Optimization of x-ray spectra in digital mammography through Monte Carlo simulations

In this work, a Monte Carlo code was used to investigate the performance of different x-ray spectra in digital mammography, through a figure of merit (FOM), defined as FOM = CNR2/(ˉ)D(g), with CNR being the contrast-to-noise ratio in image and [Formula: see text] being the average glandular dose. The FOM was studied for breasts with different thicknesses t (2 cm ≤ t ≤ 8 cm) and glandular contents (25%, 50% and 75% glandularity). The anode/filter combinations evaluated were those traditionally employed in mammography (Mo/Mo, Mo/Rh, Rh/Rh), and a W anode combined with Al or K-edge filters (Zr, Mo, Rh, Pd, Ag, Cd, Sn), for tube potentials between 22 and 34 kVp. Results show that the W anode combined with K-edge filters provides higher values of FOM for all breast thicknesses investigated. Nevertheless, the most suitable filter and tube potential depend on the breast thickness, and for t ≥ 6 cm, they also depend on breast glandularity. Particularly for thick and dense breasts, a W anode combined with K-edge filters can greatly improve the digital technique, with the values of FOM up to 200% greater than that obtained with the anode/filter combinations and tube potentials traditionally employed in mammography. For breasts with t < 4 cm, a general good performance was obtained with the W anode combined with 60 μm of the Mo filter at 24-25 kVp, while 60 μm of the Pd filter provided a general good performance at 24-26 kVp for t = 4 cm, and at 28-30 and 29-31 kVp for t = 6 and 8 cm, respectively.     

Effect of area x-ray beam equalization on image quality and dose in digital mammography

In mammography, thick or dense breast regions persistently suffer from reduced contrast-to-noise ratio (CNR) because of degraded contrast from large scatter intensities and relatively high noise. Area x-ray beam equalization can improve image quality by increasing the x-ray exposure to under-penetrated regions without increasing the exposure to other breast regions. Optimal equalization parameters with respect to image quality and patient dose were determined through computer simulations and validated with experimental observations on a step phantom and an anthropomorphic breast phantom. Three parameters important in equalization digital mammography were considered: attenuator material (Z = 13-92), beam energy (22-34 kVp) and equalization level. A Mo/Mo digital mammography system was used for image acquisition. A prototype 16 x 16 piston driven equalization system was used for preparing patient-specific equalization masks. Simulation studies showed that a molybdenum attenuator and an equalization level of 20 were optimal for improving contrast, CNR and figure of merit (FOM = CNR2/dose). Experimental measurements using these parameters showed significant improvements in contrast, CNR and FOM. Moreover, equalized images of a breast phantom showed improved image quality. These results indicate that area beam equalization can improve image quality in digital mammography.     

A computer simulation study comparing lesion detection accuracy with digital mammography, breast tomosynthesis, and cone-beam CT breast imaging

Although conventional mammography is currently the best modality to detect early breast cancer, it is limited in that the recorded image represents the superposition of a three-dimensional (3D) object onto a 2D plane. Recently, two promising approaches for 3D volumetric breast imaging have been proposed, breast tomosynthesis (BT) and CT breast imaging (CTBI). To investigate possible improvements in lesion detection accuracy with either breast tomosynthesis or CT breast imaging as compared to digital mammography (DM), a computer simulation study was conducted using simulated lesions embedded into a structured 3D breast model. The computer simulation realistically modeled x-ray transport through a breast model, as well as the signal and noise propagation through a CsI based flat-panel imager. Polyenergetic x-ray spectra of Mo/Mo 28 kVp for digital mammography, Mo/Rh 28 kVp for BT, and W/Ce 50 kVp for CTBI were modeled. For the CTBI simulation, the intensity of the x-ray spectra for each projection view was determined so as to provide a total average glandular dose of 4 mGy, which is approximately equivalent to that given in conventional two-view screening mammography. The same total dose was modeled for both the DM and BT simulations. Irregular lesions were simulated by using a stochastic growth algorithm providing lesions with an effective diameter of 5 mm. Breast tissue was simulated by generating an ensemble of backgrounds with a power law spectrum, with the composition of 50% fibroglandular and 50% adipose tissue. To evaluate lesion detection accuracy, a receiver operating characteristic (ROC) study was performed with five observers reading an ensemble of images for each case. The average area under the ROC curves (Az) was 0.76 for DM, 0.93 for BT, and 0.94 for CTBI. Results indicated that for the same dose, a 5 mm lesion embedded in a structured breast phantom was detected by the two volumetric breast imaging systems, BT and CTBI, with statistically significant higher confidence than with planar digital mammography, while the difference in lesion detection between BT and CTBI was not statistically significant.     

