Shih Ying Huang

Contrast-enhanced Dedicated Breast CT: Initial Clinical Experience

PURPOSE To quantify contrast material enhancement of breast lesions scanned with dedicated breast computed tomography (CT) and to compare their conspicuity with that at unenhanced breast CT and mammography. MATERIALS AND METHODS Approval of the institutional review board and the Radiation Use Committee and written informed consent were obtained for this HIPAA-compliant study. Between September 2006 and April 2009, 46 women (mean age, 53.2 years; age range, 35-72 years) with Breast Imaging Reporting and Data System category 4 or 5 lesions underwent unenhanced breast CT and contrast material-enhanced breast CT before biopsy. Two radiologists independently scored lesion conspicuity for contrast-enhanced breast CT versus mammography and for contrast-enhanced breast CT versus unenhanced breast CT. Mean lesion voxel intensity was measured in Hounsfield units and normalized to adipose tissue intensity on manually segmented images obtained before and after administration of contrast material. Regression models focused on conspicuity and quantified enhancement were used to estimate the effect of pathologic diagnosis (benign vs malignant), lesion type (mass vs calcifications), breast density, and interradiologist variability. RESULTS Fifty-four lesions (25 benign, 29 malignant) in 46 subjects were analyzed. Malignant lesions were seen significantly better at contrast-enhanced breast CT than at unenhanced breast CT (P < .001) or mammography (P < .001). Malignant calcifications (malignant lesions manifested mammographically as microcalcifications only, n = 7) were seen better at contrast-enhanced breast CT than at unenhanced breast CT (P < .001) and were seen similarly at contrast-enhanced breast CT and mammography. Malignant lesions enhanced 55.9 HU +/- 4.0 (standard error), whereas benign lesions enhanced 17.6 HU +/- 6.1 (P < .001). Ductal carcinoma in situ (n = 5) enhanced a mean of 59.6 HU +/- 2.8. Receiver operating characteristic curve analysis of lesion enhancement yielded an area under the receiver operating characteristic curve of 0.876. CONCLUSION Conspicuity of malignant breast lesions, including ductal carcinoma in situ, is significantly improved at contrast-enhanced breast CT. Quantifying lesion enhancement may aid in the detection and diagnosis of breast cancer.

Evaluation of the spatial resolution characteristics of a cone-beam breast CT scanner

The purpose of this study was to examine the spatial resolution of a prototype pendant-geometry cone-beam breast computed tomography (CT) system. Modulation transfer functions (MTFs) of the reconstructed image in the coronal (x and y) plane were computed as a function of the cone angle, the radial distance from the axis of rotation, the size of the reconstruction matrix, the back-projection filter used, and the number of projections acquired for the reconstruction. The results show that the cone angle and size of the reconstruction matrix have minimal impact on the MTF, while the MTF degraded radially from the axis of rotation (from 0.76 at 2.6 mm from axis of rotation down to 0.37 at 76.9 mm from axis of rotation at f=0.5 mm(-1)). The Ramp reconstruction filter increases the MTF near the axis of rotation relative to the Shepp-Logan filter, while an increase in the number of projections from 500 to 1000 increased the MTF near the periphery of the reconstructed image. The MTF in the z direction (anterior-posterior direction) was also evaluated. The z-direction MTF values tend to be higher when compared to the coronal MTF (0.85 at f =0.5 mm(-1)), and tend to be very constant throughout the coronal plane direction. The results suggest that an increase in the MTF for the prototype breast CT system is possible by optimizing various scanning and reconstruction parameters.

The effect of skin thickness determined using breast CT on mammographic dosimetry

The effect of breast skin thickness on dosimetry in mammography was investigated. Breast computed tomography (CT) acquisition techniques, combined with algorithms designed for determining specific breast metrics, were useful for estimating skin thickness. A radial-geometry edge detection scheme was implemented on coronal reconstructed breast CT (bCT) images to measure the breast skin thickness. Skin thickness of bilateral bCT volume data from 49 women and unilateral bCT volume data from 2 women (10 healthy women and 41 women with BIRADS 4 and 5 diagnoses) was robustly measured with the edge detection scheme. The mean breast skin thickness (+/-inter-breast standard deviation) was found to be 1.45 +/- 0.30 mm. Since most current published normalized glandular dose (DgN) coefficients are based on the assumption of a 4-mm breast skin thickness, the DgN values computed with Monte Carlo techniques will increase up to 18% due to the thinner skin layers (e.g., 6-cm 50% glandular breast, 28 kVp Mo-Mo spectrum). The thinner skin dimensions found in this study suggest that the current DgN values used for mammographic dosimetry lead to a slight underestimate in glandular dose.

