Factors affecting film-screen mammographic image quality

This paper discusses the technical aspects of mammographic image quality and the factors that affect it. Emphasis is placed on the role of the service professional and the challenges he or she faces as a result of implementation of the Mammography Quality Standards Act of 1992 (MQSA). The passage of the MQSA represented the first attempt to legislate diagnostic image quality. Such legislation will only succeed, however, if all members of the mammographic imaging team fully understand the factors that affect image quality, the role that each member plays in assuring image quality, and the mandates of the MQSA.     

基于重采样的胸部CT图像肺实质自动分割

目的胸部CT图像的肺实质自动分割是肺部疾病计算机辅助检测的重要基础。为提高分割速度,本文提出并实现了一种基于重采样的分割算法。方法首先对数据重采样,提取部分（1／8）体数据。再基于重采样体数据,通过阈值分割、胸腔提取、气管剔除、血管填充、左右肺分离和肺壁结节填充等步骤,得到初步分割结果。然后将该结果还原到完整数据体上,形态学平滑后即完成最终分割。最后将算法应用于20例患者数据（2556个断层）,并与放射科医生手动分割结果进行比较。结果本文算法对20例患者数据均能取得优异结果,与放射科医生手动分割的平均面积重叠率达99．02％,且适用于左右肺相连、肺壁存在结节、视野不完整等异常情况。通过数据重采样极大缩短分割时间,一般可缩短50％,一帧图像平均耗时小于0．25s。结论本文算法能够实现胸部cT图像肺实质的自动分割,结果准确可靠,鲁棒性好,速度快,基本满足实际临床需求。     

Image quality control for digital mammographic systems: Initial experience and outlook

This report presents (1) a broad topical review and a tutorial of the possibilities for image quality control (IQC) with digital systems, and (2) results and initial experience for IQC with two commercial digital imaging systems, but with limited discussion on any particular method. Digital imaging systems used for mammographically guided digital stereotactic breast biopsy were evaluated extensively at the University of Arizona. Measurements were made of linearity, sensitivity, signal-to-noise ratio, and square-wave modulation. Images of phantoms such as the American College of Radiology Accreditation Phantom and the contrast detail mammography Phantom were evaluated as well as images of the x-ray source’s focal spot. The evaluation also included the cathode ray tubes for the imaging systems. The data collected show that digital imaging systems have an important advantage over film-screen systems because they provide a digital signal as output that can be used for quantitative analysis. As a result, IQC can become a much more quantitative discipline than presently practiced, providing more information on the imaging systems under evaluation, and providing better control over their properties during actual operation.     

A method for determination of optimal image enhancement for the detection of mammographic abnormalities

We present a paradigm for empirical evaluation of digital image enhancement algorithms for mammography that uses psychophysical methods for implementation and analysis of a clinically relevant detection task. In the experiment, the observer is asked to detect and assign to a quadrant, or indicate the absence of, a simulated mammographic structure characteristic of cancer embedded in a background image of normal breast tissue. Responses are indicated interactively on a computer workstation. The parameter values for the enhancement applied to the composite image may be varied on each trial, and structure detection performance is estimated for each enhancement condition. Preliminary investigations have provided insight into an appropriate viewing duration, and furthermore, suggest that nonradiologists may be used under this methodology for the tasks investigated thus far, for predicting parameter values for clinical investigation. We are presently using this method in evaluating several contrast enhancement algorithms of possible benefit in mammography. These methods enable an objective, clinically relevant evaluation, for the purpose of optimal parameter determination or performance assessment, of digital image-processing methods potentially used in mammography.     

A Monte Carlo simulation model of mammographic imaging with x-ray sources of finite dimensions

A simulation model of mammographic x-ray sources with finite size has been developed. The model is based on Monte Carlo methods and it takes into account the electron penetration inside the anode, the anode geometry and material, as well as the resulting heel effect and the spectral and spatial distribution of x-rays. This x-ray source simulation model has been embedded into an earlier developed simulation package of a mammography unit. The main outputs of this model are Monte Carlo generated images that correspond to the irradiation of properly designed phantoms. In this way it is possible to make studies of the influence of x-ray source characteristics on MTF. This paper presents the development of the mammographic x-ray source model, accompanied by a set of simulation studies concerning the influence of magnification effects as well as that of the x-ray spatial and spectral distribution on the mammographic spatial resolution for a certain magnification factor (m = 1.4). The validity level of the model, as well as its limitations and perspectives, rise through comparisons with experimental and theoretical data.     

