S. Cheenu Kappadath

Dual‐energy digital mammography: Calibration and inverse‐mapping techniques to estimate calcification thickness and glandular‐tissue ratio

Breast cancer may manifest as microcalcifications in x-ray mammography. Small microcalcifications, essential to the early detection of breast cancer, are often obscured by overlapping tissue structures. Dual-energy imaging, where separate low- and high-energy images are acquired and synthesized to cancel the tissue structures, may improve the ability to detect and visualize microcalcifications. Transmission measurements at two different kVp values were made on breast-tissue-equivalent materials under narrow-beam geometry using an indirect flat-panel mammographic imager. The imaging scenario consisted of variable aluminum thickness (to simulate calcifications) and variable glandular ratio (defined as the ratio of the glandular-tissue thickness to the total tissue thickness) for a fixed total tissue thickness--the clinical situation of microcalcification imaging with varying tissue composition under breast compression. The coefficients of the inverse-mapping functions used to determine material composition from dual-energy measurements were calculated by a least-squares analysis. The linear function poorly modeled both the aluminum thickness and the glandular ratio. The inverse-mapping functions were found to vary as analytic functions of second (conic) or third (cubic) order. By comparing the model predictions with the calibration values, the root-mean-square residuals for both the cubic and the conic functions were approximately 50 microm for the aluminum thickness and approximately 0.05 for the glandular ratio.

Quantitative evaluation of dual-energy digital mammography for calcification imaging

Dual-energy digital mammography (DEDM), where separate low- and high-energy images are acquired and synthesized to cancel the tissue structures, may improve the ability to detect and visualize microcalcifications. Under ideal imaging conditions, when the mammography image data are free of scatter and other biases, DEDM could be used to determine the thicknesses of the imaged calcifications. We present quantitative evaluation of a DEDM technique for calcification imaging. The phantoms used in the evaluation were constructed by placing aluminium strips of known thicknesses (to simulate calcifications) across breast-tissue-equivalent materials of different glandular-tissue compositions. The images were acquired under narrow-beam geometry and high exposures to suppress the detrimental effects of scatter and random noise. The measured aluminium thicknesses were found to be approximately linear with the true aluminium thicknesses and independent of the underlying glandular-tissue composition. However, the dual-energy images underestimated the true aluminium thickness due to the presence of scatter from adjacent regions. Regions in the DEDM image that contained no aluminium yielded very low aluminium thicknesses (<0.07 mm). The aluminium contrast-to-noise ratio in the dual-energy images increased with the aluminium thickness and decreased with the glandular-tissue composition. The changes to the aluminium contrast-to-noise ratio and the contrast of the tissue structures between the low-energy and DEDM images are also presented.

Dual‐energy digital mammography for calcification imaging: Scatter and nonuniformity corrections

Mammographic images of small calcifications, which are often the earliest signs of breast cancer, can be obscured by overlapping fibroglandular tissue. We have developed and implemented a dual-energy digital mammography (DEDM) technique for calcification imaging under full-field imaging conditions using a commercially available aSi:H/CsI:Tl flat-panel based digital mammography system. The low- and high-energy images were combined using a nonlinear mapping function to cancel the tissue structures and generate the dual-energy (DE) calcification images. The total entrance-skin exposure and mean-glandular dose from the low- and high-energy images were constrained so that they were similar to screening-examination levels. To evaluate the DE calcification image, we designed a phantom using calcium carbonate crystals to simulate calcifications of various sizes (212-425 microm) overlaid with breast-tissue-equivalent material 5 cm thick with a continuously varying glandular-tissue ratio from 0% to 100%. We report on the effects of scatter radiation and nonuniformity in x-ray intensity and detector response on the DE calcification images. The nonuniformity was corrected by normalizing the low- and high-energy images with full-field reference images. Correction of scatter in the low- and high-energy images significantly reduced the background signal in the DE calcification image. Under the current implementation of DEDM, utilizing the mammography system and dose level tested, calcifications in the 300-355 microm size range were clearly visible in DE calcification images. Calcification threshold sizes decreased to the 250-280 microm size range when the visibility criteria were lowered to barely visible. Calcifications smaller than approximately 250 microm were usually not visible in most cases. The visibility of calcifications with our DEDM imaging technique was limited by quantum noise, not system noise.

An Accurate Scatter Measurement and Correction Technique for Cone Beam Breast CT Imaging Using Scanning Sampled Measurement (SSM) Technique

We developed and investigated a scanning sampled measurement (SSM) technique for scatter measurement and correction in cone beam breast CT imaging. A cylindrical polypropylene phantom (water equivalent) was mounted on a rotating table in a stationary gantry experimental cone beam breast CT imaging system. A 2-D array of lead beads, with the beads set apart about ~1 cm from each other and slightly tilted vertically, was placed between the object and x-ray source. A series of projection images were acquired as the phantom is rotated 1 degree per projection view and the lead beads array shifted vertically from one projection view to the next. A series of lead bars were also placed at the phantom edge to produce better scatter estimation across the phantom edges. Image signals in the lead beads/bars shadow were used to obtain sampled scatter measurements which were then interpolated to form an estimated scatter distribution across the projection images. The image data behind the lead bead/bar shadows were restored by interpolating image data from two adjacent projection views to form beam-block free projection images. The estimated scatter distribution was then subtracted from the corresponding restored projection image to obtain the scatter removed projection images. Our preliminary experiment has demonstrated that it is feasible to implement SSM technique for scatter estimation and correction for cone beam breast CT imaging. Scatter correction was successfully performed on all projection images using scatter distribution interpolated from SSM and restored projection image data. The resultant scatter corrected projection image data resulted in elevated CT number and largely reduced the cupping effects.

Dual-energy digital mammography for calcification imaging: noise reduction techniques

We have previously developed a dual-energy digital mammography (DEDM) technique for calcification imaging under full-field imaging conditions using a commercially available flat-panel based digital mammography system. Although dual-energy (DE) imaging could suppress the obscuration of calcifications by tissue-structure background, it also increases the intrinsic noise in the DE images. Here we report on the effects of three different noise reduction techniques on DE calcification images: a simple smoothing (boxcar) filter applied to the DE image, a median filter applied to the HE image prior to the computation of the DE image and an adaptation of the Kalenders correlated-noise reduction (KNR) technique for DEDM. We compared the different noise reduction techniques by evaluating their effects on DE calcification images of a 5 cm thick breast-tissue-equivalent slab with continuously varying glandular-tissue ratio superimposed with calcium carbonate crystals of various sizes that simulate calcifications. Evaluations of different noise reducing techniques were performed by comparison of the root-mean-square signal in background regions (no calcifications present) of the DE calcification images and the contrast-to-noise ratios (CNR) of the calcifications in the DE calcification images. Amongst the different noise reduction techniques evaluated in this study, the KNR method was found to be most effective in reducing the image noise and increasing the calcification visibility (or CNR), closely followed by the HE median filter technique. Although the simple smoothing (boxcar) filter reduced the noise, it did not improve calcification visibility. The visible calcification threshold size with DEDM over smoothly varying background at screening mammography doses, assuming a CNR threshold of 4, was estimated to be around 250 microm with both the HE median filter and the KNR techniques. The quality of DE images with noise reduction techniques based on phantom studies were verified with DE images of an animal-tissue phantom that consisted of calcifications superimposed over more realistic tissue structures.

Cone Beam Breast CT with a Flat Panel Detector- Simulation, Implementation and Demonstration

