Circular tomosynthesis: potential in imaging of breast and upper cervical spine--preliminary phantom and in vitro study

A multiple x-ray-source array (MXA) system with a planar two-dimensional source distribution for digital breast tomosynthesis

BACKGROUND

Digital breast tomosynthesis (DBT) has outpaced digital mammography in clinical adoption in the United States; however, substantial technological limitations remain to image quality in DBT, including undersampling from a one-dimensional (1D) scan geometry, x-ray source motion during acquisition, and patient motion artifacts from long exam times.

PURPOSE

A thermionic cathode x-ray system employing two-dimensional (2D, planar) multiple x-ray-source arrays (MXA) is proposed to improve DBT image quality.

METHODS

A 1D MXA, consisting of a linear array of thermionic cathodes was used to simulate a 2D MXA. The 1D MXA included 11 focal spots separated by a distance ofΔ d ${{\Delta}}d$  = 23 mm. The 11 cathodes were paired with 11 molybdenum 50 mm diameter anode disks, mounted on a rotating shaft within a single vacuum enclosure. Image quality was investigated as a function of MXA configuration by integrating the 1D MXA with a 200 × 250 mm2 flat panel detector at a source-to-detector distance of 630 mm, resulting in a 20° tomographic arc. To simulate a 2D MXA, the detector (with phantom) was translated orthogonally to the linear array by a distance ( δ $\delta $ ) ranging from δ $\delta $  = 0 mm (conventional 1D) to δ $\delta $  = 57 mm. All sources operated at 30 kV with 80 mA and 4.5 mAs/pulse, yielding ∼100 mAs per DBT dataset. DBT reconstructions involved 22 projections and used filtered backprojection with a ramp and Hann apodization filter. Volumetric reconstructions for each source were weighted by sampling differences between sources, and averaged. Image quality was assessed in terms of contrast-to-noise ratio (CNR), background clutter noise and power spectrum, and slice sensitivity profile (SSP) using a set of physical phantoms, including: (i) contrast-detail signals coupled to spherical clutter (PMMA in air); (ii) an SSP phantom; (iii) a commercial "breast" phantom (CIRS BR3D, Sun Nuclear, Norfolk, VA); and (iv) bovine muscle.

RESULTS

Background clutter noise amplitude reduced monotonically from the 1D MXA (σclutter = 5.9 A.U., δ $\delta $  = 0 mm) and 2D MXA arrays with increasing δ $\delta $ , with statistical significance between the 1D MXA and 2D MXA with δ $\delta $  = 57 mm (σclutter = 5.0 A.U., p < 0.001). The contrast-detail/clutter phantom demonstrated CNR from the 2D MXA (δ  = 57 mm) outperforming the 1D MXA in all combinations of contrast and detail. 2D power spectrum analysis of clutter demonstrated a pronounced Fourier domain null cone for the 1D MXA in the anterior field-of-view (away from the 1D MXA position), whereas the 2D MXA geometry (δ = 57 mm) did not exhibit the null cone. The SSP was 15%-50% narrower (FWHM) for the 2D versus the 1D geometry, across all reconstruction setups.

CONCLUSIONS

The advantages of a 2D source geometry for DBT imaging were demonstrated quantitatively compared to a conventional 1D line of x-ray sources. The improvement in the 2D geometry was attributed both to improved Fourier domain sampling and reduced SSP. We conclude that 2D MXA sources have the potential to substantially improve DBT imaging in comparison to existing commercial DBT systems.

Reliability and head-loading effects in imaging diagnosis of vertical subluxation in patients with rheumatoid arthritis

OBJECTIVES

The purpose of this study was to examine the reproducibility of vertical subluxation (VS) parameters using X-ray, computed tomography (CT), and tomosynthesis (TS) while comparing the head-loading effects.

METHODS

The VS parameters of 26 patients (retrospective review) were evaluated. Using the intra-class correlation coefficient, we statistically examined the intra-rater and inter-rater reliabilities of the parameters. Head-loaded and -unloaded imagings were compared using a Wilcoxon signed-rank test.

