Normal and neoplastic breast tissues have been characterised in terms of x-ray attenuation. Samples of normal fat and fibrous tissue were obtained from reduction mammoplasty and autopsy, and infiltrating duct carcinoma specimens from mastectomy and lumpectomy. A high-purity germanium spectroscopy system and a beam of 120 kV constant potential x-rays were used to determine the linear attenuation coefficient from 18 to 110 keV. Densities were determined from buoyancy measurements and were used to obtain mass attenuation coefficients. Infiltrating duct carcinomas and fat are well distinguished by x-ray attenuation. For photon energies used for film-screen mammography, infiltrating duct carcinomas are more attenuating than fibrous tissue. Above 31 keV, the ranges of attenuation of the two tissue types overlap. The attenuation coefficients of tissues have been concisely represented by equivalent thicknesses of lucite and aluminium. Analysis based on the average attenuation properties of tissues indicates that dual-energy mammography, using an ideal imaging system, would require 0.06 cGy to provide images in which 1 cm infiltrating duct carcinomas are displayed with a signal to noise ratio of 5 against a background over which the fat/fibrous contrast has been suppressed. This dose is similar to that currently used in conventional film-screen mammography.

https://iopscience.iop.org/article/10.1088/0031-9155/32/6/002/pdf

X-ray characterisation of normal and neoplastic breast tissues.

Subjective estimates of the angiographic severity of coronary artery stenoses show variability and inaccuracy. We therefore tested the accuracy of a newly developed computerized image analysis system for quantitating vessel diameter from cineangiograms. Fourteen cylindrical phantoms of known diameter were filled with contrast medium and filmed over a wide range of clinically relevant radiographic conditions in order to develop regression equations that related computer-derived to anatomic diameters. Computer measurements of vessel diameter were unaffected by vessel size, magnification, focal spot size, thickness of scattering medium, kilovolt peak, or location within the radiographic field, but a correction factor was necessary for a small but significant (p less than .01) linear dependence on contrast medium concentration. The accuracy of computerized vessel diameter measurements ranged between +/- 59 and +/- 137 mu for all conditions except for rapid vessel motion and contrast medium concentrations of 50% or less meglumine diatrizoate (Renografin 76), both of which resulted in reduced accuracy as well as in the inability to locate lumen edges of vessels less than 1 mm in diameter.

Computerized image analysis for quantitative measurement of vessel diameter from cineangiograms.

A review of breast imaging has already appeared in 1982 in this journal. Consequently, the present article concentrates on a discussion of only those developments of a more recent nature. Although the emphasis is placed on the physical aspects of the different imaging methods concerned, the essential factors relating to the clinical background and the associated radiation risk are also outlined. The completeness of detail depends on the present clinical importance of the method under discussion. X-ray mammography, which is still the most important breast imaging technique and has proved to be an effective method for breast cancer screening, is therefore treated in greater detail. Since the early 1980s, ultrasound B-mode scanning has evolved to an indispensable adjunct to x-ray mammography. For Doppler sonography, diaphanography, contrast-enhanced MRI, CT and DSA, the visualization of a tumour depends essentially on the enhanced vascularity of the lesion. Whether this will prove to be a reliable indicator for malignancy remains to be shown in controlled clinical studies. Common to all imaging systems is the increasing use of digital methods for signal processing, which also offers the possibility of computer-aided diagnosis by texture analysis and pattern recognition.

http://iopscience.iop.org/article/10.1088/0031-9155/41/3/001/pdf

Recent developments in breast imaging.

Importance Expensive and lengthy clinical trials can delay regulatory evaluation of innovative technologies, affecting patient access to high-quality medical products. Simulation is increasingly being used in product development but rarely in regulatory applications. Objectives To conduct a computer-simulated imaging trial evaluating digital breast tomosynthesis (DBT) as a replacement for digital mammography (DM) and to compare the results with a comparative clinical trial. Design, Setting, and Participants The simulated Virtual Imaging Clinical Trial for Regulatory Evaluation (VICTRE) trial was designed to replicate a clinical trial that used human patients and radiologists. Images obtained with in silico versions of DM and DBT systems via fast Monte Carlo x-ray transport were interpreted by a computational reader detecting the presence of lesions. A total of 2986 synthetic image–based virtual patients with breast sizes and radiographic densities representative of a screening population and compressed thicknesses from 3.5 to 6 cm were generated using an analytic approach in which anatomical structures are randomly created within a predefined breast volume and compressed in the craniocaudal orientation. A positive cohort contained a digitally inserted microcalcification cluster or spiculated mass. Main Outcomes and Measures The trial end point was the difference in area under the receiver operating characteristic curve between modalities for lesion detection. The trial was sized for an SE of 0.01 in the change in area under the curve (AUC), half the uncertainty in the comparative clinical trial. Results In this trial, computational readers analyzed 31 055 DM and 27 960 DBT cases from 2986 virtual patients with the following Breast Imaging Reporting and Data System densities: 286 (9.6%) extremely dense, 1200 (40.2%) heterogeneously dense, 1200 (40.2%) scattered fibroglandular densities, and 300 (10.0%) almost entirely fat. The mean (SE) change in AUC was 0.0587 (0.0062) (P  Conclusions and Relevance The results of the simulated VICTRE trial are consistent with the performance seen in the comparative trial. While further research is needed to assess the generalizability of these findings, in silico imaging trials represent a viable source of regulatory evidence for imaging devices.

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Evaluation of Digital Breast Tomosynthesis as Replacement of Full-Field Digital Mammography Using an In Silico Imaging Trial.

A Monte Carlo computer program has been used to calculate the ratio of the scatter-to-primary radiation recorded by a range of image receptors used in mammography. The dependence of this ratio on breast size and photon energy has been investigated and the contributions of different sources of scattered radiation examined. The use of magnification and grid techniques have been included in the program and the performance of the Philips mammographic grid examined in detail. The results of the calculations are in good agreement with the limited experimental data available.

https://iopscience.iop.org/article/10.1088/0031-9155/29/3/003/pdf

The computation of scatter in mammography by Monte Carlo methods

A systems analysis of reduced dose mammography with scatter removal has quantitatively specified the relationships between the several parameters in mammography systems. While the results are only preliminary in the sense that they need to be proven experimentally, they do seem to provide a good feel for the nature of the important trade‐offs. The major uncertainties in the analysis probably have to do with the formal equivalence, that is implicit in the aperture theory, between large area and detail contrast, as well as the output versus focal spot relationship that was adopted. Also, there are important questions about specifying motion unsharpness as a function of exposure time in mammography examinations.

Analysis of the significance of scattered radiation in reduced dose mammography, including magnification effects, scatter suppression, and focal spot and detector blurring.

Analytical expressions have been written for image quality in mammography. Multiparameter optimizations have been conducted to find mammographysystems providing the lowest patient dose for a given image quality. The optimizations are subject to constraints imposed by technology, such as power limits on the tube focal spot, absorption efficiency related to detector resolution, and others. The optimizations permit system geometry, kVp, filtration, detector resolution, focal spot size, and grid characteristics to vary simultaneously and self‐consistently subject to the constraints. A system configuration approaching a factor of 3 dose reduction has been found without assuming radical technological advances. The system satisfies image quality constraints for both large and small targets and would be possible to implement clinically. The sensitivity of the results to the assumptions made in the modeling has been investigated.

An approach to specifying a minimum dose system for mammography using multiparameter optimization techniques.

Grid transmission characteristics have been predicted, with good agreement demonstrated between experiment and theory. Differences between the present work and an earlier theoretical analysis have been noted. It is shown that comparison between experiment and theory can lead to a sensitive method for determining grid parameters. Generally, the derived grid parameters deviate somewhat from manufacturer supplied data. Use of the manufacturer’s nominal parameters can lead to large errors in predicting grid transmission.

A detailed experimental and theoretical comparison of the angular and energy dependencies of grid transmission.

Analytical expressions have been written for image quality in mammography. A multiparameter optimization has been conducted to find the mammography system requiring the lowest patient dose for a given image quality. The optimization is subject to constraints imposed by technology such as; power limits on tube focal spots, absorption efficiency related to detector resolution and others. The optimization permits system geometry, kVp, filtration, detector resolution, focal spot size and grid characteristics to vary simultaneously and self consistently subject to an exposure time constraint. Significant dose reductions compared to current mammography systems have been found without assuming radical technological advances.

Multiparameter Optimization Of Mammography

The theory developed by Muntz describing the relative detectability of calcifications in mammography has been recast in a way that permits meaningful experimental verification. An important result of this study is the demonstration of the power of using a normalization to a reference condition. Properly employed, normalization suppresses many of the difficult physical and psychovisual factors that appear in any attempt at analyzing radiographic examinations.

E. P. Muntz

Papers

Analysis of the significance of scattered radiation in reduced dose mammography, including magnification effects, scatter suppression, and focal spot and detector blurring.

An approach to specifying a minimum dose system for mammography using multiparameter optimization techniques.

A detailed experimental and theoretical comparison of the angular and energy dependencies of grid transmission.

Multiparameter Optimization Of Mammography

On the comparison of actual and calculated improvements in the imaging of calcifications using magnification mammography