Dual-energy imaging in full-field digital mammography: a phantom study

Dual Energy X-ray Methods for the Characterization, Quantification and Imaging of Calcification Minerals and Masses in Breast

Dual energy (DE) technique has been used by numerous studies in order to detect breast cancer in early stages. Although mammography is the gold standard, the dual energy technique offers the advantage of the suppression of the contrast between adipose and glandular tissues and reveals pathogenesis that is not present in conventional mammography. Both dual energy subtraction and dual energy contrast enhanced techniques were used in order to study the potential of dual energy technique to assist in detection or/and visualization of calcification minerals, masses and lesions obscured by overlapping tissue. This article reviews recent developments in this field, regarding: i) simulation studies carried out for the optimizations of the dual energy technique used in order to characterize and quantify calcification minerals or/and visualize suspected findings, and ii) the subsequent experimental verifications, and finally, the adaptation of the dual energy technique in clinical practice.

Development of breast lesions models database

PURPOSE

We present the development and the current state of the MaXIMA Breast Lesions Models Database, which is intended to provide researchers with both segmented and mathematical computer-based breast lesion models with realistic shape.

METHODS

The database contains various 3D images of breast lesions of irregular shapes, collected from routine patient examinations or dedicated scientific experiments. It also contains images of simulated tumour models. In order to extract the 3D shapes of the breast cancers from patient images, an in-house segmentation algorithm was developed for the analysis of 50 tomosynthesis sets from patients diagnosed with malignant and benign lesions. In addition, computed tomography (CT) scans of three breast mastectomy cases were added, as well as five whole-body CT scans. The segmentation algorithm includes a series of image processing operations and region-growing techniques with minimal interaction from the user, with the purpose of finding and segmenting the areas of the lesion. Mathematically modelled computational breast lesions, also stored in the database, are based on the 3D random walk approach.

RESULTS

The MaXIMA Imaging Database currently contains 50 breast cancer models obtained by segmentation of 3D patient breast tomosynthesis images; 8 models obtained by segmentation of whole body and breast cadavers CT images; and 80 models based on a mathematical algorithm. Each record in the database is supported with relevant information. Two applications of the database are highlighted: inserting the lesions into computationally generated breast phantoms and an approach in generating mammography images with variously shaped breast lesion models from the database for evaluation purposes. Both cases demonstrate the implementation of multiple scenarios and of an unlimited number of cases, which can be used for further software modelling and investigation of breast imaging techniques. The created database interface is web-based, user friendly and is intended to be made freely accessible through internet after the completion of the MaXIMA project.

CONCLUSIONS

The developed database will serve as an imaging data source for researchers, working on breast diagnostic imaging and on improving early breast cancer detection techniques, using existing or newly developed imaging modalities.

Multispectral X-ray imaging to distinguish among dental materials

Purpose

Dual-energy X-ray imaging is widely used today in various areas of medicine and in other applications. However, no similar technique exists for dental applications. In this study, we propose a dual-energy technique for dental diagnoses based on voltage-switching.

Materials and Methods

The method presented in this study allowed different groups of materials to be classified based on atomic number, thereby enabling two-dimensional images to be colorized. Computer simulations showed the feasibility of this approach. Using a number of different samples with typical biologic and synthetic dental materials, the technique was applied to radiographs acquired with a commercially available dental X-ray unit.

Results

This technique provided a novel visual representation of the intraoral environment in three colors, and is of diagnostic value when compared to state-of-the-art grayscale images, since the oral cavity often contains multiple permanent foreign materials.

Conclusion

This work developed a technique for two-dimensional dual-energy imaging in the context of dental applications and showed its feasibility with a commercial dental X-ray unit in simulation and experimental studies.

