Raymond J. Acciavatti

The effect of scatter and glare on image quality in contrast-enhanced breast imaging using an a-Si/CsI(Tl) full-field flat panel detector

The purpose of this study is to evaluate the performance of an antiscatter grid and its potential benefit on image quality for a full-field digital mammography (FFDM) detector geometry at energies typical for temporal subtraction contrast-enhanced (CE) breast imaging. The signal intensities from primary, scatter, and glare were quantified in images acquired with an a-Si/CsI(T1) FFDM detector using a Rh target and a 0.27 mm Cu filter at tube voltages ranging from 35 to 49 kV. Measurements were obtained at the center of the irradiation region of 20-80 mm thick breast-equivalent phantoms. The phantoms were imaged with and without an antiscatter grid. Based on these data, the performance of the antiscatter grid was determined by calculating the primary and scatter transmission factors (T(P) and T(S)) and Bucky factors (Bf). In addition, glare-to-primary ratios (GPRs) and scatter-to-primary ratios (SPRs) were quantified. The effect of the antiscatter grid on the signal-difference-to-noise ratio (SDNR) was also assessed. It was found that T(P) increases with kV but does not depend on the phantom thickness; T(P) values between 0.81 and 0.84 were measured. T(S) increases with kV and phantom thickness; T(S) values between 0.13 and 0.21 were measured. Bf decreases with kV and increases with phantom thickness; Bf ranges from 1.4 to 2.1. GPR is nearly constant, varying from 0.10 to 0.11. SPR without an antiscatter grid (SPR-) ranges from 0.35 to 1.34. SPR- decreases by approximately 9% from 35 to 49 kV for a given phantom thickness and is 3.5 times larger for an 80 mm thick breast-equivalent phantom than for a 20 mm thick breast-equivalent phantom. SPR with an antiscatter grid (SPR+) ranges from 0.06 to 0.31. SPR+ increases by approximately 23% from 35 to 49 kV for a given phantom thickness; SPR+ is four times larger for an 80 mm breast-equivalent phantom than for a 20 mm breast-equivalent phantom. When imaging a 25 mm PMMA plate at the same mean glandular dose with and without an antiscatter grid, the SDNR is 4% greater with a grid than without. For an 75 mm PMMA plate, the SDNR is 20% greater with a grid. In conclusion, at the higher x-ray energy range used for CE-DM and CE-DBT, an antiscatter grid significantly reduces SPR and improves SDNR. These effects are most pronounced for thick breasts.

Optimization of a dual-energy contrast-enhanced technique for a photon-counting digital breast tomosynthesis system: I. A theoretical model

PURPOSE Dual-energy (DE) iodine contrast-enhanced x-ray imaging of the breast has been shown to identify cancers that would otherwise be mammographically occult. In this article, theoretical modeling was performed to obtain optimally enhanced iodine images for a photon-counting digital breast tomosynthesis (DBT) system using a DE acquisition technique. METHODS In the system examined, the breast is scanned with a multislit prepatient collimator aligned with a multidetector camera. Each detector collects a projection image at a unique angle during the scan. Low-energy (LE) and high-energy (HE) projection images are acquired simultaneously in a single scan by covering alternate collimator slits with Sn and Cu filters, respectively. Sn filters ranging from 0.08 to 0.22 mm thickness and Cu filters from 0.11 to 0.27 mm thickness were investigated. A tube voltage of 49 kV was selected. Tomographic images, hereafter referred to as DBT images, were reconstructed using a shift-and-add algorithm. Iodine-enhanced DBT images were acquired by performing a weighted logarithmic subtraction of the HE and LE DBT images. The DE technique was evaluated for 20-80 mm thick breasts. Weighting factors,wt, that optimally cancel breast tissue were computed. Signal-difference-to-noise ratios (SDNRs) between iodine-enhanced and nonenhanced breast tissue normalized to the square root of the mean glandular dose (MGD) were computed as a function of the fraction of the MGD allocated to the HE images. Peak SDNR/MGD and optimal dose allocations were identified. SDNR/MGD and dose allocations were computed for several practical feasible system configurations (i.e., determined by the number of collimator slits covered by Sn and Cu). A practical system configuration and Sn-Cu filter pair that accounts for the trade-off between SDNR, tube-output, and MGD were selected. RESULTS wt depends on the Sn-Cu filter combination used, as well as on the breast thickness; to optimally cancel 0% with 50% glandular breast tissue, wt values were found to range from 0.46 to 0.72 for all breast thicknesses and Sn-Cu filter pairs studied. The optimal wt values needed to cancel all possible breast tissue glandularites vary by less than 1% for 20 mm thick breasts and 18% for 80 mm breasts. The system configuration where one collimator slit covered by Sn is alternated with two collimator slits covered by Cu delivers SDNR/MGD nearest to the peak value. A reasonable compromise is a 0.16 mm Sn-0.23 mm Cu filter pair, resulting in SDNR values between 1.64 and 0.61 and MGD between 0.70 and 0.53 mGy for 20-80 mm thick breasts at the maximum tube current. CONCLUSIONS A DE acquisition technique for a photon-counting DBT imaging system has been developed and optimized.

