Showing papers on "Digital mammography published in 2007"

Digital breast tomosynthesis: initial experience in 98 women with abnormal digital screening mammography.

Abstract: OBJECTIVE. The purpose of our study was to compare the image quality of tomosynthesis with that of conventional mammography and to estimate the recall rate of screening when tomosynthesis is used in addition to mammography.MATERIALS AND METHODS. Women with an abnormal screening mammography were recruited sequentially. Consenting women underwent tomosynthesis of the affected breast corresponding to the views obtained with diagnostic mammography. The study radiologist compared the image quality, including lesion conspicuity and feature analysis, of tomosynthesis with diagnostic film-screen mammography and assessed the need for recall when tomosynthesis was added to digital screening mammography. Screening recalls were considered unnecessary when tomosynthesis did not show a corresponding abnormality or allowed definitely benign lesion characterization. Fisher's exact test was used to determine the association of equivalence and recall status with mammographic finding type.RESULTS. There were 99 digital scre...

The prediction of breast cancer biopsy outcomes using two CAD approaches that both emphasize an intelligible decision process

Abstract: Mammography is the most effective method for breast cancer screening available today. However, the low positive predictive value of breast biopsy resulting from mammogram interpretation leads to approximately 70% unnecessary biopsies with benign outcomes. To reduce the high number of unnecessary breast biopsies, several computer-aided diagnosis (CAD) systems have been proposed in the last several years. These systems help physicians in their decision to perform a breast biopsy on a suspicious lesion seen in a mammogram or to perform a short term follow-up examination instead. We present two novel CAD approaches that both emphasize an intelligible decision process to predict breast biopsy outcomes from BI-RADS findings. An intelligible reasoning process is an important requirement for the acceptance of CAD systems by physicians. The first approach induces a global model based on decison-tree learning. The second approach is based on case-based reasoning and applies an entropic similarity measure. We have evaluated the performance of both CAD approaches on two large publicly available mammography reference databases using receiver operating characteristic (ROC) analysis, bootstrap sampling, and the ANOVA statistical significance test. Both approaches outperform the diagnosis decisions of the physicians. Hence, both systems have the potential to reduce the number of unnecessary breast biopsies in clinical practice. A comparison of the performance of the proposed decision tree and CBR approaches with a state of the art approach based on artificial neural networks (ANN) shows that the CBR approach performs slightly better than the ANN approach, which in turn results in slightly better performance than the decision-tree approach. The differences are statistically significant (p value < 0.001). On 2100 masses extracted from the DDSM database, the CRB approach for example resulted in an area under the ROC curve of A(z) = 0.89 +/- 0.01, the decision-tree approach in A(z) = 0.87 +/- 0.01, and the ANN approach in A(z) = 0.88 +/- 0.01.

Randomized Trial of Screen-Film versus Full-Field Digital Mammography with Soft-Copy Reading in Population-based Screening Program: Follow-up and Final Results of Oslo II Study

Abstract: Purpose: To prospectively compare performance indicators at screen-film mammography (SFM) and full-field digital mammography (FFDM) in a population-based screening program. Materials and Methods: The regional ethics committee approved the study; informed consent was obtained from patients. Women aged 45–69 years were assigned to undergo SFM (n = 16 985) or FFDM (n = 6944). Two-view mammograms were interpreted by using independent double reading and a five-point rating scale for probability of cancer. Positive scores were discussed at consensus meetings before decision for recall. The group was followed up for 1.5 years (women aged 45–49 years) and 2.0 years (women aged 50–69 years) to include subsequent cancers with positive scores at baseline interpretation and to estimate interval cancer rate. Recall rates, cancer detection, positive predictive values (PPVs), sensitivity, specificity, tumor characteristics, and discordant interpretations of cancers were compared. Results: Recall rate was 4.2% at FFDM an...

Full-field digital versus screen-film mammography: comparative accuracy in concurrent screening cohorts.

Abstract: OBJECTIVE. The purpose of this study was to compare the diagnostic accuracy of digital mammography with that of screen-film mammography in concurrent cohorts participating in the same population-based screening program.MATERIALS AND METHODS. In a retrospective study covering 2004–2005, we compared digital with screen-film mammography in two concurrent screening cohorts of women 50–69 years old participating in a screening program operated from mobile units. Each cohort had 14,385 participants matched by age and interpreting radiologist from all participants consecutively registered. We compared recall and cancer detection rates.RESULTS. The recall rate was higher for digital mammography (4.56% vs 3.96%, p =0.01), particularly when clustered microcalcifications were the only finding (1.05% vs 0.41%, p =10–6) and for younger women (50–59 vs 60–69 years, 5.12% vs 4.17%, p = 0.009). The higher recall rate for digital mammography was mainly evident at incidence screening. The recall rate due to poor technical ...

A comparison of the performance of digital mammography systems.

Abstract: An objective analysis of image quality parameters was performed for six digital mammography systems. The presampled modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE) for the systems were determined at different doses, for 28 kVp with a Mo/Mo or W/Al target/filter combination and 2 mm of additional aluminium filtration. The flat-panