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Purpose: Digital breast tomosynthesis (DBT) is becoming an important part of breast cancer screening and diagnosis. Compared to two-dimensional mammography, tomosynthesis introduces limited three-dimensional (3D) resolution, but maintains high in-plane resolution, low dose, and allows for similar clinical protocols. The scanning motion and oblique projections of tomosynthesis acquisitions introduce shift-variance to the image quality, in addition to effects such as source blurring and geometric magnification. Shift-variant detector response caused by oblique incidence has been extensively studied previously and is most easily mitigated by letting the source and detector move in sync. In addition, conical reconstruction grids, that is, a grid aligned with the central tomosynthesis projection, have been proposed to compensate for magnification effects. This paper introduces a shift-variant cascaded systems model for tomosynthesis and validates it against measurements. As an example, the model was used to investigate the shift-variance of a tomosynthesis system., Methods: The shift-variant cascaded systems model was validated on a slit-scanning photon-counting DBT system, with synchronous source-detector movement, using simple back-projection in a conical reconstruction volume. The modulation transfer function (MTF), normalized noise-power spectrum (NNPS), and detective quantum efficiency (DQE) were used as figures of merit. Simulations were performed for single points while measurements were done over a finite volume, assuming local shift invariance. To investigate the full extent of shift-variance, 80 locations across the volume were simulated, and the MTF and DQE at 2.5 lp/mm were calculated as a function of position., Results: The simulated metrics generally agreed well with their corresponding measurements. The frequency at 50% MTF along the scan direction showed a relatively small variation, ranging from 2.1 to 2.4 lp/mm for the different locations. The frequency at 50% MTF along the chest-mammilla direction showed a larger variation, ranging from 2.9 to 3.8 lp/mm. All points exhibited a similarly shaped NNPS but the noise magnitude varied with slice height. The zero-frequency DQE in reconstructed slices was lower than that of the projections, an effect likely caused by noise-aliasing increasing the zero-frequency noise., Conclusions: A shift-variant cascaded systems model has been developed for slit-scanning tomosynthesis using simple back-projection. The model was successfully validated against measurements. Even though the study was performed on a slit-scanning system, several parts of the framework can be applied and extended to other tomosynthesis geometries. The conical reconstruction grid has low variation in image quality in the scan direction where the 3D information is acquired, but source and geometric magnification still dominate in the slit direction, causing a larger variation in image quality. We conclude that image quality is close to shift-invariant in the scan direction, but not in the height and chest-mammilla directions, and we recommend that small measurement volumes are used when measuring image quality in these directions to minimize the effects of shift variance., (© 2018 American Association of Physicists in Medicine.)

Purpose: Digital breast tomosynthesis (DBT) is an emerging tool for breast-cancer screening and diagnostics. The purpose of this study is to present a second-generation photon-counting slit-scanning DBT system and compare it to the first-generation system in terms of geometry and image quality. The study presents the first image-quality measurements on the second-generation system., Method: The geometry of the new system is based on a combined rotational and linear motion, in contrast to a purely rotational scan motion in the first generation. In addition, the calibration routines have been updated. Image quality was measured in the center of the image field in terms of in-slice modulation transfer function (MTF), artifact spread function (ASF), and in-slice detective quantum efficiency (DQE). Images were acquired using a W/Al 29 kVp spectrum at 13 mAs with 2 mm Al additional filtration and reconstructed using simple back-projection., Result: The in-slice 50% MTF was improved in the chest-mammilla direction, going from 3.2 to 3.5 lp/mm, and the zero-frequency DQE increased from 0.71 to 0.77. The MTF and ASF were otherwise found to be on par for the two systems. The new system has reduced in-slice variation of the tomographic angle., Conclusions: The new geometry is less curved, which reduces in-slice tomographic-angle variation, and increases the maximum compression height, making the system accessible for a larger population. The improvements in MTF and DQE were attributed to the updated calibration procedures. We conclude that the second-generation system maintains the key features of the photon-counting system while maintaining or improving image quality and improving the maximum compression height., (© 2017 American Association of Physicists in Medicine.)

