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Marshall NW, Cockmartin L, Bosmans H. Investigation of test methods for QC in dual-energy based contrast-enhanced digital mammography systems: II. Artefacts/uniformity, exposure time and phantom-based dosimetry. Phys Med Biol 2023; 68:215016. [PMID: 37820686 DOI: 10.1088/1361-6560/ad027f] [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: 09/21/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023]
Abstract
Part II of this study describes constancy tests for artefacts and image uniformity, exposure time, and phantom-based dosimetry; these are applied to four mammography systems equipped with contrast enhanced mammography (CEM) capability. Artefacts were tested using a breast phantom that simulated breast shape and thickness change at the breast edge. Image uniformity was assessed using rectangular poly(methyl)methacrylate PMMA plates at phantom thicknesses of 20, 40 and 60 mm, for the low energy (LE), high energy (HE) images and the recombined CEM image. Uniformity of signal and of the signal to noise ratio was quantified. To estimate CEM exposure times, breast simulating blocks were imaged in automatic exposure mode. The resulting x-ray technique factors were then set manually and exposure time for LE and HE images and total CEM acquisition time was measured with a multimeter. Mean glandular dose (MGD) was assessed as a function of simulated breast thickness using three different phantom compositions: (i) glandular and adipose breast tissue simulating blocks combined to give glandularity values that were typical of those in a screening population, as thickness was changed (ii) PMMA sheets combined with polyethylene blocks (iii) PMMA sheets with spacers. Image uniformity was superior for LE compared to HE images. Two systems did not generate recombined images for the uniformity test when the detector was fully covered. Acquisition time for a CEM image pair for a 60 mm thick breast equivalent phantom ranged from 3.4 to 10.3 s. Phantom composition did not have a strong influence on MGD, with differences generally smaller than 10%. MGD for the HE images was lower than for the LE images, by a factor of between 1.3 and 4.0, depending on system and simulated breast thickness. When combined with the iodine signal assessment in part I, these tests provide a comprehensive assessment of CEM system imaging performance.
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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
| | - L Cockmartin
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 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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Harper LK, Faulk EA, Patel B, Collins P, Rochman C. How to Recognize and Correct Artifacts on Contrast-Enhanced Mammography. JOURNAL OF BREAST IMAGING 2023; 5:486-497. [PMID: 38416909 DOI: 10.1093/jbi/wbad041] [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: 02/12/2023] [Indexed: 03/01/2024]
Abstract
Contrast-enhanced mammography (CEM) has emerged as an important new technology in breast imaging. It can demonstrate a number of imaging artifacts that have the potential to limit interpretation by either obscuring or potentially mimicking disease. Commonly encountered artifacts on CEM include patient motion artifacts (ripple and misregistration), pectoral highlighting artifact, breast implant artifact, halo artifact, corrugation artifact, cloudy fat artifact, contrast artifacts (retention and contamination), skin artifacts (skin line enhancement and skin overexposure), and skin lesions. Skin lesions may demonstrate a variety of imaging appearances and have both benign and malignant etiologies. It is important that the technologist, radiologist, and physicist be aware of potential artifacts and skin enhancement on CEM that may affect interpretation and understand their causes and potential solutions.
