Multiscale bilateral filtering for improving image quality in digital breast tomosynthesis

Precision Medicine Assessment of the Radiographic Defect Angle of the Intrabony Defect in Periodontal Lesions by Deep Learning of Bitewing Radiographs

In dental diagnosis, evaluating the severity of periodontal disease by analyzing the radiographic defect angle of the intrabony defect is essential for effective treatment planning. However, dentists often rely on clinical examinations and manual analysis, which can be time-consuming and labor-intensive. Due to the high recurrence rate of periodontal disease after treatment, accurately evaluating the radiographic defect angle of the intrabony defect is vital for implementing targeted interventions, which can improve treatment outcomes and reduce recurrence. This study aims to streamline clinical practices and enhance patient care in managing periodontal disease by determining its severity based on the analysis of the radiographic defect angle of the intrabony defect. In this approach, radiographic defect angles of the intrabony defect greater than 37 degrees are classified as severe, while those less than 37 degrees are considered mild. This study employed a series of novel image enhancement techniques to significantly improve diagnostic accuracy. Before enhancement, the maximum accuracy was 78.85%, which increased to 95.12% following enhancement. YOLOv8 detects the affected tooth, and its mAP can reach 95.5%, with a precision reach of 94.32%. This approach assists dentists in swiftly assessing the extent of periodontal erosion, enabling timely and appropriate treatment. These techniques reduce diagnostic time and improve healthcare quality.

Evolution of tomosynthesis

Purpose

Tomosynthesis is a limited-angle multi-projection method that was conceived to address a significant limitation of conventional single-projection x-ray imaging: the overlap of structures in an image. We trace the historical evolution of tomosynthesis.

Approach

Relevant papers are discussed including descriptions of technical advances and clinical applications.

Results

We start with the invention of tomosynthesis by Ziedses des Plantes in the Netherlands and Kaufman in the United States in the mid-1930s and end with our predictions of future technical advances. Some of the other topics that are covered include a respiratory-gated chest tomosynthesis system of the late 1930s, film-based systems of the 1960s and 1970s, coded aperture tomosynthesis, fluoroscopy tomosynthesis, digital detector-based tomosynthesis for imaging the breast and body, orthopedic, dental and radiotherapy applications, optimization of acquisition parameters for breast and body tomosynthesis, reconstruction methods, characteristics of present-day tomosynthesis systems, x-ray tubes, and promising new applications including contrast-enhanced and multimodal breast imaging systems.

Conclusion

Tomosynthesis has had an exciting history that continues today. This should serve as a foundation for other papers in the special issue "Celebrating Digital Tomosynthesis: Past, Present and Future" in the Journal of Medical Imaging.

Pre-Reconstruction Processing with the Cycle-Consist Generative Adversarial Network Combined with Attention Gate to Improve Image Quality in Digital Breast Tomosynthesis

The current study proposed and evaluated "residual squeeze and excitation attention gate" (rSEAG), a novel network that can improve image quality by reducing distortion attributed to artifacts. This method was established by modifying the Cycle Generative Adversarial Network (cycleGAN)-based generator network using projection data for pre-reconstruction processing in digital breast tomosynthesis. Residual squeeze and excitation were installed in the bridge of the generator network, and the attention gate was installed in the skip connection between the encoder and decoder. Based on the radiation dose index (exposure index and division index) incident on the detector, the cases approved by the ethics committee and used for the study were classified as reference (675 projection images) and object (675 projection images). For the cases, unsupervised data containing a mixture of cases with and without masses were used. The cases were trained using cycleGAN with rSEAG and the conventional networks (ResUNet and U-Net). For testing, predictive processing was performed on cases (60 projection images) that were not used for learning. Images were generated using filtered backprojection reconstruction (kernel: Ramachandran and Lakshminarayanan) from projection data for testing data and without pre-reconstruction processing data (evaluation: in-focus plane). The distortion was evaluated using perception-based image quality evaluation (PIQE) analysis, texture analysis (feature: "Homogeneity" and "Contrast"), and a statistical model with a Gumbel distribution. PIQE has a low rSEAG value. Texture analysis showed that rSEAG and a network without cycleGAN were similar in terms of the "Contrast" feature. In dense breasts, ResUNet had the lowest "Contrast" feature and U-Net had differences between cases. The maximal variations in the Gumbel plot, rSEAG reduced the high-frequency ripple artifacts. In this study, rSEAG could improve distortion and reduce ripple artifacts.

