Randolph L. McKinley

Evaluation of fully 3-D emission mammotomography with a compact cadmium zinc telluride detector

A compact, dedicated cadmium zinc telluride (CZT) gamma camera coupled with a fully three-dimensional (3-D) acquisition system may serve as a secondary diagnostic tool for volumetric molecular imaging of breast cancers, particularly in cases when mammographic findings are inconclusive. The developed emission mammotomography system comprises a medium field-of-view, quantized CZT detector and 3-D positioning gantry. The intrinsic energy resolution, sensitivity and spatial resolution of the detector are evaluated with Tc-99m (140 keV) filled flood sources, capillary line sources, and a 3-D frequency-resolution phantom. To mimic realistic human pendant, uncompressed breast imaging, two different phantom shapes of an average sized breast, and three different lesion diameters are imaged to evaluate the system for 3-D mammotomography. Acquisition orbits not possible with conventional emission, or transmission, systems are designed to optimize the viewable breast volume while improving sampling of the breast and anterior chest wall. Complications in camera positioning about the patient necessitate a compromise in these two orbit design criteria. Image quality is evaluated with signal-to-noise ratios and contrasts of the lesions, both with and without additional torso phantom background. Reconstructed results indicate that 3-D mammotomography, incorporating a compact CZT detector, is a promising, dedicated breast imaging technique for visualization of tumors <1 cm in diameter. Additionally, there are no outstanding trajectories that consistently yield optimized quantitative lesion imaging parameters. Qualitatively, imaging breasts with realistic torso backgrounds (out-of-field activity) substantially alters image characteristics and breast morphology unless orbits which improve sampling are utilized. In practice, the sampling requirement may be less strict than initially anticipated.

Design and development of a fully 3D dedicated x-ray computed mammotomography system

Our effort to implement a volumetric x-ray computed mammotomography (CmT) system dedicated to imaging breast disease comprises: demonstrated development of a quasi-monochromatic x-ray beam providing minimal dose and other optimal imaging figures of merit; new development of a compact, variable field-of-view, fully-3D acquisition gantry with a digital flat-panel detector facilitating more nearly complete sampling of frequency space and the physical breast volume; incorporation of iterative ordered-subsets transmission (OSTR) image reconstruction allowing modeling of the system matrix. Here, we describe the prototype 3D gantry and demonstrate initial system performance. Data collected on the prototype gantry demonstrate the feasibility of using OSTR with realistic reconstruction times. The gantry consists of a rotating W-anode x-ray tube using ultra-thick K-edge filtration, and an ~20x25cm2 digital flat-panel detector located at <60cm SID. This source/detector combination can be shifted laterally changing the location of the central ray relative to the system center-of-rotation, hence changing the effective imaging field-of-view, and is mounted on a goniometric cradle allowing <50° polar tilt, then on a 360° azimuthal rotation stage. Combined, these stages provide for positioning flexibility in a banded region about a sphere, facilitating simple circle-plus-arc-like trajectories, as well as considerably more complex 3D trajectories. Complex orbits are necessary to avoid physical hindrances from the patient while acquiring the largest imaging volume of the breast. The system capabilities are demonstrated with fully-3D reconstructed images of geometric sampling and resolution phantoms, a fabricated breast phantom containing internal features of interest, and a cadaveric breast specimen. This compact prototype provides flexibility in dedicated, fully-3D CmT imaging of healthy and diseased breasts.

Simulation study of a quasi-monochromatic beam for x-ray computed mammotomography