Digital mammography image simulation using Monte Carlo

Monte Carlo simulations of digital images of the contrast detail phantom and the ACR phantom are presented for two different x-ray digital mammography modalities: a synchrotron mammography system and a next-generation scanning slot clinical system. A combination of variance reduction methods made it possible to simulate accurate images using real pixel dimensions within reasonable computation times. The complete method of image simulation, including a simple detector response model, a simple noise model, and the incorporation of system effects (MTF), is presented. The simulated images of the phantoms show good agreement with images measured on the two systems.     

Characterization of mammographic masses based on level set segmentation with new image features and patient information

Computer-aided diagnosis (CAD) for characterization of mammographic masses as malignant or benign has the potential to assist radiologists in reducing the biopsy rate without increasing false negatives. The purpose of this study was to develop an automated method for mammographic mass segmentation and explore new image based features in combination with patient information in order to improve the performance of mass characterization. The authors' previous CAD system, which used the active contour segmentation, and morphological, textural, and spiculation features, has achieved promising results in mass characterization. The new CAD system is based on the level set method and includes two new types of image features related to the presence of microcalcifications with the mass and abruptness of the mass margin, and patient age. A linear discriminant analysis (LDA) classifier with stepwise feature selection was used to merge the extracted features into a classification score. The classification accuracy was evaluated using the area under the receiver operating characteristic curve. The authors' primary data set consisted of 427 biopsy-proven masses (200 malignant and 227 benign) in 909 regions of interest (ROIs) (451 malignant and 458 benign) from multiple mammographic views. Leave-one-case-out resampling was used for training and testing. The new CAD system based on the level set segmentation and the new mammographic feature space achieved a view-based Az value of 0.83 +/- 0.01. The improvement compared to the previous CAD system was statistically significant (p = 0.02). When patient age was included in the new CAD system, view-based and case-based Az values were 0.85 +/- 0.01 and 0.87 +/- 0.02, respectively. The study also demonstrated the consistency of the newly developed CAD system by evaluating the statistics of the weights of the LDA classifiers in leave-one-case-out classification. Finally, an independent test on the publicly available digital database for screening mammography with 132 benign and 197 malignant ROIs containing masses achieved a view-based Az value of 0.84 +/- 0.02.     

Validation of a digital mammographic unit model for an objective and highly automated clinical image quality assessment

In mammography, image quality assessment has to be directly related to breast cancer indicator (e.g. microcalcifications) detectability. Recently, we proposed an X-ray source/digital detector (XRS/DD) model leading to such an assessment. This model simulates very realistic contrast-detail phantom (CDMAM) images leading to gold disc (representing microcalcifications) detectability thresholds that are very close to those of real images taken under the simulated acquisition conditions. The detection step was performed with a mathematical observer. The aim of this contribution is to include human observers into the disc detection process in real and virtual images to validate the simulation framework based on the XRS/DD model. Mathematical criteria (contrast-detail curves, image quality factor, etc.) are used to assess and to compare, from the statistical point of view, the cancer indicator detectability in real and virtual images. The quantitative results given in this paper show that the images simulated by the XRS/DD model are useful for image quality assessment in the case of all studied exposure conditions using either human or automated scoring. Also, this paper confirms that with the XRS/DD model the image quality assessment can be automated and the whole time of the procedure can be drastically reduced. Compared to standard quality assessment methods, the number of images to be acquired is divided by a factor of eight.     