Grid removal and impact on population dose in full-field digital mammography

The study purpose was to determine the impact of anti-scatter grid removal on patient dose, in full field digital mammography. Dose saving, phantom based, was evaluated with the constraint that images acquired with and without grid would provide the same contrast-to-noise ratio (CNR). The digital equipment employed a flat panel detector with cesium iodide for x-ray to light conversion, 100 microm pixel size; the x-ray source was a dual-track tube with selectable filtration. Poly(methyl-emathocrylate) (PMMA) layers in the range 20-70 mm were used to simulate the absorption of different breast thickness, while two Al foils, 0.1 and 0.2 mm thick were used to provide a certain CNR. Images with grid were acquired with the same beam quality as selected in full automatic exposure mode and the mAs levels as close as possible, and the CNR measured for each thickness between 20 and 70 mm. Phantom images without grid were acquired in manual exposure mode, by selecting the same anode/filter combination and kVp as the image with grid at the same thickness, but varying mAs from 10 to 200. For each thickness, an image without aluminum was acquired for each mAs value, in order to obtain a flat image to be used to subtract the scatter nonuniformity from the phantom images. After scatter subtraction, the CNR was measured on images without grid. The mAs value that should be set to acquire a phantom image without grid so that it has the same CNR as the corresponding grid image was calculated. Therefore, mAs reduction percentage was determined versus phantom thickness. Results showed that dose saving was lower than 30% for PMMA equivalent breast thinner than 40 mm, decreased below 10% for intermediate thickness (45-50 mm), but there was no dose gain for thickness beyond 60 mm. By applying the mAs reduction factors to a clinical population derived from a data base of 4622 breasts, dose benefit was quantified in terms of population dose. On the average, the overall dose reduction was about 8%. It was considered small, not sufficient to justify a clinical implementation, and the anti-scatter grid was maintained.     

Technique factors and their relationship to radiation dose in pendant geometry breast CT

The use of breast computed tomography (CT) as an alternative to mammography in some patients is being studied at several institutions. However, the radiation dosimetry issues associated with breast CT are markedly different than in the case of mammography. In this study, the spectral properties of an operational breast CT scanner were characterized both by physical measurement and computer modeling of the kVp-dependent spectra, from 40 to 110 kVp (Be window W anode with 0.30 mm added Cu filtration). Previously reported conversion factors, normalized glandular dose for CT-DgN(ct), derived from Monte Carlo methods, were used in concert with the output spectra of the breast scanner to compute the mean glandular dose to the breast based upon different combinations of x-ray technique factors (kVp and mAs). The mean glandular dose (MGD) was measured as a function of the compressed breast thickness (2-8 cm) and three different breast compositions (0%, 50%, and 100% glandular fractions) in four clinical mammography systems in our institution. The average MGD from these four systems was used to compute the technique factors for breast CT systems that would match the two-view mammographic dose levels. For a 14 cm diameter breast (equivalent to a 5 cm thick compressed breast in mammography), air kerma levels at the breast CT scanner's isocenter (468 mm from the source) of 4.4, 6.4, and 9.0 mGy were found to deliver equivalent mammography doses for 0%, 50%, and 100% glandular breasts (respectively) at 80 kVp. At 80 kVp (where air kerma was 11.3 mGy/100 mAs at the isocenter), 57 mAs (integrated over the entire scan) was required to match the mammography dose for a 14 cm 50% glandular breast. At 50 kVp, 360 mAs is required to match mammographic dose levels. Tables are provided for both air kerma at the isocenter and mAs for 0%, 50%, and 100% glandular breasts. Other issues that impact breast CT technique factors are also discussed.     