Measurement of breast-tissue x-ray attenuation by spectral mammography: solid lesions

Knowledge of x-ray attenuation is essential for developing and evaluating x-ray imaging technologies. For instance, techniques to distinguish between cysts and solid tumours at mammography screening would be highly desirable to reduce recalls, but the development requires knowledge of the x-ray attenuation for cysts and tumours. We have previously measured the attenuation of cyst fluid using photon-counting spectral mammography. Data on x-ray attenuation for solid breast lesions are available in the literature, but cover a relatively wide range, likely caused by natural spread between samples, random measurement errors, and different experimental conditions. In this study, we have adapted a previously developed spectral method to measure the linear attenuation of solid breast lesions. A total of 56 malignant and 5 benign lesions were included in the study. The samples were placed in a holder that allowed for thickness measurement. Spectral (energy-resolved) images of the samples were acquired and the image signal was mapped to equivalent thicknesses of two known reference materials, which can be used to derive the x-ray attenuation as a function of energy. The spread in equivalent material thicknesses was relatively large between samples, which is likely to be caused mainly by natural variation and only to a minor extent by random measurement errors and sample inhomogeneity. No significant difference in attenuation was found between benign and malignant solid lesions. The separation between cyst-fluid and tumour attenuation was, however, significant, which suggests it may be possible to distinguish cystic from solid breast lesions, and the results lay the groundwork for a clinical trial. In addition, the study adds a relatively large sample set to the published data and may contribute to a reduction in the overall uncertainty in the literature.

Tissue Cancellation in Dual Energy Mammography Using a Calibration Phantom Customized for Direct Mapping

An easily implementable tissue cancellation method for dual energy mammography is proposed to reduce anatomical noise and enhance lesion visibility. For dual energy calibration, the images of an imaging object are directly mapped onto the images of a customized calibration phantom. Each pixel pair of the low and high energy images of the imaging object was compared to pixel pairs of the low and high energy images of the calibration phantom. The correspondence was measured by absolute difference between the pixel values of imaged object and those of the calibration phantom. Then the closest pixel pair of the calibration phantom images is marked and selected. After the calibration using direct mapping, the regions with lesion yielded different thickness from the background tissues. Taking advantage of the different thickness, the visibility of cancerous lesions was enhanced with increased contrast-to-noise ratio, depending on the size of lesion and breast thickness. However, some tissues near the edge of imaged object still remained after tissue cancellation. These remaining residuals seem to occur due to the heel effect, scattering, nonparallel X-ray beam geometry and Poisson distribution of photons. To improve its performance further, scattering and the heel effect should be compensated.

Measurement of breast-tissue x-ray attenuation by spectral mammography: first results on cyst fluid

Knowledge of x-ray attenuation is essential for developing and evaluating x-ray imaging technologies. For instance, techniques to better characterize cysts at mammography screening would be highly desirable to reduce recalls, but the development is hampered by the lack of attenuation data for cysts. We have developed a method to measure x-ray attenuation of tissue samples using a prototype photon-counting spectral mammography unit. The method was applied to measure the attenuation of 50 samples of breast cyst fluid and 50 samples of water. Spectral (energy-resolved) images of the samples were acquired and the image signal was mapped to equivalent thicknesses of two known reference materials, which can be used to derive the x-ray attenuation as a function of energy. The attenuation of cyst fluid was found to be significantly different from water. There was a relatively large natural spread between different samples of cyst fluid, whereas the homogeneity of each individual sample was found to be good; the variation within samples did not reach above the quantum noise floor. The spectral method proved stable between several measurements on the same sample. Further, chemical analysis and elemental attenuation calculation were used to validate the spectral measurement on a subset of the samples. The two methods agreed within the precision of the elemental attenuation calculation over the mammographic energy range.

A unified statistical framework for material decomposition using multienergy photon counting x-ray detectors

PURPOSE

Material decomposition using multienergy photon counting x-ray detectors (PCXD) has been an active research area over the past few years. Even with some success, the problem of optimal energy selection and three material decomposition including malignant tissue is still on going research topic, and more systematic studies are required. This paper aims to address this in a unified statistical framework in a mammographic environment.

METHODS

A unified statistical framework for energy level optimization and decomposition of three materials is proposed. In particular, an energy level optimization algorithm is derived using the theory of the minimum variance unbiased estimator, and an iterative algorithm is proposed for material composition as well as system parameter estimation under the unified statistical estimation framework. To verify the performance of the proposed algorithm, the authors performed simulation studies as well as real experiments using physical breast phantom and ex vivo breast specimen. Quantitative comparisons using various performance measures were conducted, and qualitative performance evaluations for ex vivo breast specimen were also performed by comparing the ground-truth malignant tissue areas identified by radiologists.