CdZnTe detector in mammographic x-ray spectroscopy

A CdZnTe (CZT) detector was utilized in mammographic x-ray spectroscopy under clinical conditions. First, the detector response was investigated using y-rays from 241Am. The escape of secondary (Compton scattered and K fluorescent) x-rays and tailing due to carrier trapping were minor in the mammographic energy range. In addition, the transmission of primary x-rays was minimal from the results calculated using the mass attenuation coefficients of CZT. Therefore, spectral distortion in this energy range was expected to be negligible. Secondly, x-ray spectroscopy was carried out with the CZT detector. The measured spectra were in good agreement with the spectra obtained with the Compton-scatter method with a high-purity germanium detector. Moreover, the half-value layers (HVLs) calculated from the CZT spectra were consistent with the HVLs measured with an ionization chamber. The results indicate that a CZT detector can be utilized in mammographic x-ray spectroscopy without any corrections.     

The effects of tibolone and oestrogen-based HT on breast cell proliferation and mammographic density

Tibolone is a tissue-selective compound used for the treatment of climacteric symptoms and the prevention of osteoporosis in post-menopausal women. In this review some in vitro data and clinical studies indicating that the effects of tibolone on breast tissue are different from those seen with oestrogen-based hormone therapy (HT) are briefly discussed. From a clinical perspective, an increase in mammographic density and breast cell proliferation should be regarded as an unwanted side-effect of HT. Efforts should therefore be made to define treatment regimens for post-menopausal women that have minimal effects on the breast but still maintain the many advantages of HT. Data suggest that tibolone may be such an alternative.     

Image resolution of a microchannel plate x-ray image intensifier

The resolution has been evaluated for an experimental x-ray image intensifier employing three microchannel plates (MCPs) as the photon absorber and electron multipliers. The line spread function (LSF) was measured and used for determination of the modulation transfer function (MTF). The MTF was found to be independent of the incident photon energy from 20 to 150 keV. An additional measurement using a lead-bar test pattern showed that the resolution exceeded 7 line pairs (lp)/mm. The factors influencing the resolution capabilities of the intensifier are discussed. The resolution is limited primarily by the 53-micron center-to-center separation of the channels of the MCPs.     

Monte Carlo simulation of the image formation process in portal imaging

We have written Monte Carlo programs to simulate the formation of radiological images. Our code is used to propagate a simulated x-ray fluence through each component of an existing video-based portal imaging system. This simulated fluence consists of a 512 x 512 pixel image containing both contrast-detail patterns as well as checker patterns to assess spatial resolution of the simulated portal imager. All of the components of the portal imaging system were modeled as a cascade of eight linear stages. Using this code, one can assess the visual impact of changing components in the imaging chain by changing the appropriate probability density function. Virtual experiments were performed to assess the visual impact of replacing the lens and TV camera by an amorphous silicon array, and the effect of scattered radiation on portal images.     

Combination of intensity-based image registration with 3D simulation in radiation therapy

Modern techniques of radiotherapy like intensity modulated radiation therapy (IMRT) make it possible to deliver high dose to tumors of different irregular shapes at the same time sparing surrounding healthy tissue. However, internal tumor motion makes precise calculation of the delivered dose distribution challenging. This makes analysis of tumor motion necessary. One way to describe target motion is using image registration. Many registration methods have already been developed previously. However, most of them belong either to geometric approaches or to intensity approaches. Methods which take account of anatomical information and results of intensity matching can greatly improve the results of image registration. Based on this idea, a combined method of image registration followed by 3D modeling and simulation was introduced in this project. Experiments were carried out for five patients 4DCT lung datasets. In the 3D simulation, models obtained from images of end-exhalation were deformed to the state of end-inhalation. Diaphragm motions were around -25 mm in the cranial-caudal (CC) direction. To verify the quality of our new method, displacements of landmarks were calculated and compared with measurements in the CT images. Improvement of accuracy after simulations has been shown compared to the results obtained only by intensity-based image registration. The average improvement was 0.97 mm. The average Euclidean error of the combined method was around 3.77 mm. Unrealistic motions such as curl-shaped deformations in the results of image registration were corrected. The combined method required less than 30 min. Our method provides information about the deformation of the target volume, which we need for dose optimization and target definition in our planning system.     