Model-based deep CNN-regularized reconstruction for digital breast tomosynthesis with a task-based CNN image assessment approach

Objective. Digital breast tomosynthesis (DBT) is a quasi-three-dimensional breast imaging modality that improves breast cancer screening and diagnosis because it reduces fibroglandular tissue overlap compared with 2D mammography. However, DBT suffers from noise and blur problems that can lower the detectability of subtle signs of cancers such as microcalcifications (MCs). Our goal is to improve the image quality of DBT in terms of image noise and MC conspicuity.Approach. We proposed a model-based deep convolutional neural network (deep CNN or DCNN) regularized reconstruction (MDR) for DBT. It combined a model-based iterative reconstruction (MBIR) method that models the detector blur and correlated noise of the DBT system and the learning-based DCNN denoiser using the regularization-by-denoising framework. To facilitate the task-based image quality assessment, we also proposed two DCNN tools for image evaluation: a noise estimator (CNN-NE) trained to estimate the root-mean-square (RMS) noise of the images, and an MC classifier (CNN-MC) as a DCNN model observer to evaluate the detectability of clustered MCs in human subject DBTs.Main results. We demonstrated the efficacies of CNN-NE and CNN-MC on a set of physical phantom DBTs. The MDR method achieved low RMS noise and the highest detection area under the receiver operating characteristic curve (AUC) rankings evaluated by CNN-NE and CNN-MC among the reconstruction methods studied on an independent test set of human subject DBTs.Significance. The CNN-NE and CNN-MC may serve as a cost-effective surrogate for human observers to provide task-specific metrics for image quality comparisons. The proposed reconstruction method shows the promise of combining physics-based MBIR and learning-based DCNNs for DBT image reconstruction, which may potentially lead to lower dose and higher sensitivity and specificity for MC detection in breast cancer screening and diagnosis.

Deep learning denoising of digital breast tomosynthesis: Observer performance study of the effect on detection of microcalcifications in breast phantom images

BACKGROUND

The noise in digital breast tomosynthesis (DBT) includes x-ray quantum noise and detector readout noise. The total radiation dose of a DBT scan is kept at about the level of a digital mammogram but the detector noise is increased due to acquisition of multiple projections. The high noise can degrade the detectability of subtle lesions, specifically microcalcifications (MCs).

PURPOSE

We previously developed a deep-learning-based denoiser to improve the image quality of DBT. In the current study, we conducted an observer performance study with breast radiologists to investigate the feasibility of using deep-learning-based denoising to improve the detection of MCs in DBT.

METHODS

We have a modular breast phantom set containing seven 1-cm-thick heterogeneous 50% adipose/50% fibroglandular slabs custom-made by CIRS, Inc. (Norfolk, VA). We made six 5-cm-thick breast phantoms embedded with 144 simulated MC clusters of four nominal speck sizes (0.125-0.150, 0.150-0.180, 0.180-0.212, 0.212-0.250 mm) at random locations. The phantoms were imaged with a GE Pristina DBT system using the automatic standard (STD) mode. The phantoms were also imaged with the STD+ mode that increased the average glandular dose by 54% to be used as a reference condition for comparison of radiologists' reading. Our previously trained and validated denoiser was deployed to the STD images to obtain a denoised DBT set (dnSTD). Seven breast radiologists participated as readers to detect the MCs in the DBT volumes of the six phantoms under the three conditions (STD, STD+, dnSTD), totaling 18 DBT volumes. Each radiologist read all the 18 DBT volumes sequentially, which were arranged in a different order for each reader in a counter-balanced manner to minimize any potential reading order effects. They marked the location of each detected MC cluster and provided a conspicuity rating and their confidence level for the perceived cluster. The visual grading characteristics (VGC) analysis was used to compare the conspicuity ratings and the confidence levels of the radiologists for the detection of MCs.

RESULTS

The average sensitivities over all MC speck sizes were 65.3%, 73.2%, and 72.3%, respectively, for the radiologists reading the STD, dnSTD, and STD+ volumes. The sensitivity for dnSTD was significantly higher than that for STD (p < 0.005, two-tailed Wilcoxon signed rank test) and comparable to that for STD+. The average false positive rates were 3.9 ± 4.6, 2.8 ± 3.7, and 2.7 ± 3.9 marks per DBT volume, respectively, for reading the STD, dnSTD, and STD+ images but the difference between dnSTD and STD or STD+ did not reach statistical significance. The overall conspicuity ratings and confidence levels by VGC analysis for dnSTD were significantly higher than those for both STD and STD+ (p ≤ 0.001). The critical alpha value for significance was adjusted to be 0.025 with Bonferroni correction.

CONCLUSIONS

This observer study using breast phantom images showed that deep-learning-based denoising has the potential to improve the detection of MCs in noisy DBT images and increase radiologists' confidence in differentiating noise from MCs without increasing radiation dose. Further studies are needed to evaluate the generalizability of these results to the wide range of DBTs from human subjects and patient populations in clinical settings.

Evaluation of a Generative Adversarial Network to Improve Image Quality and Reduce Radiation-Dose during Digital Breast Tomosynthesis

In this study, we evaluated the improvement of image quality in digital breast tomosynthesis under low-radiation dose conditions of pre-reconstruction processing using conditional generative adversarial networks [cGAN (pix2pix)]. Pix2pix pre-reconstruction processing with filtered back projection (FBP) was compared with and without multiscale bilateral filtering (MSBF) during pre-reconstruction processing. Noise reduction and preserve contrast rates were compared using full width at half-maximum (FWHM), contrast-to-noise ratio (CNR), peak signal-to-noise ratio (PSNR), and structural similarity (SSIM) in the in-focus plane using a BR3D phantom at various radiation doses [reference-dose (automatic exposure control reference dose: AECrd), 50% and 75% reduction of AECrd] and phantom thicknesses (40 mm, 50 mm, and 60 mm). The overall performance of pix2pix pre-reconstruction processing was effective in terms of FWHM, PSNR, and SSIM. At ~50% radiation-dose reduction, FWHM yielded good results independently of the microcalcification size used in the BR3D phantom, and good noise reduction and preserved contrast. PSNR results showed that pix2pix pre-reconstruction processing represented the minimum in the error with reference FBP images at an approximately 50% reduction in radiation-dose. SSIM analysis indicated that pix2pix pre-reconstruction processing yielded superior similarity when compared with and without MSBF pre-reconstruction processing at ~50% radiation-dose reduction, with features most similar to the reference FBP images. Thus, pix2pix pre-reconstruction processing is promising for reducing noise with preserve contrast and radiation-dose reduction in clinical practice.

Effect of Dose Level on Radiologists' Detection of Microcalcifications in Digital Breast Tomosynthesis: An Observer Study with Breast Phantoms

OBJECTIVES

To compare radiologists' sensitivity, confidence level, and reading efficiency of detecting microcalcifications in digital breast tomosynthesis (DBT) at two clinically relevant dose levels.

MATERIALS AND METHODS

Six 5-cm-thick heterogeneous breast phantoms embedded with a total of 144 simulated microcalcification clusters of four speck sizes were imaged at two dose modes by a clinical DBT system. The DBT volumes at the two dose levels were read independently by six MQSA radiologists and one fellow with 1-33 years (median 12 years) of experience in a fully-crossed counter-balanced manner. The radiologist located each potential cluster and rated its conspicuity and his/her confidence that the marked location contained a cluster. The differences in the results between the two dose modes were analyzed by two-tailed paired t-test.

RESULTS

Compared to the lower-dose mode, the average glandular dose in the higher-dose mode for the 5-cm phantoms increased from 1.34 to 2.07 mGy. The detection sensitivity increased for all speck sizes and significantly for the two smaller sizes (p <0.05). An average of 13.8% fewer false positive clusters was marked. The average conspicuity rating and the radiologists' confidence level were higher for all speck sizes and reached significance (p <0.05) for the three larger sizes. The average reading time per detected cluster reduced significantly (p <0.05) by an average of 13.2%.

