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Keupers M, Woussen S, Postema S, Westerlinck H, Houbrechts K, Marshall N, Wildiers H, Cockmartin L, Bosmans H, Van Ongeval C. Limited impact of adding digital breast tomosynthesis to full field digital mammography in an elevated breast cancer risk population. Eur J Radiol 2024; 177:111540. [PMID: 38852327 DOI: 10.1016/j.ejrad.2024.111540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE To investigate the impact of adding digital breast tomosynthesis (DBT) to full field digital mammography (FFDM) in screening asymptomatic women with an elevated breast cancer life time risk (BCLTR) but without known genetic mutation. METHODS This IRB-approved single-institution multi-reader study on prospectively acquired FFDM + DBT images included 429 asymptomatic women (39-69y) with an elevated BC risk on their request form. The BCLTR was calculated for each patient using the IBISrisk calculator v8.0b. The screening protocol and reader study consisted of 4-view FFDM + DBT, which were read by four independent radiologists using the BI-RADS lexicon. Standard of care (SOC) included ultrasound (US) and magnetic resonance imaging (MRI) for women with > 30 % BCLTR. Breast cancer detection rate (BCDR), sensitivity and positive predictive value were assessed for FFDM and FFDM + DBT and detection outcomes were compared with McNemar-test. RESULTS In total 7/429 women in this clinically elevated breast cancer risk group were diagnosed with BC using SOC (BCDR 16.3/1000) of which 4 were detected with FFDM. Supplemental DBT did not detect additional cancers and BCDR was the same for FFDM vs FFDM + DBT (9.3/1000, McNemar p = 1). Moderate inter-reader agreement for diagnostic BI-RADS score was found for both study arms (ICC for FFDM and FFDM + DBT was 0.43, resp. 0.46). CONCLUSION In this single institution study, supplemental screening with DBT in addition to standard FFDM did not increase BCDR in this higher-than-average BC risk group, objectively documented using the IBISrisk calculator.
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Affiliation(s)
- Machteld Keupers
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Multidisciplinary Breast, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Sofie Woussen
- Department of Radiology, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - Sandra Postema
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Hélène Westerlinck
- Department of Radiology, AZ Diest, Statiestraat 65, 3290 Diest, Belgium.
| | - Katrien Houbrechts
- Department of Medical Physics, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Nicholas Marshall
- Department of Medical Physics, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Hans Wildiers
- Multidisciplinary Breast, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Lesley Cockmartin
- Department of Medical Physics, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Hilde Bosmans
- Department of Medical Physics, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Chantal Van Ongeval
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Multidisciplinary Breast, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Moshina N, Gräwingholt A, Lång K, Mann R, Hovda T, Hoff SR, Skaane P, Lee CI, Aase HS, Aslaksen AB, Hofvind S. Digital breast tomosynthesis in mammographic screening: false negative cancer cases in the To-Be 1 trial. Insights Imaging 2024; 15:38. [PMID: 38332187 PMCID: PMC10853101 DOI: 10.1186/s13244-023-01604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES The randomized controlled trial comparing digital breast tomosynthesis and synthetic 2D mammograms (DBT + SM) versus digital mammography (DM) (the To-Be 1 trial), 2016-2017, did not result in higher cancer detection for DBT + SM. We aimed to determine if negative cases prior to interval and consecutive screen-detected cancers from DBT + SM were due to interpretive error. METHODS Five external breast radiologists performed the individual blinded review of 239 screening examinations (90 true negative, 39 false positive, 19 prior to interval cancer, and 91 prior to consecutive screen-detected cancer) and the informed consensus review of examinations prior to interval and screen-detected cancers (n = 110). The reviewers marked suspicious findings with a score of 1-5 (probability of malignancy). A case was false negative if ≥ 2 radiologists assigned the cancer site with a score of ≥ 2 in the blinded review and if the case was assigned as false negative by a consensus in the informed review. RESULTS In the informed review, 5.3% of examinations prior to interval cancer and 18.7% prior