RESULTS

Both simulation and real experiments confirmed that the optimized energy bins by the proposed method allow better material decomposition quality. Moreover, for the specimen thickness estimation errors up to 2 mm, the proposed method provides good reconstruction results in both simulation and real ex vivo breast phantom experiments compared to existing methods.

CONCLUSIONS

The proposed statistical framework of PCXD has been successfully applied for the energy optimization and decomposition of three material in a mammographic environment. Experimental results using the physical breast phantom and ex vivo specimen support the practicality of the proposed algorithm.

X-ray properties of an anthropomorphic breast phantom for MRI and x-ray imaging

The purpose of this study is to characterize the x-ray properties of a dual-modality, anthropomorphic breast phantom whose MRI properties have been previously evaluated. The goal of this phantom is to provide a platform for optimization and standardization of two- and three-dimensional x-ray and MRI breast imaging modalities for the purpose of lesion detection and discrimination. The phantom is constructed using a mixture of lard and egg whites, resulting in a variable, tissue-mimicking structure with separate adipose- and glandular-mimicking components. The phantom can be produced with either a compressed or uncompressed shape. Mass attenuation coefficients of the phantom materials were estimated using elemental compositions from the USDA National Nutrient Database for Standard Reference and the atomic interaction models from the Monte Carlo code PENELOPE and compared with human values from the literature. The image structure was examined quantitatively by calculating and comparing spatial covariance matrices of the phantom and patient mammography images. Finally, a computerized version of the phantom was created by segmenting a computed tomography scan and used to simulate x-ray scatter of the phantom in a mammography geometry. Mass attenuation coefficients of the phantom materials were within 20% and 15% of the values for adipose and glandular tissues, respectively, which is within the estimation error of these values. Matching was improved at higher energies (>20 keV). Tissue structures in the phantom have a size similar to those in the patient data, but are slightly larger on average. Correlations in the patient data appear to be longer than those in the phantom data in the anterior-posterior direction; however, they are within the error bars of the measurement. Simulated scatter-to-primary ratio values of the phantom images were as high as 85% in some areas and were strongly affected by the heterogeneous nature of the phantom. Key physical x-ray properties of the phantom have been quantitatively evaluated and shown to be comparable to those of breast tissue. Since the MRI properties of the phantom have been previously evaluated, we believe it is a useful tool for quantitative evaluation of two- and three-dimensional x-ray and MRI breast imaging modalities for the purpose of lesion detection and characterization.

Full-spectrum CT reconstruction using a weighted least squares algorithm with an energy-axis penalty

Recent developments in X-ray detectors have created the potential to perform energy-sensitive X-ray computed tomography (CT); that is, to reconstruct a series of CT images associated with different X-ray energies from a single scan. In this paper we propose a penalized weighted least squares (PWLS) algorithm for reconstruction of polychromatic energy-differentiated X-ray CT data and a unique experimental setup to take energy-differentiated X-ray CT data. The experimental setup is designed to acquire a complete X-ray spectrum for every projection ray. We use these data to estimate the linear attenuation coefficient as a function of energy for every pixel in the reconstructed attenuation map. We use prior knowledge of the properties of attenuation spectra to smooth the reconstructions, significantly reducing the noise and improving the contrast-to-noise ratio (CNR) in the reconstructed images without significantly biasing the data. We conclude that this algorithm is an effective method for reconstructing energy-sensitive CT data and provides justification for further research in energy sensitive CT systems.

Quantification of breast density with dual energy mammography: an experimental feasibility study

PURPOSE

Breast density, the percentage of glandular breast tissue, has been shown to be a strong indicator of breast cancer risk. A quantitative method to measure breast density with dual energy mammography was investigated using physical phantoms.

METHODS

The dual energy mammography system used a tungsten anode x-ray tube with a 50 microm rhodium beam filter for low energy images and a 300 microm copper beam filter for high energy images. Glandular and adipose equivalent phantoms of uniform thickness were used to calibrate a dual energy basis decomposition algorithm. Four different phantom studies were used to evaluate the technique. The first study consisted of phantoms with thicknesses of 2.5-8.5 cm in 0.5 cm steps with variable densities centered at a mean of 28%. The second study consisted of phantoms at a fixed thickness of 4.0 cm, which ranged in densities from 0% to 100% in increments of 12.5%. The third study consisted of 4.0 cm thick phantoms at densities of 25%, 50% and 75% each imaged at three areal sizes, approximately 62.5, 125, and 250 cm2, in order to assess the effect of breast size on density measurement. The fourth study consisted of step phantoms designed to more closely mimic the shape of a female breast with maximal thicknesses from 3.0 to 7.0 cm at a fixed density of 50%. All images were corrected for x-ray scatter.