The characterization of breast anatomical metrics using dedicated breast CT

PURPOSE Accurate anatomical characterization of the breast is useful in breast phantom development and computer modeling of breast imaging technologies. Capitalizing on the three-dimensional capabilities of dedicated breast CT (bCT), a number of parameters which describe breast shape and fibroglandular distribution are defined. METHODS Among 219 bCT data sets, the effective diameter and length of the pendant breast as well as the breast volume were measured and characterized for each bra cup size. The volume glandular fraction (VGF) was determined as a function of patient age, BIRADS density, bra cup size, and breast diameter. The glandular fraction was examined in coronal and sagittal planes of the breast, and the radial distribution of breast glandular fraction within a coronal bCT image was examined for three breast regions. The areal glandular fraction (AGF) was estimated from two-dimensional projections of the breast (simulated by projecting bCT data sets) and was compared to the corresponding VGF. RESULTS The effective breast diameter and length increase with increasing bra cup size. The mean breast diameters (+/- standard error) of bra cup sizes A/AA, B, C, and D/DD were 11.1 +/- 0.5, 11.4 +/- 0.3, 13.0 +/- 0.2, and 13.7 +/- 0.2 cm, respectively. VGF was lower among older women and those with larger breast diameter and larger bra cup size. VGF increased as a function of the reported BIRADS density. AGF increased with VGF. Fibroglandular tissue was distributed primarily in the central portion of the breast. CONCLUSIONS Breast metrics were examined and a number of parameters were defined which may be useful for breast modeling. The reported data may provide researchers with useful information for characterizing the breast for various imaging or dosimetry tasks.

Noise power properties of a cone-beam CT system for breast cancer detection

The noise power properties of a cone-beam computed tomography (CT) system dedicated for breast cancer detection were investigated. Uniform polyethylene cylinders of various diameters were scanned under different system acquisition conditions. Noise power spectra were calculated from difference data generated by subtraction between two identical scans. Multidimensional noise power spectra (NPS) were used as the metric to evaluate the noise properties of the breast CT (bCT) under different system acquisition and reconstruction conditions. A comprehensive investigation of the noise properties was performed in regard to system acquisition parameters including kVp, mA, number of cone-beam projection images used, cone angle, and object size. The influence on reconstruction parameters including interpolation method, reconstruction filter, field of view, matrix size, and slice thickness were also studied. Under certain conditions, the zero-dimensional NPS (image variance) was used as a quantitative index to compare the influence from different scan parameters, especially the radiation dose. If the total scan dose is changed by linearly changing the total number of projection images while the dose per frame is kept constant, the noise power has a linear relationship with the reciprocal of the total dose. If the total scan dose is changed by linearly changing the dose per frame while the total number of projection images is kept constant, the noise power has a quadratic relationship with the reciprocal of the total dose. With the same amount of total dose, using fewer projection images results in lower image noise power in the CT image. Quantitative results from this noise power analysis provide guidance for the bCT system operation, optimization, and data reconstruction.