Effect of radiographic techniques (kVp and mAs) on image quality and patient doses in digital subtraction angiography

We investigated how varying the x-ray tube voltage and image receptor input exposure affected image quality and patient radiation doses in interventional neuroradiologic imaging. Digital subtraction angiography (DSA) images were obtained of a phantom with 1 mm diameter vessels containing iodine at concentrations between 4.5 and 50 mg/cc. The detection threshold concentration of iodine was determined by inspecting DSA images obtained at a range of x-ray tube voltages and input exposure levels. Surface doses were obtained from measured x-ray tube output data, and corresponding values of energy imparted were determined using the exposure-area product incident on the phantom. In one series of experiments, the air kerma at the image intensifier (X) was varied between 0.44 microGy per frame and 8.8 microGy per frame at a constant x-ray tube voltage of 70 kVp. In a second series of experiments, the tube voltage was varied between 50 and 100 kVp, and the mAs adjusted to maintain a constant exposure level at the input of the image intensifier. At a constant x-ray tube voltage, the surface dose and energy imparted were directly proportional to the input exposure per frame used to acquire the DSA images. On our DSA system operated below 2.2 microGy per frame, the threshold iodine concentration was found to be proportional to X(-0.57), which is in reasonable agreement with the theoretical prediction for a quantum noise limited imaging system. Above 2.2 microGy per frame, however, the threshold iodine concentration was proportional to X(-0.26), indicating that increasing the input exposure above this value will only achieve modest improvements in image quality. At a constant image intensifier input exposure level, increasing the x-ray tube voltage from 50 kVp to 100 kVp reduced the surface dose by a factor of 6.1, and the energy imparted by a factor of 3.5. The detection threshold iodine concentration was found to be proportional to kVp(n), where n was 2.1 at 1.1 microGy per frame, and 1.6 at 3.9 microGy per frame. For clinical situations that can be modeled by a uniform phantom, reducing the x-ray tube voltage rather than increasing the exposure level would best achieve improvements on our DSA imaging system performance.     

Dual-energy cardiac imaging: an image quality and dose comparison for a flat-panel detector and x-ray image intensifier

This study presents a comparison of dual-energy imaging with an x-ray image intensifier and flat-panel detector for cardiac imaging. It also investigates if the wide dynamic range of the flat-panel detector can improve dual-energy image quality while reducing patient dose. Experimental contrast-to-noise (CNR) measurements were carried out in addition to simulation studies. Patient entrance exposure and system tube loading were also recorded. The studied contrast objects were calcium and iodine. System performance was quantified with a figure-of-merit (FOM) defined as the image CNR(2) over patient entrance exposure. The range of thickness studied was from 10 to 30 cm of Lucite (PMMA). Detector dose was initially set to 140 nGy (16 microR)/frame. The high-energy 120 kVp beam was filtered by an additional 0.8 mm silver filter. Keeping the same filament current, the kVp for the low-energy beam was adjusted as a function of thickness until 140 nGy was achieved. System performance was found to be similar for both systems, with the x-ray image intensifier performing better at lower thicknesses and the flat-panel detector performing better at higher thicknesses. This requirement of fixed detector entrance exposure was then relaxed and the kVp for the low-energy beam was allowed to vary while the mAs of the x-ray tube remained fixed to study changes in dual-energy image quality, patient dose and FOM with the flat-panel detector. It was found that as the kVp for the low-energy beam was reduced, system performance would rise until reaching a maximum while simultaneously lowering patient exposure. Suggested recommendations for optimal dual-energy imaging implementation are also provided.     

Patient size and x-ray technique factors in head computed tomography examinations. II. Image quality

