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Ahmadinejad N, Rasoulighasemlouei S, Rostamzadeh N, Arian A, Mohajeri A, Miratashi Yazdi SN. Our experience using synthesized mammography vs full field digital mammography in population-based screening. Eur J Radiol Open 2023; 10:100475. [PMID: 36647512 PMCID: PMC9840104 DOI: 10.1016/j.ejro.2023.100475] [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: 12/04/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Background Synthesized Mammogram (SM) from Digital Breast Tomosynthesis (DBT) images is introduced to replace the routine Full Field Digital Mammography (FFDM) to reduce radiation dose. Purpose to compare the conspicuity of cancer related findings between SM and FFDM and combination of these methods with DBT. Methods The study was conducted in a tertiary breast imaging center, where 200 women referred for screening were enrolled in the study sequentially. Patients underwent FFDM and DBT simultaneously and a two-year follow-up was done. Data was evaluated for Breast Imaging Reporting and Data System (BI-RADS) score, breast density, mass lesions, calcification, and focal asymmetry by two expert breast radiologists. Comparison between different methods was made by Cohen Kappa test. Results 22 patients with likely malignant findings went under biopsy. Taking histopathologic findings and two-year follow up as reference, the overall sensitivity and specificity for FFDM+DBT (86.1 and 88.9 respectively) and SM+DBT (86.1 and 88.2) didn't show a meaningful difference. Comparing SM and FFDM, calcification in 20 subjects were overlooked on SM, but later detected when combined with DBT. Considering breast composition and BI-RADS categorization, an excellent agreement existed between the readers. Conclusion Screening with SM+DBT shows comparable results with FFDM+DBT considering BI-RADS categorization of the patients. Although SM showed slightly inferior sensitivity compared to FFDM, after combining DBT with SM no malignant appearing calcification or mass lesion was missed.
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Key Words
- AWS, Acquisition Workstation
- BI-RADS categorization
- BI-RADS, Breast Imaging Reporting and Data System
- Breast cancer
- CC, Cranio-Caudal
- DBT, Digital Breast Tomosynthesis
- Digital breast tomography
- Digital mammography
- FFDM, Digital Mammography
- ICC, Intra Class Correlations
- MLO, Medio Lateral Oblique
- NPV, Negative Predictive Value
- PPV, Positive Predictive Value
- SM, Synthesized Mammograms
- Synthesized mammography
- TUMS, Tehran University of Medical Sciences
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Affiliation(s)
- Nasrin Ahmadinejad
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedehsahel Rasoulighasemlouei
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Rostamzadeh
- Department of Pediatrics, Urmia University of Medical Sciences, Urmia, Iran
| | - Arvin Arian
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyedeh Nooshin Miratashi Yazdi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran,Corresponding author.
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Gulati S, Dhamija E, Anand R. Imaging Artifacts on Synthesized Mammogram: What a Radiologist should Know! Indian J Radiol Imaging 2022; 32:555-561. [DOI: 10.1055/s-0042-1754364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractSynthesized mammogram is a new technique that involves reconstruction of a two-dimensional (2D) image from the tomosynthesis images rather than separate acquisition of a standard 2D mammogram. The advent of a synthesized mammogram (s2D) has helped in reducing radiation exposure. The technique of back projection used in reconstruction makes the appearance of these images different from a standard 2D mammogram. Because this is a relatively new technique, it is associated with a learning curve. Hence, it is important for the new radiologists and technicians to be aware of certain common artifacts encountered while using s2D images, which may hinder interpretation. In this pictorial review, we would like to highlight the common artifacts encountered while reading synthesized mammographic images.