Observation of super‐resolution in digital breast tomosynthesis

PURPOSE Digital breast tomosynthesis (DBT) is a 3D x-ray imaging modality in which tomographic sections of the breast are generated from a limited range of tube angles. Because oblique x-ray incidence shifts the image of an object in subpixel detector element increments with each increasing projection angle, it is demonstrated that DBT is capable of super-resolution (i.e., subpixel resolution). METHODS By convention, DBT reconstructions are performed on planes parallel to the breast support at various depths of the breast volume. In order for resolution in each reconstructed slice to be comparable to the detector, the pixel size should match that of the detector elements; hence, the highest frequency that can be resolved in the plane of reconstruction is the alias frequency of the detector. This study considers reconstruction grids with much smaller pixelation to visualize higher frequencies. For analytical proof of super-resolution, a theoretical framework is developed in which the reconstruction of a high frequency sinusoidal input is calculated using both simple backprojection (SBP) and filtered backprojection. To study the frequency spectrum of the reconstruction, its Fourier transform is also determined. The experimental feasibility of super-resolution was investigated by acquiring images of a bar pattern phantom with frequencies higher than the detector alias frequency. RESULTS Using analytical modeling, it is shown that the central projection cannot resolve frequencies exceeding the detector alias frequency. The Fourier transform of the central projection is maximized at a lower frequency than the input as evidence of aliasing. By contrast, SBP reconstruction can resolve the input, and its Fourier transform is correctly maximized at the input frequency. Incorporating filters into the reconstruction smoothens pixelation artifacts in the spatial domain and reduces spectral leakage in the Fourier domain. It is also demonstrated that the existence of super-resolution is dependent on position in the reconstruction and on the directionality of the input frequency. Consistent with the analytical results, experimental reconstructions of bar patterns showed visibility of frequencies greater than the detector alias frequency. Super-resolution was present at positions predicted from analytical modeling. CONCLUSIONS This work demonstrates the existence of super-resolution in DBT. Super-resolution has the potential to impact the visualization of fine structural details in the breast, such as microcalcifications and other subtle signs of cancer.

3D fast spin echo with out-of-slab cancellation: A technique for high-resolution structural imaging of trabecular bone at 7 tesla

Spin‐echo‐based pulse sequences are desirable for the application of high‐resolution imaging of trabecular bone but tend to involve high‐power deposition. Increased availability of ultrahigh field scanners has opened new possibilities for imaging with increased signal‐to‐noise ratio (SNR) efficiency, but many pulse sequences that are standard at 1.5 and 3 T exceed specific absorption rate limits at 7 T. A modified, reduced specific absorption rate, three‐dimensional, fast spin‐echo pulse sequence optimized specifically for in vivo trabecular bone imaging at 7 T is introduced. The sequence involves a slab‐selective excitation pulse, low‐power nonselective refocusing pulses, and phase cycling to cancel undesired out‐of‐slab signal. In vivo images of the distal tibia were acquired using the technique at 1.5, 3, and 7 T field strengths, and SNR was found to increase at least linearly using receive coils of identical geometry. Signal dependence on the choice of refocusing flip angles in the echo train was analyzed experimentally and theoretically by combining the signal from hundreds of coherence pathways, and it is shown that a significant specific absorption rate reduction can be achieved with negligible SNR loss. Magn Reson Med 63:719–727, 2010.