RESULTS

The intra-rater reliability of TS and CT showed intra-class correlation coefficients of ≥0.8 (X-ray range: 0.6-0.8), with similar results for the inter-rater reliabilities. Furthermore, in head-loading imaging, the TS had significantly higher VS scores than that of CT (P < .05).

CONCLUSIONS

In comparison with the X-ray, TS and CT were more accurate and reproducible. In terms of head loading, the VS values for TS were worse than those for CT, indicating that TS was more effective than CT in diagnosing VS.

Source-detector trajectory optimization in cone-beam computed tomography: a comprehensive review on today’s state-of-the-art

Cone-beam computed tomography (CBCT) imaging is becoming increasingly important for a wide range of applications such as image-guided surgery, image-guided radiation therapy as well as diagnostic imaging such as breast and orthopaedic imaging. The potential benefits of non-circular source-detector trajectories was recognized in early work to improve the completeness of CBCT sampling and extend the field of view (FOV). Another important feature of interventional imaging is that prior knowledge of patient anatomy such as a preoperative CBCT or prior CT is commonly available. This provides the opportunity to integrate such prior information into the image acquisition process by customized CBCT source-detector trajectories. Such customized trajectories can be designed in order to optimize task-specific imaging performance, providing intervention or patient-specific imaging settings. The recently developed robotic CBCT C-arms as well as novel multi-source CBCT imaging systems with additional degrees of freedom provide the possibility to largely expand the scanning geometries beyond the conventional circular source-detector trajectory. This recent development has inspired the research community to innovate enhanced image quality by modifying image geometry, as opposed to hardware or algorithms. The recently proposed techniques in this field facilitate image quality improvement, FOV extension, radiation dose reduction, metal artifact reduction as well as 3D imaging under kinematic constraints. Because of the great practical value and the increasing importance of CBCT imaging in image-guided therapy for clinical and preclinical applications as well as in industry, this paper focuses on the review and discussion of the available literature in the CBCT trajectory optimization field. To the best of our knowledge, this paper is the first study that provides an exhaustive literature review regarding customized CBCT algorithms and tries to update the community with the clarification of in-depth information on the current progress and future trends.

Digital breast tomosynthesis: Image acquisition principles and artifacts

Digital breast tomosynthesis (DBT) is a new technology that is being used more frequently for both breast cancer screening and diagnostic purposes and its utilization is likely to continue to increase over time. The major benefit of tomosynthesis over 2D-mammography is that it allows radiologists to view breast tissue using a three-dimensional dataset and improves diagnostic accuracy by facilitating differentiation of potentially malignant lesions from overlap of normal tissue. In addition, image processing techniques allow reconstruction of two dimensional synthesized mammograms (SM) from DBT data, which eliminates the need for acquiring two dimensional full field digital mammography (FFDM) in addition to tomosynthesis and thereby reduces the radiation dose. DBT systems incorporate a moveable x-ray tube, which moves in a prescribed way over a limited angular range to obtain three-dimensional data of patients' breasts, and utilize reconstruction algorithms. The limited angular range for DBT leads to incomplete sampling of the object, and a movable x-ray tube prolongs the imaging time, both of which make DBT and SM susceptible to artifacts. Understanding the etiology of these artifacts should help radiologists in reducing the number of artifacts and in differentiating a true finding from one related to an artifact, thus potentially decreasing recall rates and false positive rates. This is becoming especially important with increased incorporation of DBT in practices around the world. The goal of this article is to review the physics principles behind DBT systems and use these principles to explain the origin of artifacts that can limit diagnostic evaluation.

Tomosynthesis implementation with adaptive online calibration on clinical C-arm systems

PURPOSE

Cone beam computed tomography (CBCT) systems offer physicians crucial 3D and 2D imaging capabilities during interventions. However, certain medical applications only require very specific information from the CBCTs (e.g., determination of the position of high-contrast objects). In diagnostics, tomosynthesis techniques can be used in these cases to minimize dose exposure. Therefore, integrating such techniques on CBCT systems could also be beneficial for interventions. In this paper, we investigate the performance of our implementation of circular tomosynthesis on a CBCT device.

METHODS

The tomosynthesis scan trajectory is realized with step-and-shoot on a clinical C-arm device. The online calibration algorithm uses conventionally acquired 3D CBCT of the scanned object as prior knowledge to correct the imaging geometries. The online calibration algorithm was compared to an offline calibration to test its performance. A ball bearing phantom was used to evaluate the reconstructions with respect to geometric distortions. The evaluation was done for three different scenarios to test the robustness of our tomosynthesis implementation against object deviations (e.g., pen) and different object positioning.

RESULTS

The circular tomosynthesis was tested on a ball bearing and an anthropomorphic phantom. The results show that the calibration is robust against isocenter shifts and object deviations in the CBCT. All reconstructions used 100 projections and displayed limited angle artifacts. The accuracy of the positions and shapes of high-contrast objects were, however, determined precisely. (The maximal center position deviation is 0.31 mm.) CONCLUSION: For medical procedures that primarily determine the precise position of high-contrast objects, circular tomosynthesis could offer an approach to reduce dose exposure.

Optimization of slice sensitivity profile for radiographic tomosynthesis

Similar to other tomographic imaging modalities, the slice sensitivity profile (SSP) is an important image quality metric for radiographic tomosynthesis. In this study, the relationship between the acquisition angular range (Theta) and the SSP for the linear trajectory system was carefully investigated from both theoretical and experimental perspectives. A mathematical SSP model was derived for arbitrary points in the reconstructed volume. We used a newly developed flat-panel tomosynthesis prototype system to experimentally validate the mathematical model from 20 degrees (+/-10 degrees) to 60 degrees (+/-30 degrees) angular ranges. The SSP was measured by imaging an edge phantom placed at an angle with respect to the detector plane using the modulation transfer function degradation (MTF-d) method. In addition to the experiments, computer simulations were performed to investigate the relationship in a wider angular range (2.5 degrees to 60 degrees). Furthermore, image data from an anthropomorphic phantom were collected to corroborate the system analysis. All the images in this study were constructed using a 3D view-weighted cone-beam filtered backprojection algorithm (3D VW CB-FBP). The theoretical analysis reveals that the SSP of linear trajectory tomosynthesis is inversely proportional to tan(Theta/2). This theory was supported by both simulation (chi2=1.415, DF=7, p =0.985) and phantom experiment (r=0.999, p < 0.001) and was further confirmed by an analysis of the reconstructed images of an anthropomorphic phantom. The results imply that the benefit of narrower SSP by increasing angular range quickly diminishes once beyond 40 degrees. The advantages of the MTF-d method were also demonstrated.

A review of breast tomosynthesis. Part I. The image acquisition process

Mammography is a very well-established imaging modality for the early detection and diagnosis of breast cancer. However, since the introduction of digital imaging to the realm of radiology, more advanced, and especially tomographic imaging methods have been made possible. One of these methods, breast tomosynthesis, has finally been introduced to the clinic for routine everyday use, with potential to in the future replace mammography for screening for breast cancer. In this two part paper, the extensive research performed during the development of breast tomosynthesis is reviewed, with a focus on the research addressing the medical physics aspects of this imaging modality. This first paper will review the research performed on the issues relevant to the image acquisition process, including system design, optimization of geometry and technique, x-ray scatter, and radiation dose. The companion to this paper will review all other aspects of breast tomosynthesis imaging, including the reconstruction process.

Osteoarthritis year 2012 in review: imaging

PURPOSE

This article reviews original publications related to imaging in osteoarthritis (OA) published in English from September 2011 through March 2012. In vitro data and animal studies are not covered.

METHODS

To extract relevant studies, an extensive PubMed database search was performed using the query terms "osteoarthritis" in combination with "MRI", "imaging", "radiography", "ultrasound", "computed tomography" and "nuclear medicine". Publications were sorted according to relevance based on potential impact to the OA research community with the over all goal of a balanced overview of all aspects of imaging. Focus was on publications in high-impact special-interest journals. The literature will be presented by topics covering radiography, morphologic magnetic resonance imaging (MRI), compositional and high-field MRI, quantitative MRI, ultrasound, other joints and systematic reviews. Original research that was presented as a podium or poster presentation at osteoarthritis research society international (OARSI) 2012 will not be included.

RESULTS AND CONCLUSIONS

For the search topics "MRI" and "osteoarthritis" a decrease in overall publications was observed over the 6 months following September 2011 when compared to the previous 6 months (-38.1%). For the terms "radiography" and "osteoarthritis" a decrease of 56.9% was noted. The 6 months since the last OARSI conference were characterized by several MRI-based studies dealing with epidemiologic and methodologic aspects of disease. Other modalities such as radiography or ultrasound received much less attention. Most imaging research is still concentrated on the knee although interest in other sites, especially the hand, has increased since the last OARSI meeting.

Instrumental error in chromotomosynthetic hyperspectral imaging

Chromotomosynthetic imaging (CTI) is a method of convolving spatial and spectral information that can be reconstructed into a hyperspectral image cube using the same transforms employed in medical tomosynthesis. A direct vision prism instrument operating in the visible (400-725 nm) with 0.6 mrad instantaneous field of view (IFOV) and 0.6-10 nm spectral resolution has been constructed and characterized. Reconstruction of hyperspectral data cubes requires an estimation of the instrument component properties that define the forward transform. We analyze the systematic instrumental error in collected projection data resulting from prism spectral dispersion, prism alignment, detector array position, and prism rotation angle. The shifting and broadening of both the spectral lineshape function and the spatial point spread function in the reconstructed hyperspectral imagery is compared with experimental results for monochromatic point sources. The shorter wavelength (λ<500 nm) region where the prism has the highest spectral dispersion suffers mostly from degradation of spectral resolution in the presence of systematic error, while longer wavelengths (λ>600 nm) suffer mostly from a shift of the spectral peaks. The quality of the reconstructed hyperspectral imagery is most sensitive to the misalignment of the prism rotation mount. With less than 1° total angular error in the two axes of freedom, spectral resolution was degraded by as much as a factor of 2 in the blue spectral region. For larger errors than this, spectral peaks begin to split into bimodal distributions, and spatial point response functions are reconstructed in rings with radii proportional to wavelength and spatial resolution.

Detection of osteophytes and subchondral cysts in the knee with use of tomosynthesis

PURPOSE

To evaluate the diagnostic performance of tomosynthesis in depicting osteophytes and subchondral cysts, with use of magnetic resonance (MR) imaging as the reference, and to test whether the lesions detected at radiography and tomosynthesis are associated with pain.

MATERIALS AND METHODS

The study was approved by local institutional review board, and all subjects gave written informed consent. Forty subjects (80 knees) older than 40 years were recruited irrespective of knee pain or radiographic osteoarthritis. Knees were imaged with radiography, tomosynthesis, and MR imaging. Presence of osteophytes and subchondral cysts in four locations of tibiofemoral joint (medial and lateral femur and tibia) was recorded. Knee pain was assessed by using the Western Ontario and McMaster University pain subscale.

RESULTS

MR imaging depicted 171 osteophytes and 51 subchondral cysts. Tomosynthesis had a higher sensitivity for osteophyte detection in left and right lateral femur (0.96 vs 0.75, P = .025, and 1.00 vs 0.71, P = .008, respectively), right medial femur (0.94 vs 0.72, P = .046), and right lateral tibia (1.00 vs 0.83, P = .046). For subchondral cyst detection, the sensitivity of tomosynthesis was 0.14-1.00 and that of radiography was 0.00-0.56. Both modalities had similar specificity for both lesions. Subjects with tomosynthesis-depicted osteophytes (odds ratio, 4.2-6.4; P = .001-.011) and medially located subchondral cysts (odds ratio, 6.7-17.8; P = .004-.03) were more likely to feel pain than those without. However, radiography-depicted osteophytes were more strongly associated with pain than were tomosynthesis-depicted osteophytes.