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Affiliation(s)
- Shrea Gulati
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Roshni Anand
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Delhi, India
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Huang ML, Hess K, Ma J, Santiago L, Scoggins ME, Arribas E, Adrada BE, Le-Petross HT, Leung JW, Yang W, Geiser W, Candelaria RP. Prospective Comparison of Synthesized Mammography with DBT and Full-Field Digital Mammography with DBT Uncovers Recall Disagreements That may Impact Cancer Detection. Acad Radiol 2022; 29:1039-1045. [PMID: 34538550 DOI: 10.1016/j.acra.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Synthesized mammography with digital breast tomosynthesis (SM+DBT) and full-field digital mammography with DBT were prospectively evaluated for recall rate (RR), cancer detection rate (CDR), positive predictive value 1 (PPV1), lesion recall differences, and disagreements in recall for additional imaging. MATERIALS AND METHODS From December 15, 2015 to January 15, 2017, after informed consent was obtained for this Health Insurance Portability and Accountability Act compliant study, each enrolled patient's SM+DBT and FFDM+DBT were interpreted sequentially by one of eight radiologists. RR, CDR, PPV1, and imaging findings (asymmetry, focal asymmetry, mass, architectural distortion, and calcifications) recalled were reviewed. RESULTS For SM+DBT and FFDM+DBT in 1022 patients, RR was 7.3% and 7.9% (SM+DBT vs. FFDM+DBT: diff= -0.6%; 90% CI= -1.4%, 0.1%); CDR was 6.8 and 7.8 per 1000 (SM+DBT vs. FFDM+DBT: diff= -1.0, 95% CI= -5.5, 2.8, p = 0.317); PPV1 was 9.3% and 9.9% (relative positive predictive value for SM+DBT vs. FFDM+DBT: 0.95, 95% CI: 0.73-1.22, p = 0.669). FFDM+DBT detected eight cancers; SM+DBT detected seven (missed 1 cancer with calcifications). SM+DBT and FFDM+DBT disagreed on patient recall for additional imaging in 19 patients, with majority (68%, 13/19 patients) in the recall of patients for calcifications. For calcifications, SM+DBT recalled six patients that FFDM+DBT did not recall, and FFDM+DBT recalled seven patients that SM+DBT did not recall, even though the total number of calcifications finding recalled was similar overall for both SM+DBT and FFDM+DBT. CONCLUSION Disagreement in recall of patients for calcifications may impact cancer detection by SM+DBT, warranting further investigation.
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A Comparative Efficacy Study of Diagnostic Digital Breast Tomosynthesis and Digital Mammography in BI-RADS 4 Breast Cancer Diagnosis. Eur J Radiol 2022; 153:110361. [DOI: 10.1016/j.ejrad.2022.110361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 12/28/2022]
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Vegunta S, Kling JM, Patel BK. Supplemental Cancer Screening for Women With Dense Breasts: Guidance for Health Care Professionals. Mayo Clin Proc 2021; 96:2891-2904. [PMID: 34686363 DOI: 10.1016/j.mayocp.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Mammography is the standard for breast cancer screening. The sensitivity of mammography in identifying breast cancer, however, is reduced for women with dense breasts. Thirty-eight states have passed laws requiring that all women be notified of breast tissue density results in their mammogram report. The notification includes a statement that differs by state, encouraging women to discuss supplemental screening options with their health care professionals (HCPs). Several supplemental screening tests are available for women with dense breast tissue, but no established guidelines exist to direct HCPs in their recommendation of preferred supplemental screening test. Tailored screening, which takes into consideration the patient's mammographic breast density and lifetime breast cancer risk, can guide breast cancer screening strategies that are more comprehensive. This review describes the benefits and limitations of the various available supplemental screening tests to guide HCPs and patients in choosing the appropriate breast cancer screening.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ.
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Bhavika K Patel
- Division of Breast Imaging, Mayo Clinic Hospital, Phoenix, AZ
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Architectural distortion outcome: digital breast tomosynthesis-detected versus digital mammography-detected. Radiol Med 2021; 127:30-38. [PMID: 34665431 DOI: 10.1007/s11547-021-01419-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/29/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To compare the outcome for DBT-detected and DM-detected suspicious AD, to evaluate the risk of malignancy and if is affected by the US or MRI imaging correlation. METHODS All cases with suspicious AD (ultimately assigned BI-RADS 4 or 5 categories) were retrospectively included. Two radiologists independently reviewed DM and DBT images in two sessions for detection (DM vs. DBT). US and MRI imaging correlation findings were recorded. Pathologic results were compared between DBT-detected and DM-detected AD. RESULTS Among 137 detected ADs, 103 (75.2%) were DM-detected, and 34 (24.8%) were only DBT-detected (p = 0.01). The malignancy rate was lower for DBT-detected than DM-detected AD (14.7% vs. 45.6%) (p = 0.01). Malignancy rate was higher with US-positive than US-negative correlation at DM-detected AD (49.4% vs. 27.8%) (p = 0.01). Malignancy rate was not different for DBT-detected AD with (16.7%) or without (12.5%) sonographic correlation. NPV based on radiologists' level of suspicion was high (86.2%-97.2%) but not sufficient enough to forgo biopsy. Of 34 sonographically occult ADs, a positive-MRI correlation was identified in 19 (55.9%) ADs (7 were malignant, 12 were benign). A negative-MRI correlation was identified in 15 (44.1%) ADs; all had a benign outcome (p = 0.01). CONCLUSIONS DBT-detected AD is less likely to represent malignancy than does DM-detected; however, the risk of malignancy is not low enough to forgo biopsy. MRI-negative correlation in sonographically occult AD was significantly associated with benign outcomes and can avoid unnecessary interventions.