A comparative study of volumetric and area-based breast density estimation in digital mammography: results from a screening population

We compare a volumetric versus an area-based breast density estimation method in digital mammography Bilateral images from 71 asymptomatic women were analyzed Volumetric density was measured using QuantraTM (Hologic Inc.) Area-based density was estimated using Cumulus (Ver 4.0, Univ Toronto) Correlation and regression analysis was performed to determine the association between i) density from left versus right breasts and ii) volumetric versus the area-based measures Volumetric breast density measures are strongly correlated but statistically significantly different than the area-based measures (r=0.79, p<0.001) Regression demonstrates a significant non-linear association (R2=0.70,p<0.001) The density correlation between right and left breasts is also strong for both methods, (r≥0.95, p<0.001) The strong association with the area-based density measures suggests that volumetric breast density could potentially also aid in breast cancer risk estimation The observed non-linear association between volumetric and area-based estimates may have implications for risk stratification in clinical practice.

Optimization of phosphor-based detector design for oblique x-ray incidence in digital breast tomosynthesis

PURPOSE In digital breast tomosynthesis (DBT), a volumetric reconstruction of the breast is generated from a limited range of x-ray projections. One trade-off of DBT is resolution loss in the projections due to non-normal (i.e., oblique) x-ray incidence. Although degradation in image quality due to oblique incidence has been studied using empirical data and Monte Carlo simulations, a theoretical treatment has been lacking. The purpose of this work is to extend Swanks calculations of the transfer functions of turbid granular phosphors to oblique incidence. The model is ultimately used as a tool for optimizing the design of DBT detectors. METHODS A quantum-limited system and 20 keV x-rays are considered. Under these assumptions, the modulation transfer function (MTF) and noise power spectra (NPS) are derived using the diffusion approximation to the Boltzmann equation to model optical scatter within the phosphor. This approach is applicable to a nonstructured scintillator such as gadolinium oxysulfide doped with terbium (Gd(2)O(2)S:Tb), which is commonly used in breast imaging and which can reasonably approximate other detector materials. The detective quantum efficiency (DQE) is then determined from the Nishikawa formulation, where it is written as the product of the x-ray quantum detection efficiency, the Swank factor, and the Lubberts fraction. Transfer functions are calculated for both front- and back-screen configurations, which differ by positioning the photocathode at the exit or entrance point of the x-ray beam, respectively. RESULTS In the front-screen configuration, MTF and DQE are found to have considerable angular dependence, while NPS is shown to vary minimally with projection angle. As expected, the high frequency MTF and DQE are degraded substantially at large angles. By contrast, all transfer functions for the back-screen configuration have the advantage of significantly less angular dependence. Using these models, we investigated the possibility for optimizing the design of DBT detectors. As an example optimization strategy, the phosphor thickness which maximizes the DQE at a fixed frequency is analyzed. This work demonstrates that the optimal phosphor thickness for the front-screen is angularly dependent, shifting to lower thickness at higher angles. Conversely, the back-screen is not optimized by a single thickness but instead attains reasonably high DQE values over a large range of thicknesses. Although the back-screen configuration is not suited for current detectors using a glass substrate, it may prove to be preferred in future detectors using newly proposed plastic thin-film transistor (TFT) substrates. CONCLUSIONS Using the diffusion approximation to the Boltzmann equation to model the spread of light in a scintillator, this paper develops an analytical model of MTF, NPS, and DQE for a phosphor irradiated obliquely. The model is set apart from other studies on oblique incidence in being derived from first principles. This work has applications in the optimization of DBT detector design.

Parenchymal texture analysis in digital mammography: robust texture feature identification and equivalence across devices

Abstract. An analytical framework is presented for evaluating the equivalence of parenchymal texture features across different full-field digital mammography (FFDM) systems using a physical breast phantom. Phantom images (FOR PROCESSING) are acquired from three FFDM systems using their automated exposure control setting. A panel of texture features, including gray-level histogram, co-occurrence, run length, and structural descriptors, are extracted. To identify features that are robust across imaging systems, a series of equivalence tests are performed on the feature distributions, in which the extent of their intersystem variation is compared to their intrasystem variation via the Hodges–Lehmann test statistic. Overall, histogram and structural features tend to be most robust across all systems, and certain features, such as edge enhancement, tend to be more robust to intergenerational differences between detectors of a single vendor than to intervendor differences. Texture features extracted from larger regions of interest (i.e., >63  pixels2) and with a larger offset length (i.e., >7  pixels), when applicable, also appear to be more robust across imaging systems. This framework and observations from our experiments may benefit applications utilizing mammographic texture analysis on images acquired in multivendor settings, such as in multicenter studies of computer-aided detection and breast cancer risk assessment.