CONCLUSION

Tomosynthesis depicted more osteophytes and subchondral cysts than did radiography. Subjects with tomosynthesis-depicted osteophytes and subchondral cysts were more likely to feel pain than those without such lesions.

Evaluation of respiration-correlated digital tomosynthesis in lung

Digital tomosynthesis (DTS) with a linear accelerator-mounted imaging system provides a means of reconstructing tomographic images from radiographic projections over a limited gantry arc, thus requiring only a few seconds to acquire. Its application in the thorax, however, often results in blurred images from respiration-induced motion. This work evaluates the feasibility of respiration-correlated (RC) DTS for soft-tissue visualization and patient positioning. Image data acquired with a gantry-mounted kilovoltage imaging system while recording respiration were retrospectively analyzed from patients receiving radiotherapy for non-small-cell lung carcinoma. Projection images spanning an approximately 30 degrees gantry arc were sorted into four respiration phase bins prior to DTS reconstruction, which uses a backprojection, followed by a procedure to suppress structures above and below the reconstruction plane of interest. The DTS images were reconstructed in planes at different depths through the patient and normal to a user-selected angle close to the center of the arc. The localization accuracy of RC-DTS was assessed via a comparison with CBCT. Evaluation of RC-DTS in eight tumors shows visible reduction in image blur caused by the respiratory motion. It also allows the visualization of tumor motion extent. The best image quality is achieved at the end-exhalation phase of the respiratory motion. Comparison of RC-DTS with respiration-correlated cone-beam CT in determining tumor position, motion extent and displacement between treatment sessions shows agreement in most cases within 2-3 mm, comparable in magnitude to the intraobserver repeatability of the measurement. These results suggest the method's applicability for soft-tissue image guidance in lung, but must be confirmed with further studies in larger numbers of patients.

Design and characterization of a spatially distributed multibeam field emission x-ray source for stationary digital breast tomosynthesis

Digital breast tomosynthesis (DBT) is a limited angle computed tomography technique that can distinguish tumors from its overlying breast tissues and has potentials for detection of cancers at a smaller size and earlier stage. Current prototype DBT scanners are based on the regular full-field digital mammography systems and require partial isocentric motion of an x-ray tube over certain angular range to record the projection views. This prolongs the scanning time and, in turn, degrades the imaging quality due to motion blur. To mitigate the above limitations, the concept of a stationary DBT (s-DBT) scanner has been recently proposed based on the newly developed spatially distributed multibeam field emission x-ray (MBFEX) source technique using the carbon nanotube. The purpose of this article is to evaluate the performance of the 25-beam MBFEX source array that has been designed and fabricated for the s-DBT system. The s-DBT system records all the projection images by electronically activating the multiple x-ray beams from different viewing angles without any mechanical motion. The configuration of the MBFEX source is close to the published values from the Siemens Mammomat system. The key issues including the x-ray flux, focal spot size, spatial resolution, scanning time, beam-to-beam consistency, and reliability are evaluated using the standard procedures. In this article, the authors describe the design and performance of a distributed x-ray source array specifically designed for the s-DBT system. They evaluate the emission current, current variation, lifetime, and focal spot sizes of the source array. An emission current of up to 18 mA was obtained at 0.5 x 0.3 mm effective focal spot size. The experimentally measured focal spot sizes are comparable to that of a typical commercial mammography tube without motion blurring. Trade-off between the system spatial resolution, x-ray flux, and scanning time are also discussed. Projection images of a breast phantom were collected using the x-ray source array from 25 different viewing angles without motion. These preliminary results demonstrate the feasibility of the proposed s-DBT scanner. The technology has the potential to increase the resolution and reduce the imaging time for DBT. With the present design of 25 views, they demonstrated experimentally the feasibility of achieving 11 s scanning time at full detector resolution with 0.5 x 0.3 mm source resolution without motion blur. The flexibility in configuration of the x-ray source array will also allow system designers to consider imaging geometries that are difficult to achieve with the conventional single-source rotating approach.

Thick slices from tomosynthesis data sets: phantom study for the evaluation of different algorithms

Tomosynthesis is a 3-dimensional mammography technique that generates thin slices separated one to the other by typically 1 mm from source data sets. The relatively high image noise in these thin slices raises the value of 1-cm thick slices computed from the set of reconstructed slices for image interpretation. In an initial evaluation, we investigated the potential of different algorithms for generating thick slices from tomosynthesis source data (maximum intensity projection-MIP; average algorithm-AV, and image generation by means of a new algorithm, so-called softMip). The three postprocessing techniques were evaluated using a homogeneous phantom with one textured slab with a total thickness of about 5 cm in which two 0.5-cm-thick slabs contained objects to simulate microcalcifications, spiculated masses, and round masses. The phantom was examined by tomosynthesis (GE Healthcare). Microcalcifications were simulated by inclusion of calcium particles of four different sizes. The slabs containing the inclusions were examined in two different configurations: adjacent to each other and close to the detector and with the two slabs separated by two 1-cm thick breast equivalent material slabs. The reconstructed tomosynthesis slices were postprocessed using MIP, AV, and softMip to generate 1-cm thick slices with a lower noise level. The three postprocessing algorithms were assessed by calculating the resulting contrast versus background for the simulated microcalcifications and contrast-to-noise ratios (CNR) for the other objects. The CNRs of the simulated round and spiculated masses were most favorable for the thick slices generated with the average algorithm, followed by softMip and MIP. Contrast of the simulated microcalcifications was best for MIP, followed by softMip and average projections. Our results suggest that the additional generation of thick slices may improve the visualization of objects in tomosynthesis. This improvement differs from the different algorithms for microcalcifications, speculated objects, and round masses. SoftMip is a new approach combining features of MIP and average showing image properties in between MIP and AV.

Evaluation of three types of reference image data for external beam radiotherapy target localization using digital tomosynthesis (DTS)

Digital tomosynthesis (DTS) is a fast, low-dose three-dimensional (3D) imaging approach which yields slice images with excellent in-plane resolution, though low plane-to-plane resolution. A stack of DTS slices can be reconstructed from a single limited-angle scan, with typical scan angles ranging from 10 degrees to 40 degrees and acquisition times of less than 10 s. The resulting DTS slices show soft tissue contrast approaching that of full cone-beam CT. External beam radiotherapy target localization using DTS requires the registration of on-board DTS images with corresponding reference image data. This study evaluates three types of reference volume: original reference CT, exact reference DTS (RDTS), and a more computationally efficient approximate reference DTS (RDTSapprox), as well as three different DTS scan angles (22 degrees, 44 degrees, and 65 degrees) for the DTS target localization task. Three-dimensional mutual information (MI) shared between reference and onboard DTS volumes was computed in a region surrounding the spine of a chest phantom, as translations spanning +/-5 mm and rotations spanning +/-5 degrees were simulated along each dimension in the reference volumes. The locations of the MI maxima were used as surrogates for registration accuracy, and the width of the MI peaks were used to characterize the registration robustness. The results show that conventional treatment planning CT volumes are inadequate reference volumes for direct registration with on-board DTS data. The efficient RDTSapprox method also appears insufficient for MI-based registration without further refinement of the technique, though it may be suitable for manual registration performed by a human observer. The exact RDTS volumes, on the other hand, delivered a 3D DTS localization accuracy of 0.5 mm and 0.50 along each axis, using only a single 44 degrees coronal on-board DTS scan of the chest phantom.