to consecutive round screen-detected cancer were considered false negative. In the blinded review, 10.6% of examinations prior to interval cancer and 42.9% prior to consecutive round screen-detected cancer were scored ≥ 2. A score of ≥ 2 was assigned to 47.8% of negative and 89.7% of false positive examinations. CONCLUSIONS The false negative rates were consistent with those of prior DM reviews, indicating that the lack of higher cancer detection for DBT + SM versus DM in the To-Be 1 trial is complex and not due to interpretive error alone. CRITICAL RELEVANCE STATEMENT The randomized controlled trial on digital breast tomosynthesis and synthetic 2D mammograms (DBT) and digital mammography (DM), 2016-2017, showed no difference in cancer detection for the two techniques. The rates of false negative screening examinations prior to interval and consecutive screen-detected cancer for DBT were consistent with the rates in prior DM reviews, indicating that the non-superior DBT performance in the trial might not be due to interpretive error alone. KEY POINTS • Screening with digital breast tomosynthesis (DBT) did not result in a higher breast cancer detection rate compared to screening with digital mammography (DM) in the To-Be 1 trial. • The false negative rates for examinations prior to interval and consecutive screen-detected cancer for DBT were determined in the trial to test if the lack of differences was due to interpretive error. • The false negative rates were consistent with those of prior DM reviews, indicating that the lack of higher cancer detection for DBT versus DM was complex and not due to interpretive error alone.
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Affiliation(s)
- Nataliia Moshina
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Axel Gräwingholt
- Mammographiescreening-Zentrum Paderborn, Breast Cancer Screening, Paderborn, NRW, Germany
| | - Kristina Lång
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Ritse Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Tone Hovda
- Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Solveig Roth Hoff
- Department of Radiology, Ålesund Hospital, Møre Og Romsdal Hospital Trust, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Per Skaane
- Department of Radiology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Hildegunn S Aase
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Aslak B Aslaksen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.
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Monnin P, Damet J, Bosmans H, Marshall NW. Task-based detectability in anatomical background in digital mammography, digital breast tomosynthesis and synthetic mammography. Phys Med Biol 2024; 69:025017. [PMID: 38214048 DOI: 10.1088/1361-6560/ad1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024]
Abstract
Objective.Determining the detectability of targets for the different imaging modalities in mammography in the presence of anatomical background noise is challenging. This work proposes a method to compare the image quality and detectability of targets in digital mammography (DM), digital breast tomosynthesis (DBT) and synthetic mammography.Approach. The low-frequency structured noise produced by a water phantom with acrylic spheres was used to simulate anatomical background noise for the different types of images. A method was developed to apply the non-prewhitening observer model with eye filter (NPWE) in these conditions. A homogeneous poly(methyl) methacrylate phantom with a 0.2 mm thick aluminium disc was used to calculate 2D in-plane modulation transfer function (MTF), noise power spectrum (NPS), noise equivalent quanta, and system detective quantum efficiency for 30, 50 and 70 mm thicknesses. The in-depth MTFs of DBT volumes were determined using a thin tungsten wire. The MTF, system NPS and anatomical NPS were used in the NPWE model to calculate the threshold gold thickness of the gold discs contained in the CDMAM phantom, which was taken as reference. Main results.The correspondence between the NPWE model and the CDMAM phantom (linear Pearson correlation 0.980) yielded a threshold detectability index that was used to determine the threshold diameter of spherical microcalcifications and masses. DBT imaging improved the detection of masses, which depended mostly on the reduction of anatomical background noise. Conversely, DM images yielded the best detection of microcalcifications.Significance.The method presented in this study was able to quantify image quality and object detectability for the different imaging modalities and levels of anatomical background noise.
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Affiliation(s)
- P Monnin
- Institute of radiation physics (IRA), Lausanne University Hospital (CHUV) and University of Lausanne, Rue du Grand-Pré 1, 1007 Lausanne, Switzerland
| | - J Damet
- Institute of radiation physics (IRA), Lausanne University Hospital (CHUV) and University of Lausanne, Rue du Grand-Pré 1, 1007 Lausanne, Switzerland
| | - H Bosmans
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - N W Marshall
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
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Marshall NW, Vandenbroucke D, Cockmartin L, Wanninger F, Smet M, Feng Y, Ni Y, Bosmans H. Seven general radiography x-ray detectors with pixel sizes ranging from 175 to 76 μm: technical evaluation with the focus on orthopaedic imaging. Phys Med Biol 2023; 68:195007. [PMID: 37659394 DOI: 10.1088/1361-6560/acf642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/01/2023] [Indexed: 09/04/2023]
Abstract
Aim. Flat panel detectors with small pixel sizes general can potentially improve imaging performance in radiography applications requiring fine detail resolution. This study evaluated the imaging performance of seven detectors, covering a wide range of pixel sizes, in the frame of orthopaedic applications.Material and methods. Pixel sizes ranged from 175 (detector A175) to 76μm (detector G76). Modulation transfer function (MTF) and detective quantum efficiency (DQE) were measured using International Electrotechnical Commission (IEC) RQA3 beam quality. Threshold contrast (CT) and a detectability index (d') were measured at three air kerma/image levels. Rabbit shoulder images acquired at 60 kV, over five air kerma levels, were evaluated in a visual grading study for anatomical sharpness, image noise and overall diagnostic image quality by four radiologists. The detectors were compared to detector E124.Results. The 10% point of the MTF ranged from 3.21 to 4.80 mm-1, in going from detector A175to detector G76. DQE(0.5 mm-1) measured at 2.38μGy/image was 0.50 ± 0.05 for six detectors, but was higher for F100at 0.62. High frequency DQE was superior for the smaller pixel detectors, howeverCTfor 0.25 mm discs correlated best with DQE(0.5 mm-1). Correlation betweenCTand the detectability model was good (R2= 0.964).CTfor 0.25 mm diameter discs was significantly higher for D150and F100compared to E124. The visual grading data revealed higher image quality ratings for detectors D125and F100compared to E124. An increase in air kerma was associated with improved perceived sharpness and overall quality score, independent of detector. Detectors B150, D125, F100and G76, performed well in specific tests, however only F100consistently outperformed the reference detector.Conclusion. Pixel size alone was not a reliable predictor of small detail detectability or even perceived sharpness in a visual grading analysis study.
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Affiliation(s)
- N W Marshall
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
- Agfa N.V., Septestraat 27, B-2640 Mortsel, Belgium
| | | | - L Cockmartin
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
| | - F Wanninger
- Agfa-Gevaert HealthCare GmbH, München, Germany
| | - M Smet
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
| | - Y Feng
- Theragnostic Laboratory, Biomedical Group, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
| | - Y Ni
- Theragnostic Laboratory, Biomedical Group, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
| | - H Bosmans
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
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Salomon E, Unger E, Homolka P, Cockmartin L, Petrov D, Semturs F, Songsaeng C, Panagiotis K, Vancoillie L, Figl M, Sommer A, Bosmans H, Hummel J. Technical note: Realization and uncertainty analysis for an adjustable 3D structured breast phantom in digital breast tomosynthesis. Med Phys 2023; 50:4816-4824. [PMID: 37438921 DOI: 10.1002/mp.16600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/09/2023] [Accepted: 06/07/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Projection imaging phantoms are often optimized for 2-dimensional image characteristics in homogeneous backgrounds. Therefore, evaluation of image quality in tomosynthesis (DBT) lacks accepted and established phantoms. PURPOSE We describe a 3D breast phantom with a structured, variable background. The phantom is an adaptable and advanced version of the L1 phantom by Cockmartin et al. Phantom design and its use for quality assurance measurements for DBT devices are described. Four phantoms were compared to assess the objectivity. METHODS The container size was increased to a diameter of 24 cm and a total height of 53.5 mm. Spiculated masses were replaced by five additional non-spiculated masses for higher granularity in threshold diameter resolution. These patterns are adjustable to the imaging device. The masses were printed in one session with a base layer using two-component 3D printing. New materials compared to the L1 phantom improved the attenuation difference between the lesion models and the background. Four phantoms were built and intra-human observer, inter-human observer and inter-phantom variations were determined. The latter assess the reproducibility of the phantom production. Coefficients of variance (V) were calculated for all three variations. RESULTS The difference of the attenuation coefficients between the lesion models and the background was 0.20 cm-1 (with W/Al at 32 kV, equivalent to 19-20 keV effective energy) compared to 0.21 cm-1 for 50/50 glandular/adipose breast tissue and cancerous lesions. PMMA equivalent thickness of the phantom was 47.0 mm for the Siemens Mammomat Revelation. For the masses, theV i n t r a $V_{intra}$ for the intra-observer variation was 0.248, the averaged inter-observer variation,V ¯ i n t e r $\overline{V}_{inter}$ was 0.383.V p h a n t o m $V_{phantom}$ for phantom variance was 0.321. For the micro-calcifications,V i n t r a $V_{intra}$ was 0.0429,V ¯ i n t e r = $\overline{V}_{inter}=$ 0.0731 andV p h a n t o m = $V_{phantom}=$ 0.0759. CONCLUSIONS Position, orientation and shape of the masses are reproducible and attenuation differences appropriate. The phantom presented proved to be a candidate test object for quality control.
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Affiliation(s)
- Elisabeth Salomon
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Spitalgasse, Vienna, Austria
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Spitalgasse, Vienna, Austria
| | - Peter Homolka
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Spitalgasse, Vienna, Austria
| | | | - Dimitar Petrov
- Department of Radiology, UZ Gasthuisberg, Leuven, Belgium
| | - Friedrich Semturs
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Spitalgasse, Vienna, Austria
| | - Chatsuda Songsaeng
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Spitalgasse, Vienna, Austria
- Christian Doppler Laboratory for Mathematical Modelling and Simulation of Next-Generation Medical Ultrasound Devices, Vienna, Austria
| | - Kapetas Panagiotis
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna and General Hospital, Spitalgasse, Vienna, Austria
| | | | - Michael Figl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Spitalgasse, Vienna, Austria
- Christian Doppler Laboratory for Mathematical Modelling and Simulation of Next-Generation Medical Ultrasound Devices, Vienna, Austria
| | - Alexander Sommer
- Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Hilde Bosmans
- Department of Radiology, UZ Gasthuisberg, Leuven, Belgium
| | - Johann Hummel
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Spitalgasse, Vienna, Austria
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Physical and digital phantoms for 2D and 3D x-ray breast imaging: Review on the state-of-the-art and future prospects. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Marshall NW, Bosmans H. Performance evaluation of digital breast tomosynthesis systems: physical methods and experimental data. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac9a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022]
Abstract
Abstract
Digital breast tomosynthesis (DBT) has become a well-established breast imaging technique, whose performance has been investigated in many clinical studies, including a number of prospective clinical trials. Results from these studies generally point to non-inferiority in terms of microcalcification detection and superior mass-lesion detection for DBT imaging compared to digital mammography (DM). This modality has become an essential tool in the clinic for assessment and ad-hoc screening but is not yet implemented in most breast screening programmes at a state or national level. While evidence on the clinical utility of DBT has been accumulating, there has also been progress in the development of methods for technical performance assessment and quality control of these imaging systems. DBT is a relatively complicated ‘pseudo-3D’ modality whose technical assessment poses a number of difficulties. This paper reviews methods for the technical performance assessment of DBT devices, starting at the component level in part one and leading up to discussion of system evaluation with physical test objects in part two. We provide some historical and basic theoretical perspective, often starting from methods developed for DM imaging. Data from a multi-vendor comparison are also included, acquired under the medical physics quality control protocol developed by EUREF and currently being consolidated by a European Federation of Organisations for Medical Physics working group. These data and associated methods can serve as a reference for the development of reference data and provide some context for clinical studies.
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