RESULTS

The RMS errors in breast density measurements were 0.44% for the variable thickness phantoms, 0.64% for the variable density phantoms, 2.87% for the phantoms of different areal sizes, and 4.63% for step phantoms designed to closely resemble the shape of a breast.

CONCLUSIONS

The results of the phantom studies indicate that dual energy mammography can be used to measure breast density with an RMS error of approximately 5%.

Compositional breast imaging using a dual-energy mammography protocol

PURPOSE

Mammography has a low sensitivity in dense breasts due to low contrast between malignant and normal tissue confounded by the predominant water density of the breast. Water is found in both adipose and fibroglandular tissue and constitutes most of the mass of a breast. However, significant protein mass is mainly found in the fibroglandular tissue where most cancers originate. If the protein compartment in a mammogram could be imaged without the influence of water, the sensitivity and specificity of the mammogram may be improved. This article describes a novel approach to dual-energy mammography, full-field digital compositional mammography (FFDCM), which can independently image the three compositional components of breast tissue: water, lipid, and protein.

METHODS

Dual-energy attenuation and breast shape measures are used together to solve for the three compositional thicknesses. Dual-energy measurements were performed on breast-mimicking phantoms using a full-field digital mammography unit. The phantoms were made of materials shown to have similar x-ray attenuation properties of the compositional compartments. They were made of two main stacks of thicknesses around 2 and 4 cm. Twenty-six thickness and composition combinations were used to derive the compositional calibration using a least-squares fitting approach.

RESULTS

Very high accuracy was achieved with a simple cubic fitting function with root mean square errors of 0.023, 0.011, and 0.012 cm for the water, lipid, and protein thicknesses, respectively. The repeatability (percent coefficient of variation) of these measures was tested using sequential images and was found to be 0.5%, 0.5%, and 3.3% for water, lipid, and protein, respectively. However, swapping the location of the two stacks of the phantom on the imaging plate introduced further errors showing the need for more complete system uniformity corrections. Finally, a preliminary breast image is presented of each of the compositional compartments separately.

CONCLUSIONS

FFDCM has been derived and exhibited good compositional thickness accuracy on phantoms. Preliminary breast images demonstrated the feasibility of creating individual compositional diagnostic images in a clinical environment.

Quantification of breast density with dual energy mammography: a simulation study

Breast density, the percentage of glandular breast tissue, has been identified as an important yet underutilized risk factor in the development of breast cancer. A quantitative method to measure breast density with dual energy imaging was investigated using a computer simulation model. Two configurations to measure breast density were evaluated: the usage of monoenergetic beams and an ideal detector, and the usage of polyenergetic beams with spectra from a tungsten anode x-ray tube with a detector modeled after a digital mammography system. The simulation model calculated the mean glandular dose necessary to quantify the variability of breast density to within 1/3%. The breast was modeled as a semicircle 10 cm in radius with equal homogenous thicknesses of adipose and glandular tissues. Breast thicknesses were considered in the range of 2-10 cm and energies in the range of 10-150 keV for the two monoenergetic beams, and 20-150 kVp for spectra with a tungsten anode x-ray tube. For a 4.2 cm breast thickness, the required mean glandular doses were 0.183 microGy for two monoenergetic beams at 19 and 71 keV, and 9.85 microGy for two polyenergetic spectra from a tungsten anode at 32 and 96 kVp with beam filtrations of 50 microm Rh and 300 microm Cu for the low and high energy beams, respectively. The results suggest that for either configuration, breast density can be precisely measured with dual energy imaging requiring only a small amount of additional dose to the breast. The possibility of using a standard screening mammogram as the low energy image is also discussed.