Purpose: It has been shown that breast tomosynthesis may improve sensitivity and specificity compared to two-dimensional mammography, resulting in increased detection-rate of cancers or lowered call-back rates. The purpose of this study is to characterize a spectral photon-counting multislit breast tomosynthesis system that is able to do single-scan spectral imaging with multiple collimated x-ray beams. The system differs in many aspects compared to conventional tomosynthesis using energy-integrating flat-panel detectors., Methods: The investigated system was a prototype consisting of a dual-threshold photon-counting detector with 21 collimated line detectors scanning across the compressed breast. A review of the system is done in terms of detector, acquisition geometry, and reconstruction methods. Three reconstruction methods were used, simple back-projection, filtered back-projection and an iterative algebraic reconstruction technique. The image quality was evaluated by measuring the modulation transfer-function (MTF), normalized noise-power spectrum, detective quantum-efficiency (DQE), and artifact spread-function (ASF) on reconstructed spectral tomosynthesis images for a total-energy bin (defined by a low-energy threshold calibrated to remove electronic noise) and for a high-energy bin (with a threshold calibrated to split the spectrum in roughly equal parts). Acquisition was performed using a 29 kVp W/Al x-ray spectrum at a 0.24 mGy exposure., Results: The difference in MTF between the two energy bins was negligible, that is, there was no energy dependence on resolution. The MTF dropped to 50% at 1.5 lp/mm to 2.3 lp/mm in the scan direction and 2.4 lp/mm to 3.3 lp/mm in the slit direction, depending on the reconstruction method. The full width at half maximum of the ASF was found to range from 13.8 mm to 18.0 mm for the different reconstruction methods. The zero-frequency DQE of the system was found to be 0.72. The fraction of counts in the high-energy bin was measured to be 59% of the total detected spectrum. Scantimes ranged from 4 s to 16.5 s depending on voltage and current settings., Conclusions: The characterized system generates spectral tomosynthesis images with a dual-energy photon-counting detector. Measurements show a high DQE, enabling high image quality at a low dose, which is beneficial for low-dose applications such as screening. The single-scan spectral images open up for applications such as quantitative material decomposition and contrast-enhanced tomosynthesis., (© 2017 American Association of Physicists in Medicine.)

To enable tissue function-based tumor diagnosis over the large number of existing digital mammography systems worldwide, we propose a cost-effective and robust approach to incorporate tomographic optical tissue characterization with separately acquired digital mammograms. Using a flexible contour-based registration algorithm, we were able to incorporate an independently measured two-dimensional x-ray mammogram as structural priors in a joint optical/x-ray image reconstruction, resulting in improved spatial details in the optical images and robust optical property estimation. We validated this approach with a retrospective clinical study of 67 patients, including 30 malignant and 37 benign cases, and demonstrated that the proposed approach can help to distinguish malignant from solid benign lesions and fibroglandular tissues, with a performance comparable to the approach using spatially coregistered optical/x-ray measurements.

Rationale and Objectives: The purpose of this study was to assess the performance of a MicroDose photon-counting full-field digital mammography (PCM) system in comparison to full-field digital mammography (FFDM) for area under the receiver-operating characteristic (ROC) curve (AUC), sensitivity, specificity, and feature analysis of standard-view mammography for women presenting for screening mammography, diagnostic mammography, or breast biopsy., Materials and Methods: A total of 133 women were enrolled in this study at two European medical centers, with 67 women who had a pre-existing 10-36 months FFDM enrolled prospectively into the study and 66 women who underwent breast biopsy and had screening PCM and diagnostic FFDM, including standard craniocaudal and mediolateral oblique views of the breast with the lesion, enrolled retrospectively. The case mix consisted of 49 cancers, 17 biopsy-benign cases, and 67 normal cases. Sixteen radiologists participated in the reader study and interpreted all 133 cases in both conditions, separated by washout period of ≥4 weeks. ROC curve and free-response ROC curve analyses were performed for noninferiority of PCM compared to FFDM using a noninferiority margin Δ value of 0.10. Feature analysis of the 66 cases with lesions was conducted with all 16 readers at the conclusion of the blinded reads. Mean glandular dose was recorded for all cases., Results: The AUC for PCM was 0.947 (95% confidence interval [CI], 0.920-0.974) and for FFDM was 0.931 (95% CI, 0.898-0.964). Sensitivity per case for PCM was 0.936 (95% CI, 0.897-0.976) and for FFDM was 0.908 (95% CI, 0.856-0.960). Specificity per case for PCM was 0.764 (95% CI, 0.688-0.841) and for FFDM was 0.749 (95% CI, 0.668-0.830). Free-response ROC curve figures of merit were 0.920 (95% CI, 0.881-0.959) and 0.903 (95% CI, 0.858-0.948) for PCM and FFDM, respectively. Sensitivity per lesion was 0.903 (95% CI, 0.846-0.960) and 0.883 (95% CI, 0.823-0.944) for PCM and FFDM, respectively. The average false-positive marks per image of noncancer cases were 0.265 (95% CI, 0.171-0.359) and 0.281 (95% CI, 0.188-0.374) for PCM and FFDM, respectively. Noninferiority P values for AUC, sensitivity (per case and per lesion), specificity, and average false-positive marks per image were all statistically significant (P < .001). The noninferiority P value for free-response ROC was <.025, from the 95% CI for the difference. Feature analysis resulted in PCM being preferred to FFDM by the readers for ≥70% of the cases. The average mean glandular dose for PCM was 0.74 mGy (95% CI, 0.722-0.759 mGy) and for FFDM was 1.23 mGy (95% CI, 1.199-1.262 mGy)., Conclusions: In this study, radiologist performance with PCM was not inferior to that with conventional FFDM at an average 40% lower mean glandular dose., (Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.)