The purpose of this simulation study was to evaluate the feasibility, benefits, and potential operating parameters of a quasi-monochromatic beam from a tungsten-target x-ray source yielding projection images. The application is intended for newly developed cone beam computed mammotomography (CmT) of an uncompressed breast. The value of a near monochromatic x-ray source for a fully 3D CmT application is the expected improved ability to separate tissues with very small differences in attenuation coefficients. The quasi-monochromatic beam is expected to yield enhanced tomographic image quality along with a low dose, equal to or less than that of dual view x-ray mammography. X-ray spectra were generated with a validated projection x-ray simulation tool (XSpect) for a range of tungsten tube potentials (40-100 kVp), filter materials (Z=51-65), and filter thicknesses (10th to 1000th value layer determined at 60 kVp). The breast was modeled from ICRU-44 breast tissue specifications, and a breast lesion was modeled as a 0.5 cm thick mass. The detector was modeled as a digital flat-panel detector with a 0.06 cm thick CsI x-ray absorption layer. Computed figures of merit (FOMs) included the ratio of mean beam energy post-breast to pre-breast and the ratio of lesion contrasts for edge-located and center-located lesions as indices of breast beam hardening, and SNR2/exposure and SNR2/dose as indices of exposure and dose efficiencies. The impact of optimization of these FOMs on lesion contrast is also examined. For all simulated filter materials at each given attenuation thickness [10th, 100th, 500th, 1000th value layers (VLs)], the mean and standard deviation of the pre-breast spectral full-width at tenth-maximum (FWTM) were 16.1 +/- 2.4, 10.3 +/- 2.2, 7.3 +/- 1.4, and 6.5 +/- 1.5 keV, respectively. The change in beam width at the tenth maximum from pre-breast to post-breast spectra ranged from 4.7 to 1.1 keV, for the thinnest and thickest filters, respectively. The higher Z filters (Z=57-63) produced a quasi-monochromatic beam that allowed the widest tube potential operating range (50-70 kVp) while maintaining minimal beam hardening and maximal SNR2/exposure and SNR2/dose, and providing a contrast greater than that obtained in the unfiltered case. Figures of merit improved with increasing filter thickness, with diminishing returns beyond the 500th value layer attenuation level. Operating parameters required to produce optimal spectra, while keeping exposures equal to that of dual view mammography, are within the capability of the commercial x-ray tube proposed for our experimental study, indicating that use of these highly attenuating filters is viable. Additional simulations comparing Mo/Mo, Mo/Rh, and W/Rh target/filter combinations indicate that they exhibit significantly lower SNR2/exposure than the present approach, precluding them from being used for computed mammotomography, while maintaining dose limitations and obtaining sufficient SNR. Beam hardening was also much higher in the existing techniques (17%-42%) than for our technique (2%). Simulations demonstrate that this quasi-monochromatic x-ray technique may enhance tissue separation for a newly developed cone beam computed mammotomography application for an uncompressed breast.

Experimental spectral measurements of heavy K-edge filtered beams for x-ray computed mammotomography

A dual modality computed mammotomography (CmT) and single photon emission computed tomography (SPECT) system for dedicated 3D breast imaging is in development. Using heavy K-edge filtration, the CmT component narrows the energy spectrum of the cone-shaped x-ray beam incident on the patients pendant, uncompressed breast. This quasi-monochromatic beam is expected to improve discrimination of tissue with similar attenuation coefficients while restraining absorbed dose to below that of dual view mammography. Previous simulation studies showed the optimal energy that maximizes dose efficiency for a 50/50% adipose/glandular breast is between 30 and 40 keV. This study experimentally validates these results using pre-breast and post-breast spectral measurements made under tungsten tube voltages between 40 and 100 kVp using filter materials with K-edge values ranging from 15 to 70 keV. Different filter material thicknesses are used, approximately equivalent to the 200th and 500th attenuating value layer (VL) thickness. Cerium (K = 40.4 keV) filtered post-breast spectra for 8-18 cm breasts are measured for a range of breast compositions. Figures of merit include mean beam energy, spectral full-width at tenth-maximum, beam hardening and dose for the range of breast sizes. Measurements corroborate simulation results, indicating that for a given dose, a 200th VL of cerium filtration may have optimal performance in the dedicated mammotomography paradigm.

Evaluation of tilted cone-beam CT orbits in the development of a dedicated hybrid mammotomograph

A compact dedicated 3D breast SPECT-CT (mammotomography) system is currently under development. In its initial prototype, the cone-beam CT sub-system is restricted to a fixed-tilt circular rotation around the patients pendant breast. This study evaluated stationary-tilt angles for the CT sub-system that will enable maximal volumetric sampling and viewing of the breast and chest wall. Images of geometric/anthropomorphic phantoms were acquired using various fixed-tilt circular and 3D sinusoidal trajectories. The iteratively reconstructed images showed more distortion and attenuation coefficient inaccuracy from tilted cone-beam orbits than from the complex trajectory. Additionally, line profiles illustrated cupping artifacts in planes distal to the central plane of the tilted cone-beam, otherwise not apparent for images acquired with complex trajectories. This indicates that undersampled cone-beam data may be an additional cause of cupping artifacts. High-frequency objects could be distinguished for all trajectories, but their shapes and locations were corrupted by out-of-plane frequency information. Although more acrylic balls were visualized with a fixed-tilt and nearly flat cone-beam at the posterior of the breast, 3D complex trajectories have less distortion and more complete sampling throughout the reconstruction volume. While complex trajectories would ideally be preferred, negatively fixed-tilt source-detector configuration demonstrates minimally distorted patient images.