Investigating the Potential for Super-Resolution in Digital Breast Tomosynthesis

Digital breast tomosynthesis (DBT) is an emerging 3D x-ray imaging modality in which tomographic sections of the breast are generated from a limited range of tube angles. Because non-normal x-ray incidence causes the image of an object to be translated in sub-pixel increments with increasing projection angle, it is demonstrated in this work that DBT is capable of super-resolution (i.e., sub-pixel resolution). The feasibility of super-resolution is shown with a commercial DBT system using a bar pattern phantom. In addition, a framework for investigating super-resolution analytically is proposed by calculating the reconstruction profile for a sine input whose frequency is greater than the alias frequency of the detector. To study the frequency spectrum of the reconstruction, its continuous Fourier transform is also calculated. It is shown that the central projection cannot properly resolve frequencies higher than the alias frequency of the detector. Instead, the central projection represents a high frequency signal as if it were a lower frequency signal. The Fourier transform of the central projection is maximized at this lower frequency and has considerable spectral leakage as evidence of aliasing. By contrast, simple backprojection can be used to image high frequencies properly. The Fourier transform of simple backprojection is correctly maximized at the input frequency. Adding filters to the simple backprojection reconstruction smoothens pixilation artifacts, and reduces spectral leakage found in the frequency spectrum. In conclusion, this work demonstrates the feasibility of super-resolution in DBT experimentally and provides a framework for characterizing its presence analytically.

Calculation of OTF, NPS, and DQE for oblique x-ray incidence on turbid granular phosphors

Digital breast tomosynthesis (DBT) is an imaging modality in which tomographic sections of the breast are generated from a limited range of x-ray tube angles One drawback of DBT is resolution loss in the oblique projection images The purpose of this work is to extend Swanks formulation of the transfer functions of turbid granular phosphors to oblique x-ray incidence, using the diffusion approximation to the Boltzmann equation to model the spread of light in the phosphor As expected, the modulation transfer function (MTF) and noise power spectra (NPS) are found to decrease with projection angle regardless of frequency By contrast, the dependence of detective quantum efficiency (DQE) on projection angle is frequency dependent DQE increases with projection angle at low frequencies, and only decreases with projection angle at high frequencies Importantly, the x-ray quantum detection efficiency (AQ) and the Swank information factor (AS) are also found to be angularly dependent.

Optimization of continuous tube motion and step-and-shoot motion in digital breast tomosynthesis systems with patient motion

In digital breast tomosynthesis (DBT), a reconstruction of the breast is generated from projections acquired over a limited range of x-ray tube angles. There are two principal schemes for acquiring projections, continuous tube motion and step-and-shoot motion. Although continuous tube motion has the benefit of reducing patient motion by lowering scan time, it has the drawback of introducing blurring artifacts due to focal spot motion. The purpose of this work is to determine the optimal scan time which minimizes this trade-off. To this end, the filtered backprojection reconstruction of a sinusoidal input is calculated. At various frequencies, the optimal scan time is determined by the value which maximizes the modulation of the reconstruction. Although prior authors have studied the dependency of the modulation on focal spot motion, this work is unique in also modeling patient motion. It is shown that because continuous tube motion and patient motion have competing influences on whether scan time should be long or short, the modulation is maximized by an intermediate scan time. This optimal scan time decreases with object velocity and increases with exposure time. To optimize step-and-shoot motion, we calculate the scan time for which the modulation attains the maximum value achievable in a comparable system with continuous tube motion. This scan time provides a threshold below which the benefits of step-and-shoot motion are justified. In conclusion, this work optimizes scan time in DBT systems with patient motion and either continuous tube motion or step-and-shoot motion by maximizing the modulation of the reconstruction.