We investigated how patient head characteristics, as well as the choice of x-ray technique factors, affect lesion contrast and noise values in computed tomography (CT) images. Head sizes and mean Hounsfield unit (HU) values were obtained from head CT images for five classes of patients ranging from the newborn to adults. X-ray spectra with tube voltages ranging from 80 to 140 kV were used to compute the average photon energy, and energy fluence, transmitted through the heads of patients of varying size. Image contrast, and the corresponding contrast to noise ratios (CNRs), were determined for lesions of fat, muscle, and iodine relative to a uniform water background. Maintaining a constant image CNR for each lesion, the patient energy imparted was also computed to identify the x-ray tube voltage that minimized the radiation dose. For adults, increasing the tube voltage from 80 to 140 kV changed the iodine HU from 2.62 x 10(5) to 1.27 x 10(5), the fat HU from -138 to -108, and the muscle HU from 37.1 to 33.0. Increasing the x-ray tube voltage from 80 to 140 kV increased the percentage energy fluence transmission by up to a factor of 2. For a fixed x-ray tube voltage, the percentage transmitted energy fluence in adults was more than a factor of 4 lower than for newborns. For adults, increasing the x-ray tube voltage from 80 to 140 kV improved the CNR for muscle lesions by 130%, for fat lesions by a factor of 2, and for iodine lesions by 25%. As the size of the patient increased from newborn to adults, lesion CNR was reduced by about a factor of 2. The mAs value can be reduced by 80% when scanning newborns while maintaining the same lesion CNR as for adults. Maintaining the CNR of an iodine lesion at a constant level, use of 140 kV increases the energy imparted to an adult patient by nearly a factor of 3.5 in comparison to 80 kV. For fat and muscle lesions, raising the x-ray tube voltage from 80 to 140 kV at a constant CNR increased the patient dose by 37% and 7%, respectively. Our two key findings are that for head CT examinations performed at a constant CNR, the mAs can be substantially reduced when scanning infants, and that use of the lowest x-ray tube voltage will generally reduce patient doses.     

Patient dose in digital mammography

In the present investigation, we analyze the dose of 5034 patients (20,137 images) who underwent mammographic examinations with a full-field digital mammography system. Also, we evaluate the system calibration by analyzing the exposure factors as a function of breast thickness. The information relevant to this study has been extracted from the image DICOM header and stored in a database during a 3-year period (March 2001-October 2003). Patient data included age, breast thickness, kVp, mAs, target/filter combination, and nominal dose values. Entrance surface air kerma (ESAK) without backscatter was calculated from the tube output as measured for each voltage used under clinical conditions and from the tube loading (mAs) included in the DICOM header. Mean values for the patient age and compressed breast thickness were 56 years (SD: 11) and 52 mm (SD: 13), respectively. The majority of the images was acquired using the STD (for standard) automatic mode (98%). The most frequent target/filter combination automatically selected for breast smaller than 35 mm was Mo/Mo (75%); for intermediate thicknesses between 35 and 65 mm, the combinations were Mo/Rh (54%) and Rh/Rh (38.5%); Rh/Rh was the combination selected for 91% of the cases for breasts thicker than 65 mm. A wide kVp range was observed for each target/filter combination. The most frequent values were 28 kVp for Mo/Mo, 29 kVp for Mo/Rh, and 29 and 30 kV for Rh/Rh. Exposure times ranged from 0.2 to 4.2 s with a mean value of 1.1 s. Average glandular doses (AGD) per exposure were calculated by multiplying the ESAK values by the conversion factors tabulated by Dance for women in the age groups 50 to 64 and 40 to 49. This approach is based on the dependence of breast glandularity on breast thickness and age. The total mean average glandular dose (AGD(T)) was calculated by summing the values associated with the pre-exposure and with the main exposure. Mean AGD(T) per exposure was 1.88 mGy (CI 0.01) and the mean AGD(T) per examination was 3.8 mGy, with 4 images per examination on average. The mean dose for cranio-caudal view (CC) images was 1.8 mGy, which is lower than that for medio-lateral oblique (MLO) view because the thickness for CC images was on average 10% lower than that for MLO images. Mean AGD(T) for the oldest group of women (1.90) was 3% higher than the AGD(T) for the younger group (1.85) due to the larger compressed breast thickness of women in the older group (10% on average). Differences between the corresponding AGD(T) values of each age group were lowest for breast thicknesses in the range 40-60 mm, being slightly higher for the women in the older group.     

Evaluation of detector dynamic range in the x-ray exposure domain in mammography: a comparison between film-screen and flat panel detector systems