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Synthetic 2D Mammography Versus Standard 2D Digital Mammography: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2021; 217:314-325. [DOI: 10.2214/ajr.20.24204] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Canelo-Aybar C, Carrera L, Beltrán J, Posso M, Rigau D, Lebeau A, Gräwingholt A, Castells X, Langendam M, Pérez E, Giorgi Rossi P, Van Engen R, Parmelli E, Saz-Parkinson Z, Alonso-Coello P. Digital breast tomosynthesis compared to diagnostic mammographic projections (including magnification) among women recalled at screening mammography: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC). Cancer Med 2021; 10:2191-2204. [PMID: 33675147 PMCID: PMC7982617 DOI: 10.1002/cam4.3803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diagnostic mammography projections (DxMM) have been traditionally used in the assessment of women recalled after a suspicious screening mammogram. Digital breast tomosynthesis (DBT) reduces the tissue overlap effect, thus improving image assessment. Some studies have suggested DBT might replace DxMM with at least equivalent performance. Objective To evaluate the replacement of DxMM with DBT in women recalled at screening. Methods We searched PubMed, EMBASE, and the Cochrane Library databases to identify diagnostic paired cohort studies or RCTs comparing DBT vs DxMM, published in English that: reported accuracy outcomes, recruited women recalled for assessment at mammography screening, and included a reference standard. Subgroup analysis was performed over lesion characteristics. We provided pooled accuracy estimates and differences between tests using a quadrivariate model. We assessed the certainty of the evidence using the GRADE approach. Results We included ten studies that reported specificity and sensitivity. One study included 7060 women while the remaining included between 52 and 738 women. DBT compared with DxMM showed a pooled difference for the sensitivity of 2% (95% CI 1%–3%) and a pooled difference for the specificity of 6% (95%CI 2%–11%). Restricting the analysis to the six studies that included women with microcalcification lesions gave similar results. In the context of a prevalence of 21% of breast cancer (BC) in recalled women, DBT probably detects 4 (95% CI 2–6) more BC cases and has 47 (95%CI 16–87) fewer false‐positive results per 1000 assessments. The certainty of the evidence was moderate due to risk of bias. Conclusion The evidence in the assessment of screen‐recalled findings with DBT is sparse and of moderate certainty. DBT probably has higher sensitivity and specificity than DxMM. Women, health care providers and policymakers might value as relevant the reduction of false‐positive results and related fewer invasive diagnostic procedures with DBT, without missing BC cases.