CONCLUSION

For a 5-cm-thick breast, an increase in average glandular dose from 1.34 to 2.07 mGy for DBT imaging increased the conspicuity of microcalcifications, improved the detection sensitivity by radiologists, increased their confidence levels, reduced false positive detections, and increased the reading efficiency.

Synthesis of Mammogram From Digital Breast Tomosynthesis Using Deep Convolutional Neural Network With Gradient Guided cGANs

Synthetic digital mammography (SDM), a 2D image generated from digital breast tomosynthesis (DBT), is used as a potential substitute for full-field digital mammography (FFDM) in clinic to reduce the radiation dose for breast cancer screening. Previous studies exploited projection geometry and fused projection data and DBT volume, with different post-processing techniques applied on re-projection data which may generate different image appearance compared to FFDM. To alleviate this issue, one possible solution to generate an SDM image is using a learning-based method to model the transformation from the DBT volume to the FFDM image using current DBT/FFDM combo images. In this study, we proposed to use a deep convolutional neural network (DCNN) to learn the transformation to generate SDM using current DBT/FFDM combo images. Gradient guided conditional generative adversarial networks (GGGAN) objective function was designed to preserve subtle MCs and the perceptual loss was exploited to improve the performance of the proposed DCNN on perceptual quality. We used various image quality criteria for evaluation, including preserving masses and MCs which are important in mammogram. Experiment results demonstrated progressive performance improvement of network using different objective functions in terms of those image quality criteria. The methodology we exploited in the SDM generation task to analyze and progressively improve image quality by designing objective functions may be helpful to other image generation tasks.

Deep Convolutional Neural Network With Adversarial Training for Denoising Digital Breast Tomosynthesis Images

Digital breast tomosynthesis (DBT) is a quasi-three-dimensional imaging modality that can reduce false negatives and false positives in mass lesion detection caused by overlapping breast tissue in conventional two-dimensional (2D) mammography. The patient dose of a DBT scan is similar to that of a single 2D mammogram, while acquisition of each projection view adds detector readout noise. The noise is propagated to the reconstructed DBT volume, possibly obscuring subtle signs of breast cancer such as microcalcifications (MCs). This study developed a deep convolutional neural network (DCNN) framework for denoising DBT images with a focus on improving the conspicuity of MCs as well as preserving the ill-defined margins of spiculated masses and normal tissue textures. We trained the DCNN using a weighted combination of mean squared error (MSE) loss and adversarial loss. We configured a dedicated x-ray imaging simulator in combination with digital breast phantoms to generate realistic in silico DBT data for training. We compared the DCNN training between using digital phantoms and using real physical phantoms. The proposed denoising method improved the contrast-to-noise ratio (CNR) and detectability index (d') of the simulated MCs in the validation phantom DBTs. These performance measures improved with increasing training target dose and training sample size. Promising denoising results were observed on the transferability of the digital-phantom-trained denoiser to DBT reconstructed with different techniques and on a small independent test set of human subject DBT images.

Improved digital chest tomosynthesis image quality by use of a projection-based dual-energy virtual monochromatic convolutional neural network with super resolution