Digital detectors in mammography have wide dynamic range in addition to the benefit of decoupled acquisition and display. How wide the dynamic range is and how it compares to film-screen systems in the clinical x-ray exposure domain are unclear. In this work, we compare the effective dynamic ranges of film-screen and flat panel mammography systems, along with the dynamic ranges of their component image receptors in the clinical x-ray exposure domain. An ACR mammography phantom was imaged using variable mAs (exposure) values for both systems. The dynamic range of the contrast-limited film-screen system was defined as that ratio of mAs (exposure) values for a 26 kVp Mo/Mo (HVL=0.34 mm Al) beam that yielded passing phantom scores. The same approach was done for the noise-limited digital system. Data from three independent observers delineated a useful phantom background optical density range of 1.27 to 2.63, which corresponded to a dynamic range of 2.3 +/- 0.53. The digital system had a dynamic range of 9.9 +/- 1.8, which was wider than the film-screen system (p<0.02). The dynamic range of the film-screen system was limited by the dynamic range of the film. The digital detector, on the other hand, had an estimated dynamic range of 42, which was wider than the dynamic range of the digital system in its entirety by a factor of 4. The generator/tube combination was the limiting factor in determining the digital system's dynamic range.     

Quantification of breast density with spectral mammography based on a scanned multi-slit photon-counting detector: a feasibility study

A simple and accurate measurement of breast density is crucial for the understanding of its impact in breast cancer risk models. The feasibility to quantify volumetric breast density with a photon-counting spectral mammography system has been investigated using both computer simulations and physical phantom studies. A computer simulation model involved polyenergetic spectra from a tungsten anode x-ray tube and a Si-based photon-counting detector has been evaluated for breast density quantification. The figure-of-merit (FOM), which was defined as the signal-to-noise ratio of the dual energy image with respect to the square root of mean glandular dose, was chosen to optimize the imaging protocols, in terms of tube voltage and splitting energy. A scanning multi-slit photon-counting spectral mammography system has been employed in the experimental study to quantitatively measure breast density using dual energy decomposition with glandular and adipose equivalent phantoms of uniform thickness. Four different phantom studies were designed to evaluate the accuracy of the technique, each of which addressed one specific variable in the phantom configurations, including thickness, density, area and shape. In addition to the standard calibration fitting function used for dual energy decomposition, a modified fitting function has been proposed, which brought the tube voltages used in the imaging tasks as the third variable in dual energy decomposition. For an average sized 4.5 cm thick breast, the FOM was maximized with a tube voltage of 46 kVp and a splitting energy of 24 keV. To be consistent with the tube voltage used in current clinical screening exam (～32 kVp), the optimal splitting energy was proposed to be 22 keV, which offered a FOM greater than 90% of the optimal value. In the experimental investigation, the root-mean-square (RMS) error in breast density quantification for all four phantom studies was estimated to be approximately 1.54% using standard calibration function. The results from the modified fitting function, which integrated the tube voltage as a variable in the calibration, indicated a RMS error of approximately 1.35% for all four studies. The results of the current study suggest that photon-counting spectral mammography systems may potentially be implemented for an accurate quantification of volumetric breast density, with an RMS error of less than 2%, using the proposed dual energy imaging technique.     

A search for optimal x-ray spectra in iodine contrast media mammography

The aim of this work was to search for the optimal x-ray tube voltage and anode-filter combination in digital iodine contrast media mammography. In the optimization, two entities were of interest: the average glandular dose, AGD, and the signal-to-noise ratio, SNR, for detection of diluted iodine contrast medium. The optimum is defined as the technique maximizing the figure of merit, SNR2/AGD. A Monte Carlo computer program was used which simulates the transport of photons from the x-ray tube through the compression plate, breast, breast support plate, anti-scatter grid and image detector. It computes the AGD and the SNR of an iodine detail inside the compressed breast. The breast thickness was varied between 2 and 8 cm with 10-90% glandularity. The tube voltage was varied between 20 and 55 kV for each anode material (Rh, Mo and W) in combination with either 25 microm Rh or 0.05-0.5 mm Cu added filtration. The x-ray spectra were calculated with MCNP4C (Monte Carlo N-Particle Transport Code System, version 4C). A CsI scintillator was used as the image detector. The results for Rh/0.3 mmCu, Mo/0.3 mmCu and W/0.3 mmCu were similar. For all breast thicknesses, a maximum in the figure of merit was found at approximately 45 kV for the Rh/Cu, Mo/Cu and W/Cu combinations. The corresponding results for the Rh/Rh combination gave a figure of merit that was typically lower and more slowly varying with tube voltage. For a 4 cm breast at 45 kV, the SNR2/AGD was 3.5 times higher for the Rh/0.3 mmCu combination compared with the Rh/Rh combination. The difference is even larger for thicker breasts. The SNR2/AGD increases slowly with increasing Cu-filter thickness. We conclude that tube voltages between 41 and 55 kV and added Cu-filtration will result in significant dose advantage in digital iodine contrast media mammography compared to using the Rh/Rh anode/filter combination at 25-32 kV.     