The relationship between mammographic density and duration of hormone therapy: effects of estrogen and estrogen-progestin

BACKGROUND: The purpose of this study was to examine the effects of duration of hormone therapy (HT) and treatment regimens on mammographic density. METHODS: A retrospective study was carried out of of 467 post-menopausal women who received estrogen or estrogen-progestin and had regular mammographic density determination by the Breast Imaging Reporting and Data System between 1994 and 2001. RESULTS: The fraction of women using HT who had an increase in mammographic density became more important over time. Further analysis of the effects of regimens after 4 years of HT shows that the increase in mean density was much greater in women receiving combined HT than in those receiving estrogen alone. The incidence of increased mammographic density showed significantly progressive increases over the duration of combined HT from 7.5 to 22.4%. CONCLUSIONS: Although most women using HT maintained breast density at pre-treatment levels, there is a note of caution for women using long-term HT, especially those using combined estrogen-progestin.     

一种用于全身照射技术的全身模拟定位CT扫描与图像重建方法

目的：探索一种适用于全身照射（TBI）的CT重建方法,可同体位连续扫描后获得一套完整的全身模拟定位CT。方法：使用TBI CT重建方法对患者进行CT模拟定位,完成后于Eclipse v15.5计划系统中生成一套全身模拟定位CT,将其运用到TBI计划设计与评估。在应用过程中,基于Python系统开发出相应的图像重建软件,与手动图像重建结果进行对比。结果：该全身模拟定位扫描方案可在Eclipse v15.5中实现两套CT的重建。在工作效率上,手工重建方法生成全身模拟定位CT平均需要10 min,软件重建方法只需要5 s。两种CT重建方法在图像质量上无差异,重建CT与真实值相比误差小于1 mm。使用重建的全身模拟定位进行TBI计划设计与评估,靶区适形度指数（CI）=0.854,剂量均匀性指数（HI）=0.199。结论：本文介绍的TBI全身模拟定位CT扫描与图像重建的方法可以简单、快速地获得完整的全身模拟定位CT图像,适用于后期的TBI计划设计、优化和评估过程。     

Correspondence in texture features between two mammographic views

It is well established that radiologists are better able to interpret mammograms when two mammographic views are available. Consequently, two mammographic projections are standard: mediolateral oblique (MLO) and craniocaudal (CC). Computer-aided diagnosis algorithms have been investigated for assisting in the detection and diagnosis of breast lesions in digitized/digital mammograms. A few previous studies suggest that computer-aided systems may also benefit from combining evidence from the two views. Intuitively, we expect that there would only be value in merging data from two views if they provide complementary information. A measure of the similarity of information is the correlation coefficient between corresponding features from the MLO and CC views. The purpose of this study was to investigate the correspondence in Haralick's texture features between the MLO and CC mammographic views of breast lesions. Features were ranked on the basis of correlation values and the two-view correlation of features for subgroups of data including masses versus calcification and benign versus malignant lesions were compared. All experiments were performed on a subset of mammography cases from the Digital Database for Screening Mammography (DDSM). It was observed that the texture features from the MLO and CC views were less strongly correlated for calcification lesions than for mass lesions. Similarly, texture features from the two views were less strongly correlated for benign lesions than for malignant lesions. These differences were statistically significant. The results suggest that the inclusion of texture features from multiple mammographic views in a CADx algorithm may impact the accuracy of diagnosis of calcification lesions and benign lesions.     

Mammogram synthesis using a 3D simulation. I. Breast tissue model and image acquisition simulation

A method is proposed for generating synthetic mammograms based upon simulations of breast tissue and the mammographic imaging process. A computer breast model has been designed with a realistic distribution of large and medium scale tissue structures. Parameters controlling the size and placement of simulated structures (adipose compartments and ducts) provide a method for consistently modeling images of the same simulated breast with modified position or acquisition parameters. The mammographic imaging process is simulated using a compression model and a model of the x-ray image acquisition process. The compression model estimates breast deformation using tissue elasticity parameters found in the literature and clinical force values. The synthetic mammograms were generated by a mammogram acquisition model using a monoenergetic parallel beam approximation applied to the synthetically compressed breast phantom.     