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Affiliation(s)
- Carlos Canelo-Aybar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Jessica Beltrán
- Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Margarita Posso
- Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - David Rigau
- Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Annette Lebeau
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Miranda Langendam
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Elsa Pérez
- University Hospital Dr. Josep Trueta, Girona, Spain
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ruben Van Engen
- LRCB, Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | | | - Pablo Alonso-Coello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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Sanmugasiva VV, Ramli Hamid MT, Fadzli F, Rozalli FI, Yeong CH, Ab Mumin N, Rahmat K. Diagnostic accuracy of digital breast tomosynthesis in combination with 2D mammography for the characterisation of mammographic abnormalities. Sci Rep 2020; 10:20628. [PMID: 33244075 PMCID: PMC7691352 DOI: 10.1038/s41598-020-77456-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 11/02/2020] [Indexed: 11/22/2022] Open
Abstract
This study aims to assess the diagnostic accuracy of digital breast tomosynthesis in combination with full field digital mammography (DBT + FFDM) in the charaterisation of Breast Imaging-reporting and Data System (BI-RADS) category 3, 4 and 5 lesions. Retrospective cross-sectional study of 390 patients with BI-RADS 3, 4 and 5 mammography with available histopathology examination results were recruited from in a single center of a multi-ethnic Asian population. 2 readers independently reported the FFDM and DBT images and classified lesions detected (mass, calcifications, asymmetric density and architectural distortion) based on American College of Radiology-BI-RADS lexicon. Of the 390 patients recruited, 182 malignancies were reported. Positive predictive value (PPV) of cancer was 46.7%. The PPV in BI-RADS 4a, 4b, 4c and 5 were 6.0%, 38.3%, 68.9%, and 93.1%, respectively. Among all the cancers, 76% presented as masses, 4% as calcifications and 20% as asymmetry. An additional of 4% of cancers were detected on ultrasound. The sensitivity, specificity, PPV and NPV of mass lesions detected on DBT + FFDM were 93.8%, 85.1%, 88.8% and 91.5%, respectively. The PPV for calcification is 61.6% and asymmetry is 60.7%. 81.6% of cancer detected were invasive and 13.3% were in-situ type. Our study showed that DBT is proven to be an effective tool in the diagnosis and characterization of breast lesions and supports the current body of literature that states that integrating DBT to FFDM allows good characterization of breast lesions and accurate diagnosis of cancer.
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Affiliation(s)
- Vithya Visalatchi Sanmugasiva
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Marlina Tanty Ramli Hamid
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Department of Radiology, Faculty of Medicine, University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Farhana Fadzli
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Faizatul Izza Rozalli
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, 47500, Subang Jaya, Selangor, Malaysia
| | - Nazimah Ab Mumin
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Department of Radiology, Faculty of Medicine, University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Kartini Rahmat
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Barca P, Lamastra R, Tucciariello RM, Traino A, Marini C, Aringhieri G, Caramella D, Fantacci ME. Technical evaluation of image quality in synthetic mammograms obtained from 15° and 40° digital breast tomosynthesis in a commercial system: a quantitative comparison. Phys Eng Sci Med 2020; 44:23-35. [PMID: 33226534 DOI: 10.1007/s13246-020-00948-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022]
Abstract
Digital breast tomosynthesis (DBT) has recently gained interest both for breast cancer screening and diagnosis. Its employment has increased also in conjunction with digital mammography (DM), to improve cancer detection and reduce false positive recall rate. Synthetic mammograms (SMs) reconstructed from DBT data have been introduced to replace DM in the DBT + DM approach, for preserving the benefits of the dual-acquisition modality whilst reducing radiation dose and compression time. Therefore, different DBT models have been commercialized and the effective potential of each system has been investigated. In particular, wide-angle DBT was shown to provide better depth resolution than narrow-angle DBT, while narrow-angle DBT allows better identification of microcalcifications compared to wide-angle DBT. Given the increasing employment of SMs as supplement to DBT, a comparison of image quality between SMs obtained in narrow-angle and wide-angle DBT is of practical interest. Therefore, the aim of this phantom study was to evaluate and compare the image quality of SMs reconstructed from 15° (SM15) and 40° (SM40) DBT in a commercial system. Spatial resolution, noise and contrast properties were evaluated through the modulation transfer function (MTF), noise power spectrum, maps of signal-to-noise ratio (SNR), image contrast, contrast-to-noise ratio (CNR) and contrast-detail (CD) thresholds. SM40 expressed higher MTF than SM15, but also lower SNR and CNR levels. SM15 and SM40 were characterized by slight different texture, and a different behavior in terms of contrast was found. SM15 provided better CD performances than SM40. These results suggest that the employment of wide/narrow-angle DBT + SM images should be optimized based on the specific image task.
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Affiliation(s)
- Patrizio Barca
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy.
| | - Rocco Lamastra
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy
- INFN, Pisa Section, Pisa, Italy
| | - Raffaele Maria Tucciariello
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy
- INFN, Pisa Section, Pisa, Italy
| | - Antonio Traino
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Carolina Marini
- S.D. Radiologia Senologica, "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Giacomo Aringhieri
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Maria Evelina Fantacci
- Department of Physics, University of Pisa, Largo Bruno Pontecorvo 3, 56127, Pisa, Italy
- INFN, Pisa Section, Pisa, Italy
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