Showing papers on "Digital mammography published in 2003"

Tomographic mammography using a limited number of low-dose cone-beam projection images

Abstract: A method is described for using a limited number (typically 10–50) of low-dose radiographs to reconstruct the three-dimensional (3D) distribution of x-ray attenuation in the breast. The method uses x-ray cone-beam imaging, an electronic digital detector, and constrained nonlinear iterative computational techniques. Images are reconstructed with high resolution in two dimensions and lower resolution in the third dimension. The 3D distribution of attenuation that is projected into one image in conventional mammography can be separated into many layers (typically 30–80 1-mm-thick layers, depending on breast thickness), increasing the conspicuity of features that are often obscured by overlapping structure in a single-projection view. Schemes that record breast images at nonuniform angular increments, nonuniform image exposure, and nonuniform detector resolution are investigated in order to reduce the total x-ray exposure necessary to obtain diagnostically useful 3D reconstructions, and to improve the quality of the reconstructed images for a given exposure. The total patient radiation dose can be comparable to that used for a standard two-view mammogram. The method is illustrated with images from mastectomy specimens, a phantom, and human volunteers. The results show how image quality is affected by various data-collection protocols.

Dual-Energy Contrast-enhanced Digital Subtraction Mammography: Feasibility

Abstract: A technique for demonstrating breast cancers, dual-energy contrast agent–enhanced digital subtraction mammography, was performed in 26 subjects with mammographic or clinical findings that warranted biopsy. The technique consists of high-energy and low-energy digital mammography after administration of iodinated contrast agent. Weighted subtraction of the logarithmic transform of these images is then performed to obtain an image that preferentially shows iodine. Of the 26 subjects, 13 had invasive cancers. Eleven of these tumors enhanced strongly, one enhanced moderately, and one enhanced weakly. The duct in one patient with ductal carcinoma in situ was weakly enhancing. In the other 12 patients, benign tissue enhanced diffusely in two and weakly focally in two. These results indicate that the technique is feasible and worthy of further study. © RSNA, 2003

Combining low-, high-level and empirical domain knowledge for automated segmentation of ultrasonic breast lesions

Abstract: Breast cancer is the most frequently diagnosed malignancy and the second leading cause of mortality in women . In the last decade, ultrasound along with digital mammography has come to be regarded as the gold standard for breast cancer diagnosis. Automatically detecting tumors and extracting lesion boundaries in ultrasound images is difficult due to their specular nature and the variance in shape and appearance of sonographic lesions. Past work on automated ultrasonic breast lesion segmentation has not addressed important issues such as shadowing artifacts or dealing with similar tumor like structures in the sonogram. Algorithms that claim to automatically classify ultrasonic breast lesions, rely on manual delineation of the tumor boundaries. In this paper, we present a novel technique to automatically find lesion margins in ultrasound images, by combining intensity and texture with empirical domain specific knowledge along with directional gradient and a deformable shape-based model. The images are first filtered to remove speckle noise and then contrast enhanced to emphasize the tumor regions. For the first time, a mathematical formulation of the empirical rules used by radiologists in detecting ultrasonic breast lesions, popularly known as the "Stavros Criteria" is presented in this paper. We have applied this formulation to automatically determine a seed point within the image. Probabilistic classification of image pixels based on intensity and texture is followed by region growing using the automatically determined seed point to obtain an initial segmentation of the lesion. Boundary points are found on the directional gradient of the image. Outliers are removed by a process of recursive refinement. These boundary points are then supplied as an initial estimate to a deformable model. Incorporating empirical domain specific knowledge along with low and high-level knowledge makes it possible to avoid shadowing artifacts and lowers the chance of confusing similar tumor like structures for the lesion. The system was validated on a database of breast sonograms for 42 patients. The average mean boundary error between manual and automated segmentation was 6.6 pixels and the normalized true positive area overlap was 75.1%. The algorithm was found to be robust to 1) variations in system parameters, 2) number of training samples used, and 3) the position of the seed point within the tumor. Running time for segmenting a single sonogram was 18 s on a 1.8-GHz Pentium machine.

Contrast-enhanced digital mammography: initial clinical experience.

Abstract: PURPOSE: To investigate the potential of using intravenous contrast material with full-field digital mammography to facilitate the detection and characterization of lesions in the breast. MATERIALS AND METHODS: Twenty-two women scheduled for biopsy because they were suspected of having abnormalities at breast imaging underwent imaging with contrast material–enhanced digital mammography. Six sequential images of the affected breast were obtained, with a contrast agent injected intravenously between the time the first and second images were obtained. Image processing included registration and logarithmic subtraction. Lesions were evaluated for the presence, morphology, and kinetics of enhancement. Lesion type, size, and pathologic findings were correlated with the findings at contrast-enhanced digital mammography. RESULTS: At contrast-enhanced digital mammography, enhancement was observed in eight of 10 patients with biopsy-proved cancers. In one case of ductal carcinoma in situ and one case of invasive duc...

Population-based Mammography Screening: Comparison of Screen-Film and Full-Field Digital Mammography with Soft-Copy Reading—Oslo I Study

Abstract: PURPOSE: To compare screen-film and full-field digital mammography with soft-copy reading in a population-based screening program. MATERIALS AND METHODS: Full-field digital and screen-film mammography were performed in 3,683 women aged 50–69 years. Two standard views of each breast were acquired with each modality. Images underwent independent double reading with use of a five-point rating scale for probability of cancer. Recall rates and positive predictive values were calculated. Cancer detection rates determined with both modalities were compared by using the McNemar test for paired proportions. Retrospective side-by-side analysis for conspicuity of cancers was performed by an external independent radiologist group with experience in both modalities. RESULTS: In 3,683 cases, 31 cancers were detected. Screen-film mammography depicted 28 (0.76%) malignancies, and full-field digital mammography depicted 23 (0.62%) malignancies. The difference between cancer detection rates was not significant (P = .23). T...

Integrated wavelets for enhancement of microcalcifications in digital mammography

Abstract: This paper presents a new algorithm for enhancement of microcalcifications in mammograms. The main novelty is the application of techniques we have developed for construction of filterbanks derived from the continuous wavelet transform. These discrete wavelet decompositions, called integrated wavelets, are optimally designed for enhancement of multiscale structures in images. Furthermore, we use a model based approach to refine existing methods for general enhancement of mammograms resulting in a more specific enhancement of microcalcifications. We present results of our method and compare them with known algorithms. Finally, we want to indicate how these techniques can also be applied to the detection of microcalcifications. Our algorithm was positively evaluated in a clinical study. It has been implemented in a mammography workstation designed for soft-copy reading of digital mammograms developed by IMAGETOOL, Germany.

Region-based wavelet coding methods for digital mammography

Abstract: Spatial resolution and contrast sensitivity requirements for some types of medical image techniques, including mammography, delay the implementation of new digital technologies, namely, computer-aided diagnosis, picture archiving and communications systems, or teleradiology. In order to reduce transmission time and storage cost, an efficient data-compression scheme to reduce digital data without significant degradation of medical image quality is needed. In this study, we have applied two region-based compression methods to digital mammograms. In both methods, after segmenting the breast region, a region-based discrete wavelet transform is applied, followed by an object-based extension of the set partitioning in hierarchical trees (OB-SPIHT) coding algorithm in one method, and an object-based extension of the set partitioned embedded block (OB-SPECK) coding algorithm in the other. We have compared these specific implementations against the original SPIHT and the new standard JPEG 2000, both using reversible and irreversible filters, on five digital mammograms compressed at rates ranging from 0.1 to 1.0 bit per pixel (bbp). Distortion was evaluated for all images and compression rates by the peak signal-to-noise ratio. For all images, OB-SPIHT and OB-SPECK performed substantially better than the traditional SPIHT and JPEG 2000, and a slight difference in performance was found between them. A comparison applying SPIHT and the standard JPEG 2000 to the same set of images with the background pixels fixed to zero was also carried out, obtaining similar implementation as region-based methods. For digital mammography, region-based compression methods represent an improvement in compression efficiency from full-image methods, also providing the possibility of encoding multiple regions of interest independently.