The physical performance of a scanning multislit full field digital mammography system was determined using basic image quality parameters. The system employs a direct detection detector comprised of linear silicon strip sensors in an edge-on geometry connected to photon counting electronics. The pixel size is 50 microm and the field of view 24 x 26 cm2. The performance was quantified using the presampled modulation transfer function, the normalized noise power spectrum and the detective quantum efficiency (DQE). Compared to conventional DQE methods, the scanning geometry with its intrinsic scatter rejection poses additional requirements on the measurement setup, which are investigated in this work. The DQE of the photon counting system was found to be independent of the dose level to the detector in the 7.6-206 microGy range. The peak DQE was 72% and 73% in the scan and slit direction, respectively, measured with a 28 kV W-0.5 mm Al anode-filter combination with an added 2 mm Al filtration.

We present a single-shot dual-energy subtraction mammography technique using an energy sensitive photon counting detector. An electronic threshold near the middle of the X-ray spectrum discriminates between high- and low-energy photons, and allows the simultaneous acquisition of high- and low-energy images which can be combined to suppress anatomical clutter. By setting the electronic threshold close to 33.2 keV (the k-edge of iodine) the system is optimized for dual-energy contrast-enhanced imaging of breast tumors. This method eliminates the need for separate exposures which might otherwise lead to motion artifacts. The method is illustrated in phantom images.

The scatter to primary ratio (SPR) was measured on a scanning multislit full-field digital mammography system for different thickness of breast equivalent material and different tube voltages. Scatter within the detector was measured separately and was found to be the major source of scatter in the assembly. Measured total SPRs below 6% are reported for breast range 3-7 cm. The performance of the multislit assembly is compared to other imaging geometries with different scatter rejection schemes by using the scatter detective quantum efficiency.

A theoretical evaluation of nonuniform x-ray field distributions in mammography was conducted. An automatic exposure control (AEC) is proposed for a scanning full field digital mammography system. It uses information from the leading part of the detector to vary the scan velocity dynamically, thus creating a nonuniform x-ray field in the scan direction. Nonuniform radiation fields were also created by numerically optimizing the scan velocity profile to each breast's transmission distribution, with constraints on velocity and acceleration. The goal of the proposed AEC is to produce constant pixel signal-to-noise ratio throughout the image. The target pixel SNR for each image could be set based on the breast thickness, breast composition, and the beam quality as to achieve the same contrast-to-noise ratio between images for structures of interest. The results are quantified in terms of reduction in entrance surface air kerma (ESAK) and scan time relative to a uniform x-ray field. The theoretical evaluation was performed on a set of 266 mammograms. The performance of the different methods to create nonuniform fields decreased with increased detector width, from 18% to 11% in terms of ESAK reduction and from 30% to 25% in terms of scan time reduction for the proposed AEC and detector widths from 10 to 60 mm. Some correlation was found between compressed breast thickness and the projected breast area onto the image field. This translated into an increase of the ESAK and decrease of the scan time reduction with breast thickness. Ideally a nonuniform field in two dimensions could reduce the entrance dose by 39% on average, whereas a field nonuniform in only the scanning dimension ideally yields a 20% reduction. A benefit with the proposed AEC is that the risk of underexposing the densest region of the breast can be virtually eliminated.

An evaluation of the dependence of detective quantum efficiency (DQE) on the incident energy spectrum has been made for mammography. The DQE dependence on the energy spectrum has been evaluated for energy-integrating detectors, photon-counting detectors, and detectors that measure the energy of each photon. To isolate the effect of the x-ray energy spectrum the detector has been assumed to be ideal, i.e., all noise sources are assumed to be zero except for quantum fluctuations. The result shows that the improvement in DQE, if the energy-integrating detector is compared to a single-photon counting detector, is of the order of 10%. Comparing the energy-integrating detector and the detector measuring the energy for each photon the improvement is around 30% using a molybdenum anode spectrum typical in mammography. It is shown that the optimal weight factors to combine the data in the case the energy is measured are very well approximated if the weight factors are proportional to E(-3). Another conclusion is that in calculating the DQE, a detector should be compared to one that uses ideal energy weighting for each photon since this provides the best signal-to-noise ratio. This has generally been neglected in the literature.