Visibility of microcalcification in cone beam breast CT: effects of X-ray tube voltage and radiation dose

Mammography is the only technique currently used for detecting microcalcification (MC) clusters, an early indicator of breast cancer. However, mammographic images superimpose a three-dimensional compressed breast image onto two-dimensional projection views, resulting in overlapped anatomical breast structures that may obscure the detection and visualization of MCs. One possible solution to this problem is the use of cone beam computed tomography (CBCT) with a flat-panel (FP) digital detector. Although feasibility studies of CBCT techniques for breast imaging have yielded promising results, they have not shown how radiation dose and x-ray tube voltage affect the accuracy with which MCs are detected by CBCT experimentally. We therefore conducted a phantom study using a FP-based CBCT system with various mean glandular doses and kVp values. An experimental CBCT scanner was constructed with a data acquisition rate of 7.5 frames/s. 10.5 and 14.5 cm diameter breast phantoms made of gelatin were used to simulate uncompressed breasts consisting of 100% glandular tissue. Eight different MC sizes of calcium carbonate grains, ranging from 180-200 microm to 355-425 microm, were used to simulate MCs. MCs of the same size were arranged to form a 5 x 5 MC cluster and embedded in the breast phantoms. These MC clusters were positioned at 2.8 cm away from the center of the breast phantoms. The phantoms were imaged at 60, 80, and 100 kVp. With a single scan (360 degrees), 300 projection images were acquired with 0.5 x, 1x, and 2x mean glandular dose limit for 10.5 cm phantom and with 1x, 2x, and 4x for 14.5 cm phantom. A Feldkamp algorithm with a pure ramp filter was used for image reconstruction. The normalized noise level was calculated for each x-ray tube voltage and dose level. The image quality of the CBCT images was evaluated by counting the number of visible MCs for each MC cluster for various conditions. The average percentage of the visible MCs was computed and plotted as a function of the MGD, the kVp, and the average MC size. The results showed that the MC visibility increased with the MGD significantly but decreased with the breast size. The results also showed that the x-ray tube voltage affects the detection of MCs under different circumstances. With a 50% threshold, the minimum detectable MC sizes for the 10.5 cm phantom were 348(+/-2), 288(+/-7), 257(+/-2) microm at 3, 6, and 12 mGy, respectively. Those for the 14.5 cm phantom were 355 (+/-1), 307 (+/-7), 275 (+/-5) microm at 6, 12, and 24 mGy, respectively. With a 75% threshold, the minimum detectable MC sizes for the 10.5 cm phantom were 367 (+/-1), 316 (+/-7), 265 (+/-3) microm at 3, 6, and 12 mGy, respectively. Those for the 14.5 cm phantom were 377 (+/-3), 334 (+/-5), 300 (+/-2) microm at 6, 12, and 24 mGy, respectively.     

Quantification of the effect of kvp on edge-enhancement index in phase-contrast radiography

This study was performed to measure the dependence of edge-enhancement in polychromatic phase-contrast radiography on x-ray tube operating voltage. Measurements of edge enhancement were made at tube voltages from 40 to 86 kVp using a tungsten anode x-ray tube with a nominal focal spot size of 100 micrometers. A relatively weak attenuating, sharp edge consisting of a thin lucite sheet (3 mm) in air was imaged utilizing phase-contrast radiography (PC-R). PC-R images were acquired at different radiographic techniques in which x-ray tube voltage was varied from 40 to 86 kVp. The image receptor was a single emulsion x-ray mammography cassette. Optical density profiles across the edge of the object were obtained using a film digitizer and edge-enhancement indices were calculated. Increasing kVp resulted in a gradual decrease of the edge-enhancement index. Even at the highest kVp (86), however, important edge-enhancement effects were evident. While there is some degradation in the edge-enhancement effect of phase-contrast radiography at higher kVps, the decrease from 40 to 86 kVp is relatively small (11%). Our results suggest that further investigation into the role of phase-contrast imaging at higher kVp values for the purpose of patient dose reduction while still realizing the advantage of phase-contrast effects for improved soft-tissue detectability is warranted.     