The value of scatter removal by a grid in full field digital mammography

Abstract: Our objective in this study was to investigate the usefulness of an anti-scatter grid in digital mammography using a contrast detail phantom. The mammography system we investigated was a GE Senographe 2000D. We carried out phantom measurements under various conditions with and without using the anti-scatter grid. A new version of the CDMAM phantom (version 3.4) was used. This phantom consists of a matrix of square cells with disks of varying size and contrast. For given exposure conditions detectability of these disks can be determined and used for construction of contrast detail curves. Previously, a computer program was developed at our institute that performs a fully automatic analysis of the phantom recordings using the ideal observer model. Breast thickness was simulated by a homogeneous layer of PMMA in the range of 1 to 7 cm. Series of images were recorded for different KeV and target–filter combinations depending on the simulated thickness. The dose was kept constant for each thickness with and without using a grid. It appeared that image quality improved for simulated breast thickness below 5 cm when the grid was removed. In the range from 5 to 7 cm contrast detail curves obtained with or without a grid were similar. Results suggest that for compressed breast thickness in the range of 1 to 7 cm a grid might not be needed in the digital mammography system we investigated. Below 5 cm, omitting the grid may allow lower dose to the patient without losing image quality.

Dual-energy digital mammography: calibration and inverse-mapping techniques to estimate calcification thickness and glandular-tissue ratio.

Abstract: Breast cancer may manifest as microcalcifications in x-ray mammography. Small microcalcifications, essential to the early detection of breast cancer, are often obscured by overlapping tissue structures. Dual-energy imaging, where separate low- and high-energy images are acquired and synthesized to cancel the tissue structures, may improve the ability to detect and visualize microcalcifications. Transmission measurements at two different kVp values were made on breast-tissue-equivalent materials under narrow-beam geometry using an indirect flat-panel mammographicimager. The imaging scenario consisted of variable aluminum thickness (to simulate calcifications) and variable glandular ratio (defined as the ratio of the glandular-tissue thickness to the total tissue thickness) for a fixed total tissue thickness—the clinical situation of microcalcification imaging with varying tissue composition under breast compression. The coefficients of the inverse-mapping functions used to determine material composition from dual-energy measurements were calculated by a least-squares analysis. The linear function poorly modeled both the aluminum thickness and the glandular ratio. The inverse-mapping functions were found to vary as analytic functions of second (conic) or third (cubic) order. By comparing the model predictions with the calibration values, the root-mean-square residuals for both the cubic and the conic functions were ∼50 μm for the aluminum thickness and ∼0.05 for the glandular ratio.

Diagnostic accuracy of digital mammography in patients with dense breasts who underwent problem-solving mammography: effects of image processing and lesion type.

Abstract: PURPOSE: To determine effects of lesion type (calcification vs mass) and image processing on radiologist’s performance for area under the receiver operating characteristic curve (AUC), sensitivity, and specificity for detection of masses and calcifications with digital mammography in women with mammographically dense breasts. MATERIALS AND METHODS: This study included 201 women who underwent digital mammography at seven U.S. and Canadian medical centers. Three image-processing algorithms were applied to the digital images, which were acquired with Fischer, General Electric, and Lorad digital mammography units. Eighteen readers participated in the reader study (six readers per algorithm). Baseline values for reader performance with screen-film mammograms were obtained through the additional interpretation of 179 screen-film mammograms. A repeated-measures analysis of covariance allowing unequal slopes was used in each of the nine analyses (AUC, sensitivity, and specificity for each of three machines). Bonf...