We developed a novel dual-energy (DE) virtual monochromatic (VM) very-deep super-resolution (VDSR) method with an unsharp masking reconstruction algorithm (DE–VM–VDSR) that uses projection data to improve the nodule contrast and reduce ripple artifacts during chest digital tomosynthesis (DT). For estimating the residual errors from high-resolution and multiscale VM images from the projection space, the DE–VM–VDSR algorithm employs a training network (mini-batch stochastic gradient-descent algorithm with momentum) and a hybrid super-resolution (SR) image [simultaneous algebraic reconstruction technique (SART) total-variation (TV) first-iterative shrinkage–thresholding algorithm (FISTA); SART–TV–FISTA] that involves subjective reconstruction with bilateral filtering (BF) [DE–VM–VDSR with BF]. DE-DT imaging was accomplished by pulsed X-ray exposures rapidly switched between low (60 kV, 37 projection) and high (120 kV, 37 projection) tube-potential kVp by employing a 40° swing angle. This was followed by comparison of images obtained employing the conventional polychromatic filtered backprojection (FBP), SART, SART–TV–FISTA, and DE–VM–SART–TV–FISTA algorithms. The improvements in contrast, ripple artifacts, and resolution were compared using the signal-difference-to-noise ratio (SDNR), Gumbel distribution of the largest variations, radial modulation transfer function (radial MTF) for a chest phantom with simulated ground-glass opacity (GGO) nodules, and noise power spectrum (NPS) for uniform water phantom. The novel DE–VM–VDSR with BF improved the overall performance in terms of SDNR (DE–VM–VDSR with BF: 0.1603, without BF: 0.1517; FBP: 0.0521; SART: 0.0645; SART–TV–FISTA: 0.0984; and DE–VM–SART–TV–FISTA: 0.1004), obtained a Gumbel distribution that yielded good images showing the type of simulated GGO nodules used in the chest phantom, and reduced the ripple artifacts. The NPS of DE–VM–VDSR with BF showed the lowest noise characteristics in the high-frequency region (~0.8 cycles/mm). The DE–VM–VDSR without BF yielded an improved resolution relative to that of the conventional reconstruction algorithms for radial MTF analysis (0.2–0.3 cycles/mm). Finally, based on the overall image quality, DE–VM–VDSR with BF improved the contrast and reduced the high-frequency ripple artifacts and noise.

A synthesizing method for signal-enhanced and artifact-reduced mammogram from digital breast tomosynthesis

In this paper, we propose a method for compositing a synthetic mammogram (SM) from digital breast tomosynthesis (DBT) slice images. The method consists of four parts. The first part is image reconstruction of DBT from the acquired projection data by use of backprojection-filtration (BPF) algorithm with a low-frequency boosting scheme and a high-density object reduction technique embedded. Also, a few expectation-maximization (EM) iterations have been additively implemented on top of the BPF algorithm to prepare a separate volume image. The second is generating three kinds of intermediate SMs. A forward projection image and a linear structure weighted forward projection image were computed. A maximum intensity projection of the BPF reconstructed volume image was also generated. The third part is integrating three intermediate SMs. The last is the post-processing of the SM. We scanned two physical phantoms in a prototype DBT scanner, and we have evaluated the performance of the proposed method. We also performed a clinical data study by use of 30 patient data who went through both DBT and digital mammography (DM) scans. Three experienced radiologists have read the SMs generated by several component techniques and also read the DM of each patient, and evaluated the generated SMs. The experimental phantom study and the clinical reader study consistently demonstrated the usefulness of the proposed method.

Exon prediction based on multiscale products of a genomic-inspired multiscale bilateral filtering

Multiscale signal processing techniques such as wavelet filtering have proved to be particularly successful in predicting exon sequences. Traditional wavelet predictor is domain filtering, and enforces exon features by weighting nucleotide values with coefficients. Such a measure performs linear filtering and is not suitable for preserving the short coding exons and the exon-intron boundaries. This paper describes a prediction framework that is capable of non-linearly processing DNA sequences while achieving high prediction rates. There are two key contributions. The first is the introduction of a genomic-inspired multiscale bilateral filtering (MSBF) which exploits both weighting coefficients in the spatial domain and nucleotide similarity in the range. Similarly to wavelet transform, the MSBF is also defined as a weighted sum of nucleotides. The difference is that the MSBF takes into account the variation of nucleotides at a specific codon position. The second contribution is the exploitation of inter-scale correlation in MSBF domain to find the inter-scale dependency on the differences between the exon signal and the background noise. This favourite property is used to sharp the important structures while weakening noise. Three benchmark data sets have been used in the evaluation of considered methods. By comparison with four existing techniques, the prediction results demonstrate that: the proposed method reveals at least improvement of 4.1%, 50.5%, 25.6%, 2.5%, 10.8%, 15.5%, 11.1%, 12.3%, 9.2% and 2.4% on the exons length of 1–24, 25–49, 50–74, 75–99, 100–124, 125–149, 150–174, 175–199, 200–299 and 300–300+, respectively. The MSBF of its nonlinear nature is good at energy compaction, which makes it capable of locating the sharp variations around short exons. The direct scale multiplication of coefficients at several adjacent scales obviously enhanced exon features while the noise contents were suppressed. We show that the non-linear nature and correlation-based property achieved in proposed predictor is greater than that for traditional filtering, which leads to better exon prediction performance. There are some possible applications of this predictor. Its good localization and protection of sharp variations will make the predictor be suitable to perform fault diagnosis of aero-engine.