Computation of the glandular radiation dose in digital tomosynthesis of the breast

Tomosynthesis of the breast is currently a topic of intense interest as a logical next step in the evolution of digital mammography. This study reports on the computation of glandular radiation dose in digital tomosynthesis of the breast. Previously, glandular dose estimations in tomosynthesis have been performed using data from studies of radiation dose in conventional planar mammography. This study evaluates, using Monte Carlo methods, the normalized glandular dose (DgN) to the breast during a tomosynthesis study, and characterizes its dependence on breast size, tissue composition, and x-ray spectrum. The conditions during digital tomosynthesis imaging of the breast were simulated using a computer program based on the Geant4 toolkit. With the use of simulated breasts of varying size, thickness and tissue composition, the DgN to the breast tissue was computed for varying x-ray spectra and tomosynthesis projection angle. Tomosynthesis projections centered about both the cranio-caudal (CC) and medio-lateral oblique (MLO) views were simulated. For each projection angle, the ratio of the glandular dose for that projection to the glandular dose for the zero degree projection was computed. This ratio was denoted the relative glandular dose (RGD) coefficient, and its variation under different imaging parameters was analyzed. Within mammographic energies, the RGD was found to have a weak dependence on glandular fraction and x-ray spectrum for both views. A substantial dependence on breast size and thickness was found for the MLO view, and to a lesser extent for the CC view. Although RGD values deviate substantially from unity as a function of projection angle, the RGD averaged over all projections in a complete tomosynthesis study varies from 0.91 to 1.01. The RGD results were fit to mathematical functions and the resulting equations are provided.

Cone-beam mammo-computed tomography from data along two tilting arcs

Over the past several years there has been an increasing interest in cone-beam computed tomography (CT) for breast imaging. In this article, we propose a new scheme for theoretically exact cone-beam mammo-CT and develop a corresponding Katsevich-type reconstruction algorithm. In our scheme, cone-beam scans are performed along two tilting arcs to collect a sufficient amount of information for exact reconstruction. In our algorithm, cone-beam data are filtered in a shift-invariant fashion and then weighted backprojected into the three-dimensional space for the final reconstruction. Our approach has several desirable features, including tolerance of axial data truncation, efficiency in sequential/parallel implementation, and accuracy for quantitative analysis. We also demonstrate the system performance and clinical utility of the proposed technique in numerical simulations.

Digital Mammography: Current Capabilities and Obstacles

Digital mammography represents an exciting new technology for breast imaging and possibly breast screening. The decoupling of functional components in digital mammography translates into potential operational efficiencies compared with screen-film mammography (SFM). Digital mammography is a platform for advanced applications not possible with traditional SFM. However, for digital mammography to replace SFM in daily clinical practice, operational and clinical hurdles will have to be overcome.

Digital mammography: current state and future aspects

The introduction of digital technique in mammography has been the last step in completing the process of digitalization in diagnostic imaging. Meanwhile, some different digital techniques as well as a couple of different digital mammography systems were developed and have already been available for some years. In this review article, the relevant data of key studies are reported, the current status is defined, and perspectives of digital mammography are described.

Incorporating new imaging models in breast cancer management

Mammography is the only screening test proven to decrease breast cancer morbidity and mortality. Although mammography is an effective screening tool, it does have limitations, particularly in women with dense breasts. New imaging techniques are emerging to overcome these limitations and enhance cancer detection, improving patient outcome. Digital mammography, computer aided detection, breast ultrasound and breast magnetic resonance imaging (MRI) are frequently used adjuncts to mammography in today's clinical practice. Recent studies have shown that these techniques can enhance the radiologist's ability to detect cancer and assess disease extent, which is crucial in treatment planning and staging. Positron emission tomography (PET) also plays an important role in staging breast cancer and monitoring treatment response. Other modalities such as tomosynthesis and MR lymphangiography show promise in overcoming the problems related to dense breast tissue and the lack of noninvasive methods to assess lymph node status. Imaging-guided, minimally invasive therapies are also emerging as alternatives to surgical biopsy for breast lesions. As imaging techniques improve, the role of imaging will continue to evolve with the goal remaining a decrease in breast cancer morbidity and mortality.