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

Abstract: A dual-energy technique which employs the basis decomposition method is being investigated for application to digital mammography. A three-component phantom, made up of plexiglas, polyethylene and water, was doubly exposed with the full-field digital mammography system manufactured by General Electric. The 'low' and 'high' energy images were recorded with a Mo/Mo anode-filter combination and a Rh/Rh combination, respectively. The total dose was kept within the acceptable levels of conventional mammography. The first hybrid images obtained with the dual-energy algorithm are presented in comparison with a conventional radiograph of the phantom. Image-quality characteristics at contrast cancellation angles between plexiglas and water are discussed. Preliminary results show that a combination of a standard Mo-anode 28 kV radiograph with a Rh-anode 49 kV radiograph provides the best compromise between image-quality and dose in the hybrid image.

Fundamentals of digital mammography: physics, technology and practical considerations

Abstract: Screen-film image receptors have been the standard detector used in conventional mammography. New developments in detector technology and computers are altering the landscape of mammography imaging. Full Field Digital Mammography (FFDM) offers the promise of revolutionizing the practice of mammography through its superior dose and contrast performance. Advanced applications made possible through digital imaging, such as automated computer-aided diagnosis, dualenergy and 3D tomosynthesis are expected to further improve diagnostic sensitivity and specificity. This primer describes the technical basis for current and future advances in mammographic detector technology. These include all of the following: • Lower dose • Improved image quality • Computer-aided diagnosis • Softcopy review and digital archiving • Tomosynthesis and other three-dimensional visualization techniques • Reduction in breast compression pressure

X-ray scattering in full-field digital mammography.

Abstract: Effects of x-ray scattering on full-field digital mammography are analyzed with the scattering model of Seibert and Boone [Med. Phys. 15, 567–575 (1988)]. A new method is introduced for the estimation of model parameters from measurements. It is shown that with breasts thinner than a certain threshold, removing the anti-scatter grid leads to an improved contrast-to-noise ratio with a smaller patient dose. A fast approximate algorithm is presented for determining the scattered field in a gridless digital mammogram.

Dose reduction in full-field digital mammography: an anthropomorphic breast phantom study

Abstract: The aim of this study was to evaluate the potential for radiation dose reduction by using other beam qualities in full-field digital mammography (FFDM) compared with screen-film mammography (SFM). FFDM was performed using an amorphous silicon detector with a caesium iodide scintillator layer (Senographe 2000D, GE, Milwaukee, USA). SFM was performed using a state-of-the-art conventional system (Senographe DMR, GE, Milwaukee, USA) with a dedicated screen-film combination. An anthropomorphic breast phantom with superimposed microcalcifications (50-200 microm) was used to evaluate the detectability of microcalcifications. Contact mammograms and magnification views (m=1.8) performed with both the digital and the screen-film system were compared. Images were exposed automatically. Molybdenum/Molybdenum (Mo/Mo) anode-filter combination, 28 kVp and 63 mAs were selected by the automatic optimization of parameters (AOP) of the conventional system. This exposure protocol (protocol A) was also used as baseline for the digital system. Dose reduction in digital mammography was achieved by using protocol B with Mo/Rh and 31 kVp and protocol C with Rh/Rh and 32 kVp. The detectability of microcalcifications was assessed by 3 experienced readers with a confidence level ranging from 1 to 5. A receiver operating characteristic (ROC) analysis was performed. In protocol A the area under the ROC-curve (A(z)) for contact views performed by the screen-film system was 0.64 and for those performed with the FFDM system 0.68. The A(z) values were 0.74 in protocol B and 0.65 in protocol C for the digital system. For the conventional and digital magnification views A(z) values were 0.71 and 0.79, respectively. For protocol B the A(z) value was 0.81 and for protocol C it was 0.76. There is no statistically significant difference in the A(z) values for the different protocols in digital mammography and no significant difference from the screen-film system. A potential for dose reduction by using other beam qualities seems to be possible with this digital system.

Use of iodine-based contrast media in digital full-field mammography--initial experience.

