Scanning equalization mammography: preliminary evaluation

Effects of exposure equalization on image signal-to-noise ratios in digital mammography: a simulation study with an anthropomorphic breast phantom

PURPOSE

The scan equalization digital mammography (SEDM) technique combines slot scanning and exposure equalization to improve low-contrast performance of digital mammography in dense tissue areas. In this study, full-field digital mammography (FFDM) images of an anthropomorphic breast phantom acquired with an anti-scatter grid at various exposure levels were superimposed to simulate SEDM images and investigate the improvement of low-contrast performance as quantified by primary signal-to-noise ratios (PSNRs).

METHODS

We imaged an anthropomorphic breast phantom (Gammex 169 "Rachel," Gammex RMI, Middleton, WI) at various exposure levels using a FFDM system (Senographe 2000D, GE Medical Systems, Milwaukee, WI). The exposure equalization factors were computed based on a standard FFDM image acquired in the automatic exposure control (AEC) mode. The equalized image was simulated and constructed by superimposing a selected set of FFDM images acquired at 2, 1, 1/2, 1/4, 1/8, 1/16, and 1/32 times of exposure levels to the standard AEC timed technique (125 mAs) using the equalization factors computed for each region. Finally, the equalized image was renormalized regionally with the exposure equalization factors to result in an appearance similar to that with standard digital mammography. Two sets of FFDM images were acquired to allow for two identically, but independently, formed equalized images to be subtracted from each other to estimate the noise levels. Similarly, two identically but independently acquired standard FFDM images were subtracted to estimate the noise levels. Corrections were applied to remove the excess system noise accumulated during image superimposition in forming the equalized image. PSNRs over the compressed area of breast phantom were computed and used to quantitatively study the effects of exposure equalization on low-contrast performance in digital mammography.

RESULTS

We found that the highest achievable PSNR improvement factor was 1.89 for the anthropomorphic breast phantom used in this study. The overall PSNRs were measured to be 79.6 for the FFDM imaging and 107.6 for the simulated SEDM imaging on average in the compressed area of breast phantom, resulting in an average improvement of PSNR by ∼35% with exposure equalization. We also found that the PSNRs appeared to be largely uniform with exposure equalization, and the standard deviations of PSNRs were estimated to be 10.3 and 7.9 for the FFDM imaging and the simulated SEDM imaging, respectively. The average glandular dose for SEDM was estimated to be 212.5 mrad, ∼34% lower than that of standard AEC-timed FFDM (323.8 mrad) as a result of exposure equalization for the entire breast phantom.

CONCLUSIONS

Exposure equalization was found to substantially improve image PSNRs in dense tissue regions and result in more uniform image PSNRs. This improvement may lead to better low-contrast performance in detecting and visualizing soft tissue masses and micro-calcifications in dense tissue areas for breast imaging tasks.

A digital density equalization technique to improve visualization of breast periphery in mammography

In mammographic imaging, the film area corresponding to the breast periphery is overexposed, resulting in high optical density and degraded contrast in this region. A digital, model-driven density equalization technique was designed and developed to overcome this overexposure problem, taking into account the non-linear characteristic curve of the film-digitizer system. The method is based on several image processing and analysis techniques, such as thresholding, which is used to segment the pixels of the mammogram belonging to the breast region from the background, and wavelet-based fusion, which is used to equalize the pixels of breast periphery selectively while leaving the remaining breast region unaffected. Initial application of the method resulted in density-equalized mammographic images, characterized by improved contrast at the breast periphery.

A phantom-based evaluation of an exposure equalization technique in mammography

An anatomical filter based exposure equalization technique in mammography is evaluated quantitatively using a phantom. The evaluation is carried out by a comparative observer performance study, comparing the equalization technique with a conventional one based on visualization of low contrast, 6 mm circular details and high contrast, 0.5 mm and 0.25 mm small size details. These details are situated at the phantom edge, simulating the breast periphery. Visualization of these details is studied with respect to the parameters of tube voltage, optical density, detail location and phantom thickness. Phantom images are interpreted independently by three observers using a four-point grading scale. Use of the Wilcoxon signed ranks test for paired data shows statistically highly significant improvement (p < 0.0001) in the visualization of details for the equalization technique for all values of the parameters studied. The improvement is independent of tube voltage but dependent on optical density, detail location and phantom thickness. Optimal performance is obtained for detail location closer to the outer border of the simulated breast periphery and/or further away from the film, as well as for a greater phantom thickness simulating both thick and dense breast.

Evaluation of an anatomical filter-based exposure equalization technique in mammography

An anatomical filter-based exposure equalization technique in mammography is clinically evaluated. An observer performance comparative study, between this technique and the conventional one, is carried out on the basis of the visualization of six anatomical features situated at the breast periphery. The effect of parenchymal breast patterns and compressed breast thickness in the visualization of these features is studied. 533 craniocaudal mammograms were interpreted by two radiologists independently, using a five-point rating scale. Use of the Wilcoxon ranking test for unpaired data shows statistically highly significant improvement (p < 0.0001) in the visualization of the nipple, areola, skin and subcutaneous fat in all cases, for the equalization technique. The improvement is dependent on parenchymal breast patterns and compressed breast thickness for peripheral Cooper's ligaments and peripheral surface veins. In the case of total fatty replacement and/or thin breasts neither technique seems to be superior (p > 0.05) with respect to these two features. Clinical results indicate the value of this technique in clinical routine.

Classification of compressed breast shapes for the design of equalization filters in x-ray mammography

We are developing an external filter method for equalizing the x-ray exposure in mammography. Each filter is specially designed to match the shape of the compressed breast border and to preferentially attenuate the x-ray beam in the peripheral region of the breast. To be practical, this method should require the use of only a limited number of custom built filters. It is hypothesized that this would be possible if compressed breasts can be classified into a finite number of shapes. A study was performed to determine the number of shapes. Based on the parabolic appearance of the outer borders of compressed breasts in mammograms, the borders were fit with the polynomial equations y = ax2 + bx3 and y = ax2 + bx3 + cx4. The goodness-of-fit of these equations was compared. The a,b and a,b,c coefficients were employed in a K-Means clustering procedure to classify 470 CC-view and 484 MLO-view borders into 2-10 clusters. The mean coefficients of the borders within a given cluster defined the "filter" shape, and the individual borders were translated and rotated to best match that filter shape. The average rms differences between the individual borders and the "filter" were computed as were the standard deviations of those differences. The optimally shifted and rotated borders were refit with the above polynomial equations, and plotted for visual evaluation of clustering success. Both polynomial fits were adequate with rms errors of about 2 mm for the 2-coefficient equation, and about 1 mm for the 3-coefficient equation. Although the fits to the original borders were superior for the 3-coefficient equation, the matches to the "filter" borders determined by clustering were not significantly improved. A variety of modified clustering methods were developed and utilized, but none produced major improvements in clustering. Results indicate that 3 or 4 filter shapes may be adequate for each mammographic projection (CC- and MLO-view). To account for the wide variations in exposures observed at the peripheral regions of breasts classified to be of a particular shape, it may be necessary to employ different filters for thin, medium and thick breasts. Even with this added requirement, it should be possible to use a small number of filters as desired.

Storage phosphor digital mammography

Digital mammography using storage phosphor CR is still in the investigational stage. It is the only digital mammography system that has been tested in preliminary clinical trials with promising early results. Further clinical studies are needed to assess the impact of the limited spatial resolution of storage phosphor technology on its application as a digital screening mammography system. Further studies also are needed to determine the optimum image processing parameters needed in digital mammography.