The effect of the antiscatter grid on full-field digital mammography phantom images

Computer Analysis of Mammography Phantom Images (CAMPI) is a method for making quantitative measurements of image quality. This article reports on a recent application of this method to a prototype full-field digital mammography (FFDM) machine. Images of a modified ACR phantom were acquired on the General Electric Diagnostic Molybdenum Rhodium (GE-DMR) FFDM machine at a number of x-ray techniques, both with and without the scatter reduction grid. The techniques were chosen so that one had sets of grid and non-grid images with matched doses (200 mrads) and matched gray-scale values (1500). A third set was acquired at constant 26 kVp and varying mAs for both grid conditions. Analyses of the images yielded signal-to-noise-ratio (SNR), contrast and noise corresponding to each target object, and a non-uniformity measure. The results showed that under conditions of equal gray-scale value the grid images were markedly superior, albeit at higher doses than the non-grid images. Under constant dose conditions, the non-grid images were slightly superior in SNR (7%) but markedly less uniform (60%). Overall, the grid images had substantially greater contrast and superior image uniformity. These conclusions applied to the whole kVp range studied for the Mo-Mo target filter combination and 4 cm of breast equivalent material of average composition. These results suggest that use of the non-grid technique in digital mammography with the GE-DMR-FFDM unit, is presently not warranted. With improved uniformity correction procedure, this conclusion would change and one should be able to realize a 14% reduction in patient dose at the same SNR by using a non-grid technique.     

Optimized radiographic spectra for small animal digital subtraction angiography

The increasing use of small animals in basic research has spurred interest in new imaging methodologies. Digital subtraction angiography (DSA) offers a particularly appealing approach to functional imaging in the small animal. This study examines the optimal x-ray, molybdenum (Mo) or tungsten (W) target sources, and technique to produce the highest quality small animal functional subtraction angiograms in terms of contrast and signal-difference-to-noise ratio squared (SdNR2). Two limiting conditions were considered-normalization with respect to dose and normalization against tube loading. Image contrast and SdNR2 were simulated using an established x-ray model. DSA images of live rats were taken at two representative tube potentials for the W and Mo sources. Results show that for small animal DSA, the Mo source provides better contrast. However, with digital detectors, SdNR2 is the more relevant figure of merit. The W source operated at kVps >60 achieved a higher SdNR2. The highest SdNR2 was obtained at voltages above 90 kVp. However, operation at the higher potential results in significantly greater dose and tube load and reduced contrast quantization. A reasonable tradeoff can be achieved at tube potentials at the beginning of the performance plateau, around 70 kVp, where the relative gain in SdNR2 is the greatest.     

A comparison of the performance of digital mammography systems

An objective analysis of image quality parameters was performed for six digital mammography systems. The presampled modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE) for the systems were determined at different doses, for 28 kVp with a Mo/Mo or W/Al target/filter combination and 2 mm of additional aluminium filtration. The flat-panel units have higher MTF and DQE in the mid to high frequency range than standard CR systems. The highest DQE, over the whole dose range, is for the slit-scanning direct photon counting system. Dual-side read CR can overcome the inherent x-ray absorption and signal collection limitations of standard CR mammography, improving the low-frequency DQE by 40%, to the same level as full-field systems, but it does not improve the poor spatial resolution of phosphor.     

Dual-energy approach to contrast-enhanced mammography using the balanced filter method: spectral optimization and preliminary phantom measurement