Abstract: Aim To investigate the use of iodine-based contrast media in digital full-field mammography. Methods After performing initial phantom studies, seven patients underwent digital mammography (Senographe 2000D, GE Medical Systems, Milwaukee, USA) using a specially filtered beam before as well as 60, 120, and 180 seconds after injection of 80 ml of iodine contrast medium (Ultravist 370, Schering AG, Germany). The precontrast mammograms were then subtracted from the postcontrast mammograms and the resulting images compared with a contrast-enhanced dynamic MRI study, performed on all women. Results Contrast medium accumulation within the tumors was visualized with a good quality in all cases. The conditions under which successful contrast-enhanced digital mammography can be performed were determined in phantom studies. Conclusions Contrast-enhanced digital mammography has a potential for improving the visualization of breast tumors in mammography using special beam filtering, adjusted x-ray parameters, proper timing, and suitable subtraction software.

Advances in Mammography Have Improved Early Detection of Breast Cancer

Abstract: Breast cancer remains a leading cause of death among women throughout the world. The incidence is increasing globally and the disease remains a significant public health problem. Mammography is currently the best method to detect early breast cancer before it becomes clinically palpable. The use of mammography results in a 25% to 30% decreased mortality rate in screened women compared with controls after 5 to 7 years. Today’s dedicated mammographic equipment with specially designed X-ray screen/film combinations coupled with controlled film processing produces excellent image quality mammograms. It is important to produce reliable high-contrast, high-resolution images for mammography. Both the American College of Radiology Mammography Accreditation Program and the Mammography Quality Standards Act have had significant impact on the technical quality of mammographic images in the USA and worldwide. The recent development in digital mammography has opened the possibility for improving diagnosis and novel applications. This article reviews the major technical developments that led to today’s high quality mammograms.

An adaptive algorithm for the detection of microcalcifications in simulated low-dose mammography.

Abstract: This paper uses the task of microcalcification detection as a benchmark problem to assess the potential for dose reduction in x-ray mammography. We present the results of a newly developed algorithm for detection of microcalcifications as a case study for a typical commercial film-screen system (Kodak Min-R 2000/2190). The first part of the paper deals with the simulation of dose reduction for film-screen mammography based on a physical model of the imaging process. Use of a more sensitive film-screen system is expected to result in additional smoothing of the image. We introduce two different models of that behaviour, called moderate and strong smoothing. We then present an adaptive, model-based microcalcification detection algorithm. Comparing detection results with ground-truth images obtained under the supervision of an expert radiologist allows us to establish the soundness of the detection algorithm. We measure the performance on the dose-reduced images in order to assess the loss of information due to dose reduction. It turns out that the smoothing behaviour has a strong influence on detection rates. For moderate smoothing. a dose reduction by 25% has no serious influence on the detection results. whereas a dose reduction by 50% already entails a marked deterioration of the performance. Strong smoothing generally leads to an unacceptable loss of image quality. The test results emphasize the impact of the more sensitive film-screen system and its characteristics on the problem of assessing the potential for dose reduction in film-screen mammography. The general approach presented in the paper can be adapted to fully digital mammography.

New contrast media designed for x-ray energy subtraction imaging in digital mammography.

Abstract: RATIONALE AND OBJECTIVES In contrast-enhanced dual-energy subtraction imaging 2 images acquired postcontrast media administration at different energies are subtracted to highlight structures hidden in the absence of contrast media. X-ray spectra of the newly developed digital full-field mammography units (GE Senographe 2000 D) are dominated by the emission lines of the Mo or Rh anodes. The K-edge of Zirconium (Zr) is flanked by these 2 emission lines. Thus, the attenuation of Zr should experience a pronounced change of attenuation in parallel with a change of anodes. Under clinically relevant conditions, the contrasting behavior of Zr should be compared with that of other elements having K-edge energies outside the window spanned by the 2 anode emission lines. METHODS Solutions containing the contrasting elements Br, Y, Zr, I, and Gd were investigated for dual-energy subtraction in digital mammography with the 2 anode/filter settings (Mo/Mo and Rh/Rh). These solutions were investigated in phantom studies in the energy range conventionally used in mammography. Additionally, the contrasting behavior of Zr and I was compared in an in vivo study in rats. RESULTS The sweeping over the K-edge by alternating between the Mo and Rh anodes increases the detection of Zr in energy subtraction imaging at constant high voltage. This procedure does not lead to sufficient contrast enhancement for iodine-based contrast media which become detectable by increasing the high voltage to 40-49 kV. CONCLUSION The instrumental and physical data outlined predestine Zr as contrasting element with a high potential for energy subtraction imaging in digital mammography in the energy range conventionally applied.

