0.96±0.68 mSv caput(-1) for the Top 20 diagnostic radiology exams.

List-mode maximum-likelihood reconstruction for the ClearPEM system

A dedicated implementation of list-mode maximum-likelihood expectation-maximization (MLEM) reconstruction for the ClearPEM system is presented. The system is composed of two face-to-face detectors, which can be rotated to acquire data from different angular positions. Due to the specific design with irregular sampling and depth of interaction capability, the possible number of lines of response (LOR) is significantly greater than the number of detected events in a standard clinical study. Because reconstruction methods based on data histogramming to sinogram lead to a high computational cost and/or a loss of the intrinsical system resolution, it is necessary to consider the processing of events in list-mode during the reconstruction. The presented method adopted EM algorithm to maximize the logarithmic likelihood function that is expressed in list-mode. The voxel efficiency is corrected by pre-calculated efficiency maps based on flood phantom acquisitions. The method is also implemented with parallelization by distributing the calculation of the acquired events into different threads for significantly increasing computational speed. The results of a Derenzo phantom study show that the presented algorithm can achieve a similar result as 3D-OSEM reconstruction based on data histogramming with significantly lower reconstruction time (6 times faster with one thread, 20 times faster with 8 threads distributed in 8 CPU cores). In clinical studies with lower acquired events, the acceleration ratio can be even higher. The result from a breast phantom study shows that lesions with 15 mm in diameter, each, as well as a small lesion with 5 mm in diameter are clearly visible and can be characterized. The mouse imaging studies show also great potential of the system in small animal applications.

Clear-PEM: Monte Carlo performance and image reconstruction studies

The Clear-PEM prototype under development aims to improve early stage breast cancer diagnostics. The proposed device is based on cerium doped lutetium crystal matrices developed by the Crystal Clear Collaboration, as well as on modern data acquisition techniques. A series of Monte Carlo studies were performed to evaluate detection sensitivity, background rate and intrinsic spatial resolution in order to optimize the final detector concept. A description of the developed GEANT4 based simulation framework and PEM image reconstruction software is also presented in this paper. First simulation results indicates that Clear-PEM design significantly increases detection sensitivity in comparison with conventional PET cameras for breast cancer diagnostics. Count-rate simulation results are within operation limits for the data acquisition system, able to read 1 MHz event rate, allowing to take full profit of the large detector acceptance.

Optimization of 2D image reconstruction for positron emission mammography using IDL

The Clear-PEM system is a prototype machine for Positron Emission Mammography (PEM) under development within the Portuguese PET-Mammography consortium. We have embedded 2D image reconstruction algorithms implemented in IDL within the prototypes image analysis package. The IDL implementation of these algorithms proved to be accurate and computationally efficient. In this paper, we present the implementation of the MLEM, OSEM and ART 2D iterative image reconstruction algorithms for PEM using IDL. C and IDL implementations are compared using realistic Monte Carlo simulated data. We show that IDL can be used for the easy implementation of image reconstruction algorithms for emission tomography.

An overview of the Clear-PEM breast imaging scanner

We present an overview of the Clear-PEM breast imaging scanner. Clear-PEM is a unique dual-head Positron Emission Mammography scanner using APD-based detector modules that are capable of measuring depth-of-interaction (DOI) with a resolution of 2 mm in 20 mm long LYSO:Ce crystals. Such capability leads to an image spatial resolution of 1.2 mm and a high efficiency, foreseeing the detection of 3 mm breast lesions in less than 7 minutes exams. The full system comprises 192 detector modules in a total of 6144 LYSO:Ce crystals and 384 32-pixel APD arrays readout by ASICs with 192 input channels that represents an unprecedented level of integration in PET systems. Throughout the project and besides the detector module, we had developed dedicated Frontend and Data Acquisition electronics, the mechanical design and construction of the detector heads and the robotic gantry, as well as all the software that include calibration (energy, time and DOI), normalization and image reconstruction algorithms. In this work we will discuss the developments and present the commissioning results of the detector before the beginning of the clinical trials program, scheduled for the end of the present year.

System matrix calculation for Clear-PEM using ART and linograms

The Clear-PEM device is a positron emission mammography (PEM) unit based on planar detectors and is currently under development. We have developed a 2D algebraic reconstruction technique (ART) algorithm using linograms to reconstruct Clear-PEM data. In this work we evaluate three different methods of calculating the system matrix used by the ART algorithm, which we designate as the pixel-, ray- and tube-driven methods, respectively. The methods were tested using Monte Carlo simulated data. The results obtained show that ART algorithm allows, for these cases, accurate image reconstruction and indicate that a more accurate modeling of the image system matrix using tubes of response (TORs) provides the best image evaluation indexes.

Characterization of the Clear-PEM breast imaging scanner performance

We present results on the characterization of the Clear-PEM breast imaging scanner. Clear-PEM is a dual-head Positron Emission Mammography scanner using APD-based detector modules that are capable of measuring depth-of-interaction (DOI) with a resolution of 2 mm in LYSO:Ce crystals. The full system comprises 192 detector modules in a total of 6144 LYSO:Ce crystals and 384 32-pixel APD arrays readout by ASICs with 192 input channels, which represents an unprecedented level of integration in APD-based PET systems. The system includes Frontend and Data Acquisition electronics and a robotic gantry for detector placement and rotation. The software implements calibration (energy, time and DOI), normalization and image reconstruction algorithms. In this work, the scanner main technical characteristics, calibration strategies and the spectrometric performance in a clinical environment are presented. Images obtained with point sources and extended uniform sources are also presented. The first commissioning results show 99.7% active channels. After calibration, the dispersion of the channels absolute gain is 15.3%, which demonstrate that despite the large number of channels the system is rather uniform. The mean energy resolution at 511 keV is 15.9% for all channels, and the mean DOI constant is 5.9%/mm, which is consistent with a 2 mm DOI resolution, or better. The coincidence time resolution at 511 keV, for a energy window between 400 and 600 keV, is 5.2 ns FWHM. The image resolution measured with point sources was found to be of the order of 1.3 mm FWHM. The DOI capability was found to have a strong impact on the image sharpness. Images of extended uniform 68Ge sources, corrected for sensitivity and for the artifacts due detector dead spaces, have good uniformity. First clinical breast images are presented.

Development of breast and tumour models for simulation of novel multimodal PEM-UWB technique for detection and classification of breast tumours

This paper presents an initial study towards the development of a multimodal breast imaging technique that combines Positron Emission Mammography (PEM) and Ultra WideBand (UWB) radar which has the potential to be complementary in breast cancer detection and classification due to the different types of information provided by the two modalities. The first step in evaluating test the potential of the multimodal PEM-UWB technique is to develop realistic numerical breast and tumour models, which can simultaneously be used for both PEM and UWB.

Assessment of DOI resolution in a fully mounted PEM scanner

The ClearPEM scanner is a dedicated system to perform breast imaging with the ability of measuring DOI, allowing an image spatial resolution close to 1.5 mm. The DOI is measured by calculating the amplitude asymmetry between the signals produced by two APD, one in the top and other in the bottom of the crystal. The DOI resolution measured in laboratory tests is 2.0 mm. In this paper we present a method to periodically confirm this value with the scanner fully mounted. The DOI resolution obtained with this method was 2.8 mm, which is consistent with the resolution measured during the laboratory tests.