Breast CT

Assessing the impact of incidental findings in a lung cancer screening study by using low-dose computed tomography

PURPOSE

To assess the prevalence and nature of incidental findings (IF) seen in low-dose computed tomographies (LDCT) from a lung cancer screening study for at-risk individuals.

MATERIALS AND METHODS

Radiology reports from LDCTs of 4073 participants of a lung cancer screening study were retrospectively reviewed for findings other than lung nodules, that is, IFs, which were regarded as actionable. The frequency, nature, and expected cost of these IFs, and their anticipated follow-up were estimated.

RESULTS

There were 880 IFs described in 782 study participants (19%); the median age of the participants was 62 years (range, 46-80 years). More IFs were found in men (55%) than in women. The majority of these findings were noncardiovascular (76%), for which imaging was suggested for 74%. There were 7 severe IFs (0.8%) that merited immediate attention. Seven known cancers were diagnosed from follow-ups of the IFs. The majority of IFs (n = 486 [55%]) would require imaging follow-up if clinically indicated, with an estimated total a cost of CAN$45,500 to CAN$51,000 to provide initial diagnostic workup.

CONCLUSION

IFs on lung cancer screening studies are not uncommon and frequently require imaging or other follow-up for definitive diagnoses and to assess their clinical relevance. The implication of IFs has to be considered when determining a cost-effective and ethical protocol for the utilisation of LDCT in a high-risk population.

Varying collimation for dark-field extraction

Although x-ray imaging is widely used in biomedical applications, biological soft tissues have small density changes, leading to low contrast resolution for attenuation-based x-ray imaging. Over the past years, x-ray small-angle scattering was studied as a new contrast mechanism to enhance subtle structural variation within the soft tissue. In this paper, we present a detection method to extract this type of x-ray scattering data, which are also referred to as dark-field signals. The key idea is to acquire an x-ray projection multiple times with varying collimation before an x-ray detector array. The projection data acquired with a collimator of a sufficiently high collimation aspect ratio contain mainly the primary beam with little scattering, while the data acquired with an appropriately reduced collimation aspect ratio include both the primary beam and small-angle scattering signals. Then, analysis of these corresponding datasets will produce desirable dark-field signals; for example, via digitally subtraction. In the numerical experiments, the feasibility of our dark-field detection technology is demonstrated in Monte Carlo simulation. The results show that the acquired dark field signals can clearly reveal the structural information of tissues in terms of Rayleigh scattering characteristics.

Photon counting multienergy x-ray imaging: effect of the characteristic x rays on detector performance

PURPOSE

The purpose of this work was to investigate the effect of characteristic x rays on the performance of photon counting detectors for multienergy x-ray imaging. X-ray and CT systems with photon counting detectors have compelling advantages compared to energy integrating detectors, and cadmium zinc telluride (CZT) detector is the detector of choice. However, current CZT detectors exhibit several limitations that hamper their practical applications. These limitations include hole trapping, high leakage current, and charge sharing between detector pixels. Charge sharing occurs due to the diffusion of charge when it drifts toward the pixel electrodes. It also occurs due to nonlocal reabsorption of characteristic and scattered x rays created in the detector volume. Hole trapping, leakage current, and charge diffusion may potentially have technical solutions. Characteristic x-ray escape and scatter, however, are fundamental in nature and cannot be easily addressed. The x-ray scatter in the CZT material is small at photon energies used in x-ray imaging. Therefore, the remaining major factor is characteristic x ray.

METHODS

Monte Carlo simulations were used for this study. An experimental photon counting multienergy x-ray imaging system was used to compare simulations to experimental results. An x-ray spectrum at 120 kVp tube voltage was used. The x-ray energy range was split into five subregions (energy bins) and Monte Carlo simulations were performed at average x-ray energies corresponding to these energy bins. The detector pixel size was changed within the 0.1-1 mm range, which covered all possible applications including radiography and CT imaging. The pixel shapes included square and strip pixels. For strip pixels, tilted angle irradiation of the CZT detector was also investigated.

RESULTS

The characteristic x rays escaped the pixels in approximately 70% of all x-ray interactions for the smallest pixel size of 0.1 mm. The escape fraction decreased to 20% for the largest pixel size of 1 mm. All escape fractions, for all pixel sizes, at five energies, for square and strip pixels, and at three tilt angles were calculated and presented in tables. Simulated and measured spectra at 120 kVp were compared.

CONCLUSIONS

Characteristic x-ray escape deteriorates energy and spatial resolution, particularly for small pixel sizes. Correction methods should be developed based on the results of the simulations and experimental study.

Quantitative characterization of optical and physiological parameters in normal breasts using time-resolved spectroscopy: in vivo results of 19 Singapore women

We report the quantitative measurements of optical and physiological parameters of normal breasts from 19 Singapore women by using time-resolved diffuse optical spectroscopy. Intrinsic absorption coefficient (mu(a)) and reduced scattering coefficients (mu(s) (')) of breasts were calculated from the time-resolved photon migration data. Physiology of breasts was characterized using the concentrations of oxyhemoglobin, deoxyhemoglobin, total hemoglobin (THC), and oxygenation saturation. On average, the experiment results showed that the mu(a) of young women (below 40 years old) was 36 to 38% greater than that of older women (above 40 years old) and that parameter THC was approximately 42% greater. Results also showed that the THC of premenopausal women was 24.3 microMol/L, which was approximately 69% larger than that of postmenopausal women at 14.1 microMol/L. Meanwhile, the mu(a) of premenopausal women was approximately 60% larger than that of postmenopausal women. Correlation analysis further showed that the optical and physiological parameters of breasts were strongly influenced by changes in the women's age, menopausal states, and body mass index. These in vivo experiment results will contribute to the breast tissue diagnosis between healthy and diseased breast tissues.

Methodology for generating a 3D computerized breast phantom from empirical data

The initial process for creating a flexible three-dimensional computer-generated breast phantom based on empirical data is described. Dedicated breast computed-tomography data were processed to suppress noise and scatter artifacts in the reconstructed image set. An automated algorithm was developed to classify the breast into its primary components. A preliminary phantom defined using subdivision surfaces was generated from the segmented data. To demonstrate potential applications of the phantom, simulated mammographic image data were acquired of the phantom using a simplistic compression model and an analytic projection algorithm directly on the surface model. The simulated image was generated using a model for a polyenergetic cone-beam projection of the compressed phantom. The methods used to create the breast phantom generate resulting images that have a high level of tissue structure detail available and appear similar to actual mammograms. Fractal dimension measurements of simulated images of the phantom are comparatively similar to measurements from images of real human subjects. A realistic and geometrically defined breast phantom that can accurately simulate imaging data may have many applications in breast imaging research.

Conebeam CT of the head and neck, part 2: clinical applications

SUMMARY

Conebeam x-ray CT (CBCT) is being increasingly used for point-of-service head and neck and dentomaxillofacial imaging. This technique provides relatively high isotropic spatial resolution of osseous structures with a reduced radiation dose compared with conventional CT scans. In this second installment in a 2-part review, the clinical applications in the dentomaxillofacial and head and neck regions will be explored, with particular emphasis on diagnostic imaging of the sinuses, temporal bone, and craniofacial structures. Several controversies surrounding the emergence of CBCT technology will also be addressed.

Breast cancer imaging: a perspective for the next decade

Breast imaging is largely indicated for detection, diagnosis, and clinical management of breast cancer and for evaluation of the integrity of breast implants. In this work, a prospective view of techniques for breast cancer detection and diagnosis is provided based on an assessment of current trends. The potential role of emerging techniques that are under various stages of research and development is also addressed. It appears that the primary imaging tool for breast cancer screening in the next decade will be high-resolution, high-contrast, anatomical x-ray imaging with or without depth information. MRI and ultrasonography will have an increasingly important adjunctive role for imaging high-risk patients and women with dense breasts. Pilot studies with dedicated breast CT have demonstrated high-resolution three-dimensional imaging capabilities, but several technological barriers must be overcome before clinical adoption. Radionuclide based imaging techniques and x-ray imaging with intravenously injected contrast offer substantial potential as a diagnostic tools and for evaluation of suspicious lesions. Developing optical and electromagnetic imaging techniques hold significant potential for physiologic information and they are likely to be of most value when integrated with or adjunctively used with techniques that provide anatomic information. Experimental studies with breast specimens suggest that phase-sensitive x-ray imaging techniques can provide edge enhancement and contrast improvement but more research is needed to evaluate their potential role in clinical breast imaging. From the technological perspective, in addition to improvements within each modality, there is likely to be a trend towards multi-modality systems that combine anatomic with physiologic information. We are also likely to transition from a standardized screening, where all women undergo the same imaging exam (mammography), to selection of a screening modality or modalities based an individual-risk or other classification.