Development and validation of a simulation procedure to study the visibility of micro calcifications in digital mammograms

Abstract: The visibility of micro calcifications is a determining factor for digital mammography. To address the problem of quantification, we developed a procedure to simulate micro calcifications into real mammograms. First, the shapes, sizes and x-raytransmission coefficients of real micro calcifications were derived from the appearance of biopsy specimens in the raw data of magnified, digital images acquired at 27 kVp and Mo/Mo anode-filter combination. This allowed us to create “ideal templates” of micro calcifications. The x-ray transmissions of the real micro calcifications values were expressed in Al-equivalent thickness. This made it possible to recalculate the x-ray transmission characteristics of a particular ideal template for other x-ray beam qualities. Extra corrections for differences in spatial resolution were based on the presampled two-dimensional modulation transfer functions and on the difference in pixel size. Three radiologists compared the appearance of real and simulated micro calcifications in a two-alternative forced choice (2AFC) evaluation. They perceived no differences between real and simulated lesions. Preliminary results show that it is possible to simulate micro calcifications with well defined characteristics that are indistinguishable from real ones. It should be noted, however, that the full potential of the approach has not been proven. In future work, these templates may be useful to evaluate particular aspects of digital mammograms, such as the effects of processing and of viewing conditions on the visibility of micro calcifications.

Performance of advanced a-Si/CsI-based flat-panel x-ray detectors for mammography

Abstract: The GE Senographe 2000D, the first full field digital mammography system based on amorphous Silicon (a-Si) flat panel arrays and a Cesium-Iodide (CsI) scintillator, has been in clinical use for several years. The purpose of this paper is to demonstrate and quantify improvements in the detective quantum efficiency (DQE) for both typical screening and ultra-low exposure levels for this technology platform. A new figure of merit, the electronic noise factor, is introduced to explicitly quantify the influence of the electronic noise, conversion factor, modulation transfer function (MTF), and pixel pitch towards the reduction of DQE at low exposure levels. Methods to improve the DQE through an optimization of both the flat panel design and the scintillator deposition process are discussed. The results show a substantial improvement in the DQE(f) at all frequencies and demonstrate the potential for DQE(0) to exceed 80%. The combination of high DQE at ultra low exposures and the inherent fast read-out capability makes this technology platform ideal for both current clinical procedures and advanced applications that may use multiple projections (tomosynthesis) or contrast media to enhance digital mammography.

Optimal radiographic techniques for digital mammograms obtained with an amorphous selenium detector

Abstract: Traditional film/screen mammograms are obtained using Molybdenum or Rhodium target x-ray tubes. The energy spectrum from these sources matches the limited latitude of film/screen systems. For digital imaging systems, the latitude is linear over a wide range of exposures and arbitrary H&D curves can be obtained with image processing. This allows the recorded contrast to noise ratio (CNR) to be optimized by considering a wide range of radiographic techniques. For this work, we modeled the radiographic process for a digital (amorphous selenium) mammography system. The optimal CNR relative to dose was determined for several target/filter combinations, for a wide range of kVp values, and for varying breast thickness. The target/filter combinations included: Mo/Mo, Mo/Rh, Rh/Rh, W/Al, W/Mo, W/Ag, and W/Sn. As breast thickness increased, the use of a tungsten target with a tin filter resulted in a 34% improvement in CNR for the same dose to the breast when compared to the use of a Molybdenum target with a Molybdenum filter. Notably, the W/Sn target/filter combination resulted in a significantly lower mA-s for the same breast dose (2/3 to 1/5 lower for a breast thickness from 4 to 8cm). In mammography applications, use of a Tungsten tube rather than the traditional Molybdenum tube should lead to significant reductions in exposure time and tube heat while maintaining similar image quality and dose.