This paper describes our experiences in the simulation, implementation and application of a flat panel detector based cone beam computed tomography (CT) imaging system for dedicated 3-D breast imaging. In our simulation study, the breast was analytically modeled as a cylinder of breast tissue loosely molded into cylindrical shape with embedded soft tissue masses and calcifications. Attenuation coefficients for various types of breast tissue, soft tissue masses and calcifications were estimated for various kVps to generate simulated image signals. Projection images were computed to incorporate X-ray attenuation, geometric magnification, X-ray detection, detector blurring, image pixelization and digitization. Based on the X-ray kVp/filtration used, transmittance through the phantom, detective quantum efficiency (DQE), exposure level, and imaging geometry, the photon fluence was estimated and used to compute the quantum noise level on a pixel-by-pixel basis for various dose levels at the isocenter. This estimated noise level was then used with a random number generator to generate and add a fluctuation component to the noiseless transmitted image signal. The noise carrying projection images were then convolved with a Gaussian-like kernel, computed from measured 1-D line spread function (LSF) to simulate detector blurring. Additional 2-D Gaussian filtering was applied to the projection images and tested for improving the detection of soft tissue masses and calcifications in the reconstructed images. Reconstruction was performed using the Feldkamp filtered backprojection algorithm. All simulations were performed on a 24 PC (2.4 GHz Dual-Xeon CPU) cluster with MPI parallel programming. With 600 mrads mean glandular dose (MGD) at the phantom center, soft tissue masses as small as 1 mm in diameter could be visualized in a 10 cm diameter 50% glandular 50% adipose or fatter breast tissue, and 2 mm or larger masses were visible in a 100% glandular 0% adipose breast tissue. We have also demonstrated that 0.15 mm or larger calcification could be detected with a 100 mum detector pixel size while 0.2 mm or larger calcifications were visible with a pixel size of 200 mum. Our simulation study has shown that the cone-beam CT breast imaging can provide reasonable good quality and detectability at a dose level similar to that of two views mammography. For imaging experiments, a stationary x-ray source and detector, a stationary gantry, rotating phantom system was constructed to demonstrate cone beam breast CT imaging. Breast specimens from mastectomy were imaged to demonstrate the superior tissue contrast that can be achieved with the cone beam CT technique. Various phantoms were imaged to demonstrate that calcifications as small as 280 mum could be imaged at 80 RVp with a voxel size of 140 mum with an estimated isocenter dose of 1.8 rad

Observed intercamera variability in clinically relevant performance characteristics for Siemens Symbia gamma cameras

We conducted an evaluation of the intercamera (i.e., between cameras) variability in clinically relevant performance characteristics for Symbia gamma cameras (Siemens Medical Solutions, Malvern, PA) based on measurements made using nine separate systems. The significance of the observed intercamera variability was determined by comparing it to the intracamera (i.e., within a single camera) variability. Measurements of performance characteristics were based on the standards of the National Electrical Manufacturers Association and reports 6, 9, 22, and 52 from the American Association of Physicists in Medicine. All measurements were performed using T99mc (except C57o used for extrinsic resolution) and low‐energy, high‐resolution collimation. Of the nine cameras, four have crystals 3/8 in. thick and five have crystals 5/8 in. thick. We evaluated intrinsic energy resolution, intrinsic and extrinsic spatial resolution, intrinsic integral and differential flood uniformity over the useful field‐of‐view, count rate at 20% count loss, planar sensitivity, single‐photon emission computed tomography (SPECT) resolution, and SPECT integral uniformity. The intracamera variability was estimated by repeated measurements of the performance characteristics on a single system. The significance of the observed intercamera variability was evaluated using the two‐tailed F distribution. The planar sensitivity of the gamma cameras tested was found be variable at the 99.8% confidence level for both the 3/8‐in. and 5/8‐in. crystal systems. The integral uniformity and energy resolution were found to be variable only for the 5/8‐in. crystal systems at the 98% and 90% confidence level, respectively. All other performance characteristics tested exhibited no significant variability between camera systems. The measured variability reported here could perhaps be used to define nominal performance values of Symbia gamma cameras for planar and SPECT imaging. PACS numbers: 87.62.+n, 87.58.Pm, 87.58.Ce

Visibility of simulated microcalcifications--A hardcopy-based comparison of three mammographic systems

Full-field digital mammography systems are currently available for clinical use. These digital systems offer improved image quality, flexible image processing, display, storage, retrieval, and transmission. These systems employ a variety of different x-ray detectors based on storage phosphors (in computed radiography), charge-coupled devices (CCDs), or amorphous silicon flat panels (FPs). The objective of this study is to compare three different types of mammographic detectors: screenfilm (SF) combination, a CsI-based FP detector, a CCD and x-ray phosphor-based detector for their performance in detection of simulated microcalcifications. Microcalcifications (MCs) were simulated with calcium carbonate grains of various sizes (90-355 microm). They were overlapped with a slab of simulated 50% adipose/50% glandular breast tissue for a uniform background or an anthropomorphic breast phantom for a tissue structure background. Images of the phantoms, acquired with and without magnification, were reviewed by mammographers, physicists, and students. A five-point confidence level rating was given for each MC reviewed. Average ratings from the mammographers were used to compare the performances of the three imaging systems, various MC size groups, and two magnification modes. The results indicate that with uniform background and no magnification, the FP system performed the best while the SF system did slightly better than the CCD system. With magnification added, all detection tasks were improved except for the smallest and largest one or two size groups. In particular, detection in the SF and CCD images was significantly improved over that in the FP images. With tissue structure background and no magnification, the FP system was outperformed by the SF and the CCD systems. With magnification added, the performance of the FP and the CCD systems was improved significantly. With this improvement, the SF and FP systems were outperformed by the CCD system.

An empirical model of diagnostic x‐ray attenuation under narrow‐beam geometry

PURPOSE The purpose of this study was to develop and validate a mathematical model to describe narrow-beam attenuation of kilovoltage x-ray beams for the intended applications of half-value layer (HVL) and quarter-value layer (QVL) estimations, patient organ shielding, and computer modeling. METHODS An empirical model, which uses the Lambert W function and represents a generalized Lambert-Beer law, was developed. To validate this model, transmission of diagnostic energy x-ray beams was measured over a wide range of attenuator thicknesses [0.49-33.03 mm Al on a computed tomography (CT) scanner, 0.09-1.93 mm Al on two mammography systems, and 0.1-0.45 mm Cu and 0.49-14.87 mm Al using general radiography]. Exposure measurements were acquired under narrow-beam geometry using standard methods, including the appropriate ionization chamber, for each radiographic system. Nonlinear regression was used to find the best-fit curve of the proposed Lambert W model to each measured transmission versus attenuator thickness data set. In addition to validating the Lambert W model, we also assessed the performance of two-point Lambert W interpolation compared to traditional methods for estimating the HVL and QVL [i.e., semi-logarithmic (exponential) and linear interpolation]. RESULTS The Lambert W model was validated for modeling attenuation versus attenuator thickness with respect to the data collected in this study (R2 > 0.99). Furthermore, Lambert W interpolation was more accurate and less sensitive to the choice of interpolation points used to estimate the HVL and/or QVL than the traditional methods of semilogarithmic and linear interpolation. CONCLUSIONS The proposed Lambert W model accurately describes attenuation of both monoenergetic radiation and (kilovoltage) polyenergetic beams (under narrow-beam geometry).

Performance Evaluation of Material Decomposition With Rapid-Kilovoltage-Switching Dual-Energy CT and Implications for Assessing Bone Mineral Density

OBJECTIVE The purpose of this article is to quantitatively investigate the accuracy and performance of dual-energy CT (DECT) material density images and to calculate the areal bone mineral density (aBMD) for comparison with dual-energy x-ray absorptiometry (DEXA). MATERIALS AND METHODS A rapid-kilovoltage-switching DECT scanner was used to create material density images of various two-material phantoms of known concentrations under different experimental conditions. They were subsequently also scanned by single-energy CT and DEXA. The total uncertainty and accuracy of the DECT concentration measurements was quantified by the root-mean-square (RMS) error, and linear regression was performed to evaluate measurement changes under varying scanning conditions. Alterations to accuracy with concentric (anthropomorphic) phantom geometry were explored. The sensitivity of DECT and DEXA to changes in material density was evaluated. Correlations between DEXA and DECT-derived aBMD values were assessed. RESULTS The RMS error of DECT concentration measurements in air ranged from 9% to 244% depending on the materials. Concentration measurements made off-isocenter or with a different DECT protocol were slightly lower (≈ 5%), whereas measurement in scattering conditions resulted in a reduction of 8-27%. In concentric phantoms, higher-attenuating material in the outer chamber increased measured values of the inner material for all methods. DECT was more sensitive than DEXA to changes in BMD at 2 mg/mL K2HPO4. Measurements of aBMD using DECT and DEXA were highly correlated (R(2) = 0.98). CONCLUSION DECT material density images were linear in response but prone to poor accuracy and biases. DECT-based aBMD could be used to monitor relative change in bone density.