Dual-energy contrast agent-enhanced mammography is a technique of demonstrating breast cancers obscured by a cluttered background resulting from the contrast between soft tissues in the breast. The technique has usually been implemented by exploiting two exposures to different x-ray tube voltages. In this article, another dual-energy approach using the balanced filter method without switching the tube voltages is described. For the spectral optimization of dual-energy mammography using the balanced filters, we applied a theoretical framework reported by Lemacks et al. [Med. Phys. 29, 1739-1751 (2002)] to calculate the signal-to-noise ratio (SNR) in an iodinated contrast agent subtraction image. This permits the selection of beam parameters such as tube voltage and balanced filter material, and the optimization of the latter's thickness with respect to some critical quantity-in this case, mean glandular dose. For an imaging system with a 0.1 mm thick CsI:T1 scintillator, we predict that the optimal tube voltage would be 45 kVp for a tungsten anode using zirconium, iodine, and neodymium balanced filters. A mean glandular dose of 1.0 mGy is required to obtain an SNR of 5 in order to detect 1.0 mg/cm2 iodine in the resulting clutter-free image of a 5 cm thick breast composed of 50% adipose and 50% glandular tissue. In addition to spectral optimization, we carried out phantom measurements to demonstrate the present dual-energy approach for obtaining a clutter-free image, which preferentially shows iodine, of a breast phantom comprising three major components-acrylic spheres, olive oil, and an iodinated contrast agent. The detection of iodine details on the cluttered background originating from the contrast between acrylic spheres and olive oil is analogous to the task of distinguishing contrast agents in a mixture of glandular and adipose tissues.     

Effect of Dose Reduction on the Ability of Digital Mammography to Detect Simulated Microcalcifications

The purpose of this article was to report the relationship between radiation dose and the ability of sentence digital mammography to detect microcalcifications. All images were acquired by computed radiography and an anthropomorphic breast phantom. The tube voltage and anode/filter combination used were 28 kVp and Mo/Mo. Simulated microcalcifications with an approximate diameter of 250–350 μm were positioned on the phantom. Groups of six microcalcifications were arranged in one of two patterns, a line cluster 1 cm long or a hexagonal cluster 4 mm wide. One of the six microcalcifications was removed to create a negative control. Each cluster was placed on 25 different points. Four levels of milliampere-second (mAs) values were applied: 100%, 50%, 25%, and 12.5%. Five staff radiologists participated in an observer performance test. All observers used a workstation with a 3-megapixel monochrome LCD monitor. The areas under the receiver-operating characteristics curves (AUC) were used to compare diagnostic performance among the four doses. The overall AUC scores were 0.97 with 100% mAs, 0.93 (n.s.) with 50%, 0.90 (p < 0.05) with 25%, and 0.81 (p < 0.01) with 12.5% mAs. Among the negative series, the percentage of images on which observers were able to identify the removed microcalcification point decreased from 88.8% with 100% mAs to 83.6% (n.s.) with 50%, 74.8% (p < 0.001) with 25%, and 67.2% (p < 0.001) with 12.5% mAs. A certain level of dose reduction in digital mammography may be an option.Key words: Digital mammography, computed radiography, observer performance, radiation dose, ROC-based analysis, phantoms, imaging     

Fiducial markers in prostate for kV imaging: quantification of visibility and optimization of imaging conditions

The purpose of this work is to investigate possible smaller, less-dense fiducial markers implantable into the prostate for target localization and patient repositioning verification in an on-board kV-kV imaging system on a proton gantry. The experiments used a pelvic phantom and a variety of commercially available fiducial markers: CIVCO carbon marker of ?; 1 × 3 mm, gold seed markers of ?; 0.8 × 3 mm and ?; 1.2 × 3 mm, and IBA Visicoil helical gold linear markers in diameters of 0.35, 0.50, 0.75 and 1.15 mm. Two orthogonal on-board kV imagers were arranged for digital radiographic imaging of the phantom through the lateral and anterior-posterior directions. The contrast-to-noise ratio (CNR) for a given marker was calculated and used as a quantitative measure of its visibility. The patient entrance skin exposure (ESE) was measured and parameterized for kVp, mAs and source-to-surface distance. The ratio of CNR to ESE was first introduced to characterize the efficiency for imaging a marker using a given x-ray technique in order to optimize the marker's visibility and simultaneously minimize the x-ray imaging dose. If CNR > 2, which corresponds to a significance p < 0.05, is required for acceptable visibility, the carbon marker and the smallest Visicoil marker are not suitable for imaging through dense bone but the others are capable of being employed in the clinic. It is predicted that other markers in development should have a greater thickness than equivalent of 0.14 mm thick gold in order to produce the acceptable visibility in the lateral kV imaging. The linear Visicoil marker of ?; 0.50 × 5 mm is most suitable for kV imaging in the prostate for proton therapy as it induces the least proton dose perturbation amongst the acceptable markers. An optimal range of 120-130 kVp and 40-80 mAs is determined using the maximal CNR/ESE and CNR > 2 for laterally imaging this marker in the prostate.