New design of a structured CsI(Tl) screen for digital mammography

Abstract: Columnar CsI(Tl) screens are now routinely used for digital x-ray imaging in a wide variety of applications such as mammography, dental radiography, and non-destructive testing. While commercially available CsI(Tl) screens exhibit excellent properties, it is possible to significantly improve their performance. Here, we report on a new design of a columnar CsI(Tl) screen. Specifically, columnar CsI(Tl) screens were subjected to mechanical pixelation for minimizing the long range spread of scintillation light within the film, thus enhancing spatial and contrast resolution, and increasing the detective quantum efficiency (DQE(f)) of the digital imaging detector. To date we have fabricated up to 200 μm thick pixelated CsI(Tl) screens for mammography, and characterized their performance using a CCD camera. This paper presents a comparison of the new pixelated CsI(Tl) screens, conventional columnar CsI(Tl) screens, and Gd 2 O 2 S(Tb) screens. The data show that pixelated screens substantially improve the DQE(f) of the digital imaging system.

Neural vs. statistical classifier in conjunction with genetic algorithm feature selection in digital mammography

Abstract: Digital mammography is one of the most suitable methods for early detection of breast cancer. It uses digital mammograms to find suspicious areas containing benign and malignant microcalcifications. However, it is very difficult to distinguish benign and malignant microcalcifications. This is reflected in the high percentage of unnecessary biopsies that are performed and many deaths caused by late detection or misdiagnosis. A computer based feature selection and classification system can provide a second opinion to the radiologists in assessment of microcalcifications. The research proposes and investigates a neural-genetic algorithm for feature selection in conjunction with neural and statistical classifiers to classify microcalcification patterns in digital mammograms. The obtained results show that the proposed approach is able to find an appropriate feature subset and neural classifier achieves better results than two statistical models.

Acceptability of diagnostic tests for breast cancer.

Abstract: Summary Purpose. To assess the acceptability of new non-invasive breast cancer diagnostic tests intended to triage women in need of biopsy. Methods. Women who had abnormal screening tests and had been recommended to have a biopsy were invited to receive digital mammography, magnetic resonance imaging (MRI), and nuclear medicine evaluation (Tc-99msestamibi scanning) before biopsy. Participants completed a questionnaire about satisfaction and acceptability of the procedures. Satisfaction measured women’s overall and test-specific satisfaction. Acceptability was measured by self-reported discomfort, embarrassment and women’s preference in terms of willingness to pay to avoid a biopsy. Results. Women were satisfied with all of the potential diagnostic triage procedures. Most found the tests more comfortable than a routine mammogram (47, 50, and 66% undergoing MRI, digital mammography, and sestamibi scanning, respectively). Women who provided a response to willingness to pay questions (N = 43) were willing to pay an average of $611 to have a test instead of a biopsy, if the test was as accurate as biopsy. The willingness to pay significantly decreased to $308 if the test only had 95% accuracy. Those who had prior benign breast disease were less willing to pay for a test with 95% accuracy than those without this history. Conclusion. Instead of immediate biopsy after an abnormal screening, these results suggest that women would find non-invasive triage tests acceptable, or preferable to biopsy if they were equally accurate or nearly equally accurate as a biopsy. New technologies to diagnose breast cancer should focus on decreasing discomfort as well as increasing test accuracy.

Measurements on a full-field digital mammography system with a photon counting crystalline silicon detector

Abstract: Sectra Microdose is the first single photon counting mammography detector. An edge-on crystalline silicon detector is connected to application specific integrated circuits that individually process each photon. The detector is scanned across the breast and the rejection of scattered radiation exceeds 97% without the use of a Bucky. Processing of each x-rays individually enables an optimization of the information transfer from the x-rays to the image in a way previously not possible. Combined with an almost absence of noise from scattered radiation and from electronics we foresee a possibility to reduce the radiation dose and/or increase the image quality. We will discuss fundamental features of the new direct photon counting technique in terms of dose efficiency and present preliminary measurements for a prototype on physical parameters such as Noise Power Spectra (NPS), MTF and DQE.