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Affiliation(s)
- Laura K Harper
- Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ, USA
| | - Ellen A Faulk
- University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
| | - Bhavika Patel
- Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ, USA
| | - Patricia Collins
- University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
| | - Carrie Rochman
- University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
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Gennaro G, Baldan E, Bezzon E, Caumo F. Artifact reduction in contrast-enhanced mammography. Insights Imaging 2022; 13:90. [PMID: 35554734 PMCID: PMC9098782 DOI: 10.1186/s13244-022-01211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a new algorithm developed to reduce artifacts in dual-energy subtraction (DES) contrast-enhanced mammography (CEM) images while preserving contrast enhancement of possible lesions. METHODS A retrospective multi-reader paired study was performed by using 134 CEM studies obtained from the first 134 women enrolled in a prospective clinical study aiming to compare the clinical performance of CEM to those of breast MRI in screening of women at increased risk of breast cancer. Four experienced readers compared independently the standard (STD) DES images with those obtained by reprocessing the raw images by a new algorithm (NEW), expected to reduce the DES artifact intensity. The intensity of three types of artifacts (breast-in-breast, ripple, and skinfold enhancement) and the intensity of possible contrast uptake were assessed visually and rated using a categorical ordinal scale. Proportions of images rated by the majority of readers as "Absent", "Weak", "Medium", "Strong" in each artifact intensity category were compared between the two algorithms. P-values lower than 0.05 were considered statistically significant. RESULTS The NEW algorithm succeeded in eliminating 84.5% of breast-in-breast artifacts, 84.2% of ripple artifacts, and 56.9% of skinfold enhancement artifacts versus STD DES images, and reduced the artifact intensity in 12.1%, 13.0%, and 28.8% of the images, respectively. The visibility of lesion contrast uptake was the same with the STD and the NEW algorithms. CONCLUSION The new dual-energy subtraction algorithm demonstrated to be effective in reducing/eliminating CEM-related artifacts while preserving lesion contrast enhancement.
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Affiliation(s)
- Gisella Gennaro
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy.
| | - Enrica Baldan
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy
| | - Elisabetta Bezzon
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy
| | - Francesca Caumo
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy
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Sun Y, Wang S, Liu Z, You C, Li R, Mao N, Duan S, Lynn HS, Gu Y. Identifying factors that may influence the classification performance of radiomics models using contrast-enhanced mammography (CEM) images. Cancer Imaging 2022; 22:22. [PMID: 35550658 PMCID: PMC9101829 DOI: 10.1186/s40644-022-00460-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Radiomics plays an important role in the field of oncology. Few studies have focused on the identification of factors that may influence the classification performance of radiomics models. The goal of this study was to use contrast-enhanced mammography (CEM) images to identify factors that may potentially influence the performance of radiomics models in diagnosing breast lesions. Methods A total of 157 women with 161 breast lesions were included. Least absolute shrinkage and selection operator (LASSO) regression and the random forest (RF) algorithm were employed to construct radiomics models. The classification result for each lesion was obtained by using 100 rounds of five-fold cross-validation. The image features interpreted by the radiologists were used in the exploratory factor analyses. Univariate and multivariate analyses were performed to determine the association between the image features and misclassification. Additional exploratory analyses were performed to examine the findings. Results Among the lesions misclassified by both LASSO and RF ≥ 20% of the iterations in the cross-validation and those misclassified by both algorithms ≤5% of the iterations, univariate analysis showed that larger lesion size and the presence of rim artifacts and/or ripple artifacts were associated with more misclassifications among benign lesions, and smaller lesion size was associated with more misclassifications among malignant lesions (all p < 0.050). Multivariate analysis showed that smaller lesion size (odds ratio [OR] = 0.699, p = 0.002) and the presence of air trapping artifacts (OR = 35.568, p = 0.025) were factors that may lead to misclassification among malignant lesions. Additional exploratory analyses showed that benign lesions with rim artifacts and small malignant lesions (< 20 mm) with air trapping artifacts were misclassified by approximately 50% more in rate compared with benign and malignant lesions without these factors. Conclusions Lesion size and artifacts in CEM images may affect the diagnostic performance of radiomics models. The classification results for lesions presenting with certain factors may be less reliable. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00460-8.
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Affiliation(s)
- Yuqi Sun
- Department of Biostatistics, Key Laboratory on Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Simin Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China
| | - Ziang Liu
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China
| | - Ruimin Li
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Shandong, 264000, China
| | - Shaofeng Duan
- GE Healthcare China, No. 1 Huatuo Road, Shanghai, 210000, China
| | - Henry S Lynn
- Department of Biostatistics, Key Laboratory on Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China.
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