Experimentally determined spectral optimization for dedicated breast computed tomography

PURPOSE The current study aimed to experimentally identify the optimal technique factors (x-ray tube potential and added filtration material/thickness) to maximize soft-tissue contrast, microcalcification contrast, and iodine contrast enhancement using cadaveric breast specimens imaged with dedicated breast computed tomography (bCT). Secondarily, the study aimed to evaluate the accuracy of phantom materials as tissue surrogates and to characterize the change in accuracy with varying bCT technique factors. METHODS A cadaveric breast specimen was acquired under appropriate approval and scanned using a prototype bCT scanner. Inserted into the specimen were cylindrical inserts of polyethylene, water, iodine contrast medium (iodixanol, 2.5 mg/ml), and calcium hydroxyapatite (100 mg/ml). Six x-ray tube potentials (50, 60, 70, 80, 90, and 100 kVp) and three different filters (0.2 mm Cu, 1.5 mm Al, and 0.2 mm Sn) were tested. For each set of technique factors, the intensity (linear attenuation coefficient) and noise were measured within six regions of interest (ROIs): Glandular tissue, adipose tissue, polyethylene, water, iodine contrast medium, and calcium hydroxyapatite. Dose-normalized contrast to noise ratio (CNRD) was measured for pairwise comparisons among the six ROIs. Regression models were used to estimate the effect of tube potential and added filtration on intensity, noise, and CNRD. RESULTS Iodine contrast enhancement was maximized using 60 kVp and 0.2 mm Cu. Microcalcification contrast and soft-tissue contrast were maximized at 60 kVp. The 0.2 mm Cu filter achieved significantly higher CNRD for iodine contrast enhancement than the other two filters (p = 0.01), but microcalcification contrast and soft-tissue contrast were similar using the copper and aluminum filters. The average percent difference in linear attenuation coefficient, across all tube potentials, for polyethylene versus adipose tissue was 1.8%, 1.7%, and 1.3% for 0.2 mm Cu, 1.5 mm Al, and 0.2 mm Sn, respectively. For water versus glandular tissue, the average percent difference was 2.7%, 3.9%, and 4.2% for the three filter types. CONCLUSIONS Contrast-enhanced bCT, using injected iodine contrast medium, may be optimized for maximum contrast of enhancing lesions at 60 kVp with 0.2 mm Cu filtration. Soft-tissue contrast and microcalcification contrast may also benefit from lower tube potentials (60 kVp). The linear attenuation coefficients of water and polyethylene slightly overestimate the values of their corresponding tissues, but the reported differences may serve as guidance for dosimetry and quality assurance using tissue equivalent phantoms.

Noise variance analysis using a flat panel x-ray detector: A method for additive noise assessment with application to breast CT applications

PURPOSE A simplified linear model approach was proposed to accurately model the response of a flat panel detector used for breast CT (bCT). METHODS Individual detector pixel mean and variance were measured from bCT projection images acquired both in air and with a polyethylene cylinder, with the detector operating in both fixed low gain and dynamic gain mode. Once the coefficients of the linear model are determined, the fractional additive noise can be used as a quantitative metric to evaluate the systems efficiency in utilizing x-ray photons, including the performance of different gain modes of the detector. RESULTS Fractional additive noise increases as the object thickness increases or as the radiation dose to the detector decreases. For bCT scan techniques on the UC Davis prototype scanner (80 kVp, 500 views total, 30 frames/s), in the low gain mode, additive noise contributes 21% of the total pixel noise variance for a 10 cm object and 44% for a 17 cm object. With the dynamic gain mode, additive noise only represents approximately 2.6% of the total pixel noise variance for a 10 cm object and 7.3% for a 17 cm object. CONCLUSIONS The existence of the signal-independent additive noise is the primary cause for a quadratic relationship between bCT noise variance and the inverse of radiation dose at the detector. With the knowledge of the additive noise contribution to experimentally acquired images, system modifications can be made to reduce the impact of additive noise and improve the quantum noise efficiency of the bCT system.

An X-ray Computed Tomography/Positron Emission Tomography System Designed Specifically for Breast Imaging

Mammography has served the population of women who are at-risk for breast cancer well over the past 30 years. While mammography has undergone a number of changes as digital detector technology has advanced, other modalities such as computed tomography have experienced technological sophistication over this same time frame as well. The advent of large field of view flat panel detector systems enable the development of breast CT and several other niche CT applications, which rely on cone beam geometry. The breast, it turns out, is well suited to cone beam CT imaging because the lack of bones reduces artifacts, and the natural tapering of the breast anteriorly reduces the x-ray path lengths through the breast at large cone angle, reducing cone beam artifacts as well. We are in the process of designing a third prototype system which will enable the use of breast CT for image guided interventional procedures. This system will have several copies fabricated so that several breast CT scanners can be used in a multi-institutional clinical trial to better understand the role that this technology can bring to breast imaging.