The impact of calibration phantom errors on dual-energy digital mammography

Microcalcification is one of the earliest and main indicators of breast cancer. Because dual-energy digital mammography could suppress the contrast between the adipose and glandular tissues of the breast, it is considered a promising technique that will improve the detection of microcalcification. In dual-energy digital mammography, the imaged object is a human breast, while in calibration measurements only the phantoms of breast tissue equivalent materials are available. Consequently, the differences between phantoms and breast tissues will lead to calibration phantom errors. Based on the dual-energy imaging model, formulae of calibration phantom errors are derived in this paper. Then, this type of error is quantitatively analyzed using publicly available data and compared with other types of error. The results demonstrate that the calibration phantom error is large and dominant in dual-energy mammography, seriously decreasing calculation precision. Further investigations on the physical meaning of calibration phantom error reveal that the imaged objects with the same glandular ratio have identical calibration phantom error. Finally, an error correction method is proposed based on our findings.

Generalized subtraction methods in digital mammography

Digital mammography can greatly facilitate new applications, with the potential of further improving early diagnosis of breast cancer. Indeed, early manifestations of breast cancer are often very subtle and are displayed on the variable pattern of normal anatomy that may either obscure or simulate disease. This is particularly important in dense breasts, because of the complexity of overlying fibroglandular structures. The requirement of improved lesion conspicuity has brought to the application of a number of subtraction methods such as the tomographic technique to exploit depth-dependent information or the digital angiography where subtraction in the temporal domain is applied in conjuction with administration of contrast medium. Since there are various parameters that might be used for subtraction, such techniques have to be intended in generalized form. Generalized subtraction methods in mammography are here presented and compared.

Dual-energy mammography: simulation studies

This paper presents a mammography simulator and demonstrates its applicability in feasibility studies in dual-energy (DE) subtraction mammography. This mammography simulator is an evolution of a previously presented x-ray imaging simulation system, which has been extended with new functionalities that are specific for DE simulations. The new features include incident exposure and dose calculations, the implementation of a DE subtraction algorithm as well as amendments to the detector and source modelling. The system was then verified by simulating experiments and comparing their results against published data. The simulator was used to carry out a feasibility study of the applicability of DE techniques in mammography, and more precisely to examine whether this modality could result in better visualization and detection of microcalcifications. Investigations were carried out using a 3D breast software phantom of average thickness, monoenergetic and polyenergetic beam spectra and various detector configurations. Dual-shot techniques were simulated. Results showed the advantage of using monoenergetic in comparison with polyenergetic beams. Optimization studies with monochromatic sources were carried out to obtain the optimal low and high incident energies, based on the assessment of the figure of merit of the simulated microcalcifications in the subtracted images. The results of the simulation study with the optimal energies demonstrated that the use of the DE technique can improve visualization and increase detectability, allowing identification of microcalcifications of sizes as small as 200 microm. The quantitative results are also verified by means of a visual inspection of the synthetic images.

Evaluation of the minimum iodine concentration for contrast-enhanced subtraction mammography

Early manifestation of breast cancer is often very subtle and is displayed in a complex and variable pattern of normal anatomy that may obscure the disease. The use of dual-energy techniques, that can remove the structural noise, and contrast media, that enhance the region surrounding the tumour, could help us to improve the detectability of the lesions. The aim of this work is to investigate the use of an iodine-based contrast medium in mammography with two different double exposure techniques: K-edge subtraction mammography and temporal subtraction mammography. Both techniques have been investigated by using an ideal source, like monochromatic beams produced at a synchrotron radiation facility and a clinical digital mammography system. A dedicated three-component phantom containing cavities filled with different iodine concentrations has been developed and used for measurements. For each technique, information about the minimum iodine concentration, which provides a significant enhancement of the detectability of the pathology by minimizing the risk due to high dose and high concentration of contrast medium, has been obtained. In particular, for cavities of 5 and 8 mm in diameter filled with iodine solutions, the minimum concentration needed to obtain a contrast-to-noise ratio of 5 with a mean glandular dose of 2 mGy has been calculated. The minimum concentrations estimated with monochromatic beams and K-edge subtraction mammography are 0.9 mg ml(-1) and 1.34 mg ml(-1) for the biggest and smallest details, respectively, while for temporal subtraction mammography they are 0.84 mg ml(-1) and 1.31 mg ml(-1). With the conventional clinical system the minimum concentrations for the K-edge subtraction mammography are 4.13 mg ml(-1) (8 mm diameter) and 5.75 mg ml(-1) (5 mm diameter), while for the temporal subtraction mammography they are 1.01 mg ml(-1) (8 mm diameter) and 1.57 mg ml(-1) (5 mm diameter).