Synthesizing mammogram from digital breast tomosynthesis

The purpose of this study is to develop a new method for generating synthesized mammogram (SM) from digital breast tomosynthesis (DBT) and to assess its potential as an adjunct to DBT. We first applied multiscale bilateral filtering to the reconstructed DBT slices to enhance the high-frequency features and reduce noise. A maximum intensity projection (MIP) image was then obtained from the high-frequency components of the DBT slices. A multiscale image fusion method was designed to combine the MIP image and the central DBT projection view into an SM and further enhance the high-frequency features. We conducted a pilot reader study to visually assess the image quality of SM in comparison to full field digital mammograms (FFDM). For each DBT craniocaudal or mediolateral view, a clinical FFDM of the corresponding view was retrospectively collected. Three MQSA radiologists, blinded to the pathological and other clinical information, independently interpreted the SM and the corresponding FFDM side by side marked with the lesion locations. The differences in the BI-RADS assessments of both MCs and masses between SM and FFDM did not achieve statistical significance for all three readers. The conspicuity of MCs on SM was superior to that on FFDM and the BI-RADS assessments of MCs were comparable while the conspicuity of masses on SM was degraded and interpretation on SM was less accurate than that on FFDM. The SM may be useful for efficient prescreening of MCs in DBT but the DBT should be used for detection and characterization of masses.

Use of a Total Variation Minimization Iterative Reconstruction Algorithm to Evaluate Reduced Projections during Digital Breast Tomosynthesis

Purpose

We evaluated the efficacies of the adaptive steepest descent projection onto convex sets (ASD-POCS), simultaneous algebraic reconstruction technique (SART), filtered back projection (FBP), and maximum likelihood expectation maximization (MLEM) total variation minimization iterative algorithms for reducing exposure doses during digital breast tomosynthesis for reduced projections.

Methods

Reconstructions were evaluated using normal (15 projections) and half (i.e., thinned-out normal) projections (seven projections). The algorithms were assessed by determining the full width at half-maximum (FWHM), and the BR3D Phantom was used to evaluate the contrast-to-noise ratio (CNR) for the in-focus plane. A mean similarity measure of structural similarity (MSSIM) was also used to identify the preservation of contrast in clinical cases.

Results

Spatial resolution tended to deteriorate in ASD-POCS algorithm reconstructions involving a reduced number of projections. However, the microcalcification size did not affect the rate of FWHM change. The ASD-POCS algorithm yielded a high CNR independently of the simulated mass lesion size and projection number. The ASD-POCS algorithm yielded a high MSSIM in reconstructions from reduced numbers of projections.

Conclusions

The ASD-POCS algorithm can preserve contrast despite a reduced number of projections and could therefore be used to reduce radiation doses.

Detector Blur and Correlated Noise Modeling for Digital Breast Tomosynthesis Reconstruction

This paper describes a new image reconstruction method for digital breast tomosynthesis (DBT). The new method incorporates detector blur into the forward model. The detector blur in DBT causes correlation in the measurement noise. By making a few approximations that are reasonable for breast imaging, we formulated a regularized quadratic optimization problem with a data-fit term that incorporates models for detector blur and correlated noise (DBCN). We derived a computationally efficient separable quadratic surrogate (SQS) algorithm to solve the optimization problem that has a non-diagonal noise covariance matrix. We evaluated the SQS-DBCN method by reconstructing DBT scans of breast phantoms and human subjects. The contrast-to-noise ratio and sharpness of microcalcifications were analyzed and compared with those by the simultaneous algebraic reconstruction technique. The quality of soft tissue lesions and parenchymal patterns was examined. The results demonstrate the potential to improve the image quality of reconstructed DBT images by incorporating the system physics model. This paper is a first step toward model-based iterative reconstruction for DBT.