A semiempirical linear model of indirect, flat-panel x-ray detectors.

PURPOSE It is important to understand signal and noise transfer in the indirect, flat-panel x-ray detector when developing and optimizing imaging systems. For optimization where simulating images is necessary, this study introduces a semiempirical model to simulate projection images with user-defined x-ray fluence interaction. METHODS The signal and noise transfer in the indirect, flat-panel x-ray detectors is characterized by statistics consistent with energy-integration of x-ray photons. For an incident x-ray spectrum, x-ray photons are attenuated and absorbed in the x-ray scintillator to produce light photons, which are coupled to photodiodes for signal readout. The signal mean and variance are linearly related to the energy-integrated x-ray spectrum by empirically determined factors. With the known first- and second-order statistics, images can be simulated by incorporating multipixel signal statistics and the modulation transfer function of the imaging system. To estimate the semiempirical input to this model, 500 projection images (using an indirect, flat-panel x-ray detector in the breast CT system) were acquired with 50-100 kilovolt (kV) x-ray spectra filtered with 0.1-mm tin (Sn), 0.2-mm copper (Cu), 1.5-mm aluminum (Al), or 0.05-mm silver (Ag). The signal mean and variance of each detector element and the noise power spectra (NPS) were calculated and incorporated into this model for accuracy. Additionally, the modulation transfer function of the detector system was physically measured and incorporated in the image simulation steps. For validation purposes, simulated and measured projection images of air scans were compared using 40 kV∕0.1-mm Sn, 65 kV∕0.2-mm Cu, 85 kV∕1.5-mm Al, and 95 kV∕0.05-mm Ag. RESULTS The linear relationship between the measured signal statistics and the energy-integrated x-ray spectrum was confirmed and incorporated into the model. The signal mean and variance factors were linearly related to kV for each filter material (r(2) of signal mean to kV: 0.91, 0.93, 0.86, and 0.99 for 0.1-mm Sn, 0.2-mm Cu, 1.5-mm Al, and 0.05-mm Ag, respectively; r(2) of signal variance to kV: 0.99 for all four filters). The comparison of the signal and noise (mean, variance, and NPS) between the simulated and measured air scan images suggested that this model was reasonable in predicting accurate signal statistics of air scan images using absolute percent error. Overall, the model was found to be accurate in estimating signal statistics and spatial correlation between the detector elements of the images acquired with indirect, flat-panel x-ray detectors. CONCLUSIONS The semiempirical linear model of the indirect, flat-panel x-ray detectors was described and validated with images of air scans. The model was found to be a useful tool in understanding the signal and noise transfer within indirect, flat-panel x-ray detector systems.

Simulation and Phantom Studies of Contrast-Enhanced Dual Energy Mammography (CEDEM)

Contrast-enhanced dual energy mammography (CEDEM) has been shown effective in enhancing the visibility of breast cancer in diagnostic mammographic images. The simulation and phantom studies of CEDEM were implemented to enhance acquisition techniques of a dedicated cone-beam breast CT scanner fabricated in our laboratory. CEDEM images were computer-simulated numerically, and the results were compared and validated with physical experiments using a custom-made breast-equivalent phantom with pseudo anatomical structures. The technique factors to be optimized included low- and high-energy x-ray spectra (kVp), spectra filters and mAs (x-ray tube current × scan time in second). Signal-difference-to-noise ratio (SDNR) of the log-weighted subtracted image was computed to optimize subtraction parameters using several combinations of breast compositions and thicknesses. Both simulation and phantom studies suggest that 40 kVp (filtered with 1.5 mm Al) and 50 kVp (filtered with 1.5 mm Al and 0.3 mm Cu) were the optimal spectra with the highest SDNR on the dual energy subtracted image of a 6-cm, 50% glandular breast. Breast composition and thickness were found to have little influence on the optimized technique factors. We conclude that the simulation and phantom studies demonstrated the effectiveness of CEDEM using the prototype breast CT scanner in producing high-quality, lesion-enhanced images.