Evaluation of dual-energy subtraction of digital mammography images under conditions found in a commercial unit

Radiological contrast-to-noise ratio (CNR) is evaluated in subtracted images of microcalcifications in breast tissue. CNR is calculated for dual-kVp subtraction combining beams available in a Senographe 2000D, assuming single breast compression. Spectra were obtained from Boone et al (1997 Med. Phys. 24 1863-73), and the study was limited to lowest 25 kV Mo/Mo and highest 40 kV Rh/Rh beams, for 2.58 x 10(-4) C kg(-1) (1R) total exposure. For a standard case combining 25 kVp Mo/Mo and 40 kVp Rh/Rh beams, predicted maximum CNR for 300 microm calcification in 5 cm thick, 50% glandular, breast is about 1.2, below Rose's criterion for visualization. Total mean glandular doses are about 2.5 cGy for a standard case. The effect that input factors might have on predictions has been evaluated. Choice between alternative spectra can affect CNR by 50%. Assumed calcification composition leads to differences of 67% in calculated CNR, and assumed breast tissue composition can alter CNR by 45%; these results are weakly dependent on calcification or breast thickness, or on the assumed fraction of glandular tissue. CNR values are related to detected spectra effective energy. Calculations predict that above 37 kVp Mo/Mo beams are more energetic than Rh/Rh at the same kVp, due to beam hardening.

Dual-energy digital mammography for calcification imaging: scatter and nonuniformity corrections

Mammographic images of small calcifications, which are often the earliest signs of breast cancer, can be obscured by overlapping fibroglandular tissue. We have developed and implemented a dual-energy digital mammography (DEDM) technique for calcification imaging under full-field imaging conditions using a commercially available aSi:H/CsI:Tl flat-panel based digital mammography system. The low- and high-energy images were combined using a nonlinear mapping function to cancel the tissue structures and generate the dual-energy (DE) calcification images. The total entrance-skin exposure and mean-glandular dose from the low- and high-energy images were constrained so that they were similar to screening-examination levels. To evaluate the DE calcification image, we designed a phantom using calcium carbonate crystals to simulate calcifications of various sizes (212-425 microm) overlaid with breast-tissue-equivalent material 5 cm thick with a continuously varying glandular-tissue ratio from 0% to 100%. We report on the effects of scatter radiation and nonuniformity in x-ray intensity and detector response on the DE calcification images. The nonuniformity was corrected by normalizing the low- and high-energy images with full-field reference images. Correction of scatter in the low- and high-energy images significantly reduced the background signal in the DE calcification image. Under the current implementation of DEDM, utilizing the mammography system and dose level tested, calcifications in the 300-355 microm size range were clearly visible in DE calcification images. Calcification threshold sizes decreased to the 250-280 microm size range when the visibility criteria were lowered to barely visible. Calcifications smaller than approximately 250 microm were usually not visible in most cases. The visibility of calcifications with our DEDM imaging technique was limited by quantum noise, not system noise.

A prototype of a quasi-monochromatic system for mammography applications

Improvement in image contrast and dose reduction, in mammographic x-ray imaging, can be achieved using narrow energy band x-ray beams in the 16-24 keV range. As part of an Italian Government funded project, a quasi-monochromatic system for mammography applications has been developed. The system is based on a tunable narrow energy band x-ray source operating in the 16-24 keV energy range. The bremsstrahlung beam is monochromatized via Bragg diffraction by a highly oriented pyrolytic graphite mosaic crystal (HOPG). The scanning system provides a large field (18 x 24 cm2) of quasi-monochromatic x-rays with energy resolution ranging from 10% at 18 keV to 17.2% at 24 keV. The system has been characterized in terms of fluence rate and energy resolution. An x-ray tube developed ad hoc allows us to acquire images in a reasonable time to minimize the motion blur. A qualitative analysis has been performed in order to know if the prototype system performances are far from a clinical application, by evaluating the spatial resolution, the field uniformity and the image quality as a function of the quasi-monochromatic beam energy. Dose evaluation has been performed as a function of the energy and compared to a conventional system for mammography. The quasi-monochromatic prototype system can produce comparable image quality at half the dose.