Performance of dedicated emission mammotomography for various breast shapes and sizes

We evaluate the effect of breast shape and size and lesion location on a dedicated emission mammotomography system developed in our lab. The hemispherical positioning gantry allows ample flexibility in sampling a pendant, uncompressed breast. Realistic anthropomorphic torso (which includes the upper portion of the arm) and breast phantoms draw attention to the necessity of using unique camera trajectories (orbits) rather than simple circular camera trajectories. We have implemented several novel three-dimensional (3D) orbits with fully contoured radius-of-rotation capability for compensating for the positioning demands that emerge from different breast shapes and sizes. While a general orbit design may remain the same between two different breasts, the absolute polar tilt range and radius-of-rotation range may vary. We have demonstrated that using 3D orbits with increased polar camera tilt, lesions near the chest wall can be visualized for both large and small sized breasts (325 ml to 1,060 ml), for a range of intrinsic contrasts (three to ten times higher activity concentration in the lesion than breast background). Overall, nearly complete 3D acquisition schemes yield image data with relatively high lesion SNRs and contrasts and with minimal distortion of the uncompressed breast shape.

Initial study of quasi-monochromatic X-ray beam performance for X-ray computed mammotomography

We evaluate the feasibility, benefits, and operating parameters of a quasimonochromatic beam for a newly developed x-ray cone beam computed mammotomography application. The value of a near monochromatic x-ray source for fully 3D dedicated mammotomography is the expected improved ability to separate tissues with very small differences in attenuation coefficients while maintaining dose levels at or below that of existing dual view mammography. In previous studies, simulations for a range of tungsten tube potentials, K-edge filter materials, filter thicknesses, and a 12 cm uncompressed breast, with a digital flat-panel CsI(Tl) detector model, indicated that thick, rare earth filter materials may provide optimized image quality. Figures of merit computed included: lesion contrast under different filtering conditions; ratio of measured lesion contrast with and without filtering; and exposure efficiency (SNR/sup 2//exposure). Initial experiments are performed with a custom built x-ray mammotomography system, cerium foil filters, and plastic breast and lesion tissue-equivalent slabs. Simulation results showed that tube potentials of 50-70 kVp with filters of Z=57-63 yielded quasimonochromatic x-ray spectra with improved FOMs. Initial experimental measurements corroborate simulation results in that, relative trends and rank order of contrast ratios and exposure efficiency were in agreement. These studies show that this approach can be implemented practically with simple hardware and yield improved exposure efficiency versus the unfiltered or minimally filtered case.

Analysis of a novel offset cone-beam computed mammotomography system geometry for accomodating various breast sizes.

We evaluate a newly developed dedicated cone-beam transmission computed mammotomography (CmT) system configuration using an optimized quasi-monochromatic cone beam technique for attenuation correction of SPECT in a planned dual-modality emission and transmission system for pendant, uncompressed breasts. In this study, we perform initial CmT acquisitions using various sized breast phantoms to evaluate an offset cone-beam geometry. This offset geometry provides conjugate projections through a full 360 degree gantry rotation, and thus yields a greatly increased effective field of view, allowing a much wider range of breast sizes to be imaged without truncation in reconstructed images. Using a tungsten X-ray tube and digital flat-panel X-ray detector in a compact geometry, we obtained initial CmT scans without shift and with the offset geometry, using geometrical frequency/resolution phantoms and two different sizes of breast phantoms. Acquired data were reconstructed using an ordered subsets transmission iterative algorithm. Projection images indicate that the larger, 20 cm wide, breast requires use of a half-cone-beam offset scan to eliminate truncation artifacts. Reconstructed image results illustrate elimination of truncation artifacts, and that the novel quasi-monochromatic beam yields reduced beam hardening. The offset geometry CmT system can indeed potentially be used for structural imaging and accurate attenuation correction for the functional dedicated breast SPECT system.