Improving image quality for digital breast tomosynthesis: an automated detection and diffusion-based method for metal artifact reduction

In digital breast tomosynthesis (DBT), the high-attenuation metallic clips marking a previous biopsy site in the breast cause errors in the estimation of attenuation along the ray paths intersecting the markers during reconstruction, which result in interplane and inplane artifacts obscuring the visibility of subtle lesions. We proposed a new metal artifact reduction (MAR) method to improve image quality. Our method uses automatic detection and segmentation to generate a marker location map for each projection (PV). A voting technique based on the geometric correlation among different PVs is designed to reduce false positives (FPs) and to label the pixels on the PVs and the voxels in the imaged volume that represent the location and shape of the markers. An iterative diffusion method replaces the labeled pixels on the PVs with estimated tissue intensity from the neighboring regions while preserving the original pixel values in the neighboring regions. The inpainted PVs are then used for DBT reconstruction. The markers are repainted on the reconstructed DBT slices for radiologists' information. The MAR method is independent of reconstruction techniques or acquisition geometry. For the training set, the method achieved 100% success rate with one FP in 19 views. For the test set, the success rate by view was 97.2% for core biopsy microclips and 66.7% for clusters of large post-lumpectomy markers with a total of 10 FPs in 58 views. All FPs were large dense benign calcifications that also generated artifacts if they were not corrected by MAR. For the views with successful detection, the metal artifacts were reduced to a level that was not visually apparent in the reconstructed slices. The visibility of breast lesions obscured by the reconstruction artifacts from the metallic markers was restored.

Analysis of computer-aided detection techniques and signal characteristics for clustered microcalcifications on digital mammography and digital breast tomosynthesis

With IRB approval, digital breast tomosynthesis (DBT) images of human subjects were collected using a GE GEN2 DBT prototype system. Corresponding digital mammograms (DMs) of the same subjects were collected retrospectively from patient files. The data set contained a total of 237 views of DBT and equal number of DM views from 120 human subjects, each included 163 views with microcalcification clusters (MCs) and 74 views without MCs. The data set was separated into training and independent test sets. The pre-processing, object prescreening and segmentation, false positive reduction and clustering strategies for MC detection by three computer-aided detection (CADe) systems designed for DM, DBT, and a planar projection image generated from DBT were analyzed. Receiver operating characteristic (ROC) curves based on features extracted from microcalcifications and free-response ROC (FROC) curves based on scores from MCs were used to quantify the performance of the systems. Jackknife FROC (JAFROC) and non-parametric analysis methods were used to determine the statistical difference between the FROC curves. The difference between the CAD_DM and CAD_DBT systems when the false positive rate was estimated from cases without MCs did not reach statistical significance. The study indicates that the large search space in DBT may not be a limiting factor for CADe to achieve similar performance as that observed in DM.

Computer-aided detection system for clustered microcalcifications in digital breast tomosynthesis using joint information from volumetric and planar projection images

We propose a novel approach for the detection of microcalcification clusters (MCs) using joint information from digital breast tomosynthesis (DBT) volume and planar projection (PPJ) image. A data set of 307 DBT views was collected with IRB approval using a prototype DBT system. The system acquires 21 projection views (PVs) from a wide tomographic angle of 60° (60°-21PV) at about twice the dose of a digital mammography (DM) system, which allows us the flexibility of simulating other DBT acquisition geometries using a subset of the PVs. In this study, we simulated a 30° DBT geometry using the central 11 PVs (30°-11PV). The narrower tomographic angle is closer to DBT geometries commercially available or under development and the dose is matched approximately to that of a DM. We developed a new joint-CAD system for detection of clustered microcalcifications. The DBT volume was reconstructed with a multiscale bilateral filtering regularized method and a PPJ image was generated from the reconstructed volume. Task-specific detection strategies were designed to combine information from the DBT volume and the PPJ image. The data set was divided into a training set (127 views with MCs) and an independent test set (104 views with MCs and 76 views without MCs). The joint-CAD system outperformed the individual CAD systems for DBT volume or PPJ image alone; the differences in the test performances were statistically significant (p  <  0.05) using JAFROC analysis.