Computer simulation of image intensifier-based computed tomography detector: vascular application

This present study reports the results of a computer simulation whose aim was to predict the low-contrast imaging performance of which a conventional x-ray image intensifier with charge coupled device (CCD) camera would be capable if incorporated into a computed tomography (CT) volume imager. A vascular imaging task was modeled in our simulation. The effects of detector noise, x-ray exposure levels, analog-to-digital conversion (ADC) precision and residual levels of detected x-ray scatter were considered. The results of this simulation indicate that the low-contrast imaging performance of an image intensifier-based CT system was most limited by the CCD detector readout noise. Given this limitation the detection of greater than about 100,000 detected photons/pixel/projection gave marginal improvement in low-contrast resolution. At these exposures 12 bit ADC precision resulted in little additional image noise. The effects of detecting scattered x rays are twofold; decreasing the signal-to-noise ratio associated with our modeled artery and introducing a cupping artifact. Based on the results from the simulation, it appears that an image intensifier-based CT system is a feasible concept from a noise viewpoint, if the anticipated imaging task is intravenous angiography.     

Image quality evaluation of flat panel and image intensifier digital magnification in x-ray fluoroscopy

Interventional devices used in radiology often have dimensions on the order of a pixel, and radiologists resort to image magnification to better visualize such small devices. Traditional image intensifier (II) systems use analog magnification with x-ray exposure inversely proportional to the area of field of view (FOV) so as to maintain light output for the camera. Analog magnification is impossible with flat panel (FP) detectors, and images must be magnified using digital interpolation that does not reduce the pixel partial area effect for small devices. We quantitatively investigated image quality of digital and analog magnification using a clinically relevant task of detecting a partially deployed stent in x-ray fluoroscopy image sequences that were created using realistic detector models. Using the standard exposure strategy for II analog magnification, exposure was increased from a nominal 43.65 nGy (5.0 microR) per frame at 23 cm FOV to 79.9 nGy (9.15 microR) per frame and 117.81 nGy (13.49 microR) per frame at 17 cm and 14 cm FOV, respectively. Contrast sensitivity improved significantly (p<0.1) by 43.5+/-6.5% and 64.1+/-7.3% with the 17 cm and 14 cm FOV, respectively. Exposure for digitally magnified images was varied in an adaptive forced choice experiment so as to match performance with II analog magnification. For digital magnification, bilinear interpolation was used to give magnified stents sizes equivalent to those in the analog magnified images. For equivalent image quality, FP required 34.87+/-2.59, 80.16+/-5.37, and 84.08+/-5.59 nGy per frame at normal, and the two magnification modes, respectively. Hence, FP with digital magnification gives significant (p<0.1) dose savings of 20+/-6% and 27+/-5% at the normal and highest magnification modes, respectively. Digitally magnified II images required exposures of 110.85+/-8.07 and 103.34+/-5.90 nGy per frame for the two magnifications levels, respectively, giving no significant (p>0.1) dose savings. A spatiotemporal human observer model based on signal detection theory successfully predicted the human data and was used to predict other conditions associated with image magnification. Model predictions quantitatively showed that magnification is most useful when signal size is relatively small and that FP digital magnification can improve image quality for the stent deployment task without increasing exposure. In conclusion, the results show that FP digital magnification can be useful and dose efficient as compared to analog magnification.     

Measurement of x-ray tube potential in the mammographic region

In mammography it is important to be able to measure x-ray tube potential with an accuracy of +/- 1 kV or better. Mammography x-ray sets generally use molybdenum for both target and filter. Consequently, a high proportion of the x-ray spectrum consists of characteristic radiation from the target. Devices for estimating tube potential such as penetrameters and digital kV meters, which depend on the relation between tube potential and the filtered x-ray spectrum, could be affected in their performance unless calibrated on similar x-ray sets. This paper reports tube potential measurements on a Mo/Mo x-ray set from 25 to 37 kV using the fluorescence technique, a manufacturer's potential divider, two penetrameters of different design and two digital meters of a single design. Agreement between all four techniques was good, being within the various combined experimental errors associated with each, from 37 down to 28 kV, below which the results diverged only slightly.