Investigation of cone-beam acquisitions implemented using a novel dedicated mammotomography system with unique arbitrary orbit capability (Honorable Mention Poster Award)

We investigate cone-beam acquisitions implemented on a novel dedicated cone-beam transmission computed mammotomography (CmT) system with unique arbitrary orbit capability for pendant, uncompressed breasts. We use a previously reported optimized quasi-monochromatic beam technique together with orbits made possible with a novel CmT gantry system, to evaluate Vertical-Axis-Of-Rotation (VAOR), Circle-Plus-Two-Arcs (CP2A), and Saddle trajectories. Aquisition parameters include: W target, 60 kVp tube potential, 100th VL Nd filtration, 1.25 mAs, 55 cm SID, CsI(Tl) digital flat panel x-ray detector, and 7.7cm diameter uniform disc (Defrise) and resolution phantoms. Complex orbits were also performed for a realistic breast phantom. Reconstructions used an iterative ordered subsets transmission (OSTR) algorithm with 4x4 binned projections, 8 subsets, and 10 iterations, with 0.125 mm3 voxels. We evaluate the results for image artifacts, distortion, and resolution. Reconstructed images of the disc coronal and sagittal slices show significant distortion of the discs and phantom interfaces away from the central plane of the cone-beam for VAOR, less distortion for CP2A, and minimal distortion for the complex 3D Saddle orbit. Resolution phantoms indicate no loss of resolution with the Saddle orbit, with the smallest 1.1mm diameter rods clearly resolved. Other image artifacts such as streaking were also significantly reduced in the Saddle orbit case. Results indicate that arbitrary orbits of pendant uncompressed breasts using cone-beam acquisitions and OSTR iterative reconstructions can be successfully implemented for dedicated CmT to improve angular sampling with significant reduction in distortion and other image artifacts. This capability has the potential to improve the performance of dedicated CmT by adequately sampling the breast and anterior chest volumes of prone patients with pendant, uncompressed breasts.

Preliminary investigation of dose for a dedicated mammotomography system

We use a previously reported, optimized quasi-monochromatic beam technique together with unique complex acquisition trajectories made possible with a novel, dedicated cone-beam transmission computed mammotomography (CmT) system to investigate effects of low dose imaging of pendant, uncompressed breasts. Investigators have used a guideline of dose for CmT type applications as that used for dual-view mammography (4-6 mGy for average breast size). This dose is somewhat arbitrary, and it may be possible to reduce this significantly without sacrificing image quality using our quasi-monochromatic x-ray beam, 3D complex acquisition orbits, and iterative reconstruction techniques. A low-scatter acrylic resolution phantom in various media, a breast phantom with sponge and oil-filled lesions, and a cadaver breast are used to evaluate the effect of lowered dose on resolution and image artifacts. Complex saddle acquisition trajectories (necessary to overcome cone-beam distortion) are carried out for total exposures of 96, 300, and 600 mAs over 240 projections. These exposures relate approximately to 1/10th, 1/3rd, and 2/3rd of the standard dual view mammography dose for an average sized 50% adipose/glandular breast. Iterative reconstruction uses an OSTR algorithm with 0.125 mm3 voxels. Image artifacts increased as dose was reduced but did not appear to greatly degrade image quality except at the lowest contrast tested (1% absolute contrast). As expected, noise increased as dose was reduced. However, this did not appear to affect resolution for rods in air (high contrast), nor rods in oil (20% absolute contrast). Resolution was reduced for rods in water (1% absolute contrast) due to increased prevalence of image artifacts as well as increased noise. Breast phantom imaging of soft lesions in a highly glandular breast (6% absolute contrast) clearly yielded the 60uL and all larger volume lesions. Preliminary biological breast tissue results illustrate excellent subjective image quality at all dose levels tested. Results indicate that our quasi-monochromatic beam together with complex orbit capability and iterative reconstruction has the potential to provide sufficient image quality for practical 3D mammotomography of uncompressed breasts at significantly lower dose than dual view mammography. This is nominally a 2-fold improvement over other approaches using circular orbits and broader spectral x-ray beams. While simple image filtering (post-reconstruction smoothing) could improve noise quality, improvements in image artifact correction and scatter correction are required to more accurately determine the lower limits on dose. A contrast-detail study is also warranted with a greater variety of lesion sizes and contrasts.