Soft Copy versus Hard Copy Reading in Digital Mammography

Abstract: The objective of this study was to compare soft copy reading at a mammography work station with hard copy reading of full-field digital mammographic images. Mammograms of 60 patients (n = 29 malignant, n = 31 benign) performed with full-field digital mammography (Senographe 2000D, GE, Buc, France) were evaluated. Reading was performed based on hard copy prints (Scopix, Agfa, Leverkusen, Germany) and on 2 k × 2.5 k high-resolution monitors (Sun Ultra 60, Sun Microsystems, Palo Alto, California, USA). Four readers with different levels of experience in mammography categorized the mammograms according to the BI-RADS classification. The comparative study was performed by four readers, and at least 2 months elapsed between the reading sessions. Postprocessing, of course, was available only at the work station (windowing and leveling, zooming, inversion). Sensitivity, specificity, and positive predictive value were evaluated. Diagnostic accuracy of the evaluation was determined. Sensitivity for malignant lesions in hard copy versus soft copy reading was 97% vs 90%, 97% vs 97%, 93% vs 97%, and 76% vs 76% for the four readers, respectively. Specificity was 52% vs 68%, 58% vs 74%, 65% vs 48%, and 61% vs 68%. Accuracy for the classification of malignant lesions according to the BI-RADS categories showed no difference between hard copy and soft copy reading. Soft copy reading is possible with the available system and enables radiologists to use the advantages of a digital system.

Evaluation of detector dynamic range in the x-ray exposure domain in mammography: a comparison between film-screen and flat panel detector systems.

Abstract: Digital detectors in mammography have wide dynamic range in addition to the benefit of decoupled acquisition and display. How wide the dynamic range is and how it compares to film-screen systems in the clinical x-ray exposure domain are unclear. In this work, we compare the effective dynamic ranges of film-screen and flat panel mammography systems, along with the dynamic ranges of their component image receptors in the clinical x-ray exposure domain. An ACR mammography phantom was imaged using variable mAs (exposure) values for both systems. The dynamic range of the contrast-limited film-screen system was defined as that ratio of mAs (exposure) values for a 26 kVp Mo/Mo (HVL=0.34 mm Al) beam that yielded passing phantom scores. The same approach was done for the noise-limited digital system. Data from three independent observers delineated a useful phantom background optical density range of 1.27 to 2.63, which corresponded to a dynamic range of 2.3 +/- 0.53. The digital system had a dynamic range of 9.9 +/- 1.8, which was wider than the film-screen system (p<0.02). The dynamic range of the film-screen system was limited by the dynamic range of the film. The digital detector, on the other hand, had an estimated dynamic range of 42, which was wider than the dynamic range of the digital system in its entirety by a factor of 4. The generator/tube combination was the limiting factor in determining the digital system's dynamic range.

Comparison of screen-film and full-field digital mammography: image contrast and lesion characterization.

Abstract: Purpose This study compared screen-film mammography (SFM) with full-field digital mammography (FFDM) of the same patients. Materials and methods Twenty-four patients underwent surgery or biopsy, including 17 with carcinoma. Patients underwent both SFM and FFDM after providing informed consent. The abnormal findings consisted of 10 masses and 15 areas of microcalcification. The optical density of the breast tissue surrounding any lesion or mass was measured. Three readers evaluated the visibility of the masses and calcifications (contrast, margin, and type) by consensus from hard copies of the images. When evaluating FFDM, SFM was used as the standard of comparison. Results FFDM showed greater contrast of mass than SFM. The contrast of mass on FFDM was judged visually superior or equivalent to that of SFM, and microcalcifications were the same in most cases. The margin of the mass was better defined by FFDM in two cases. Determination of the type of microcalcification was similar for SFM and FFDM. Conclusion FFDM provided greater contrast than SFM. FFDM might be helpful for detecting masses and observing their margins. Although FFDM may be of some use for detecting calcification, it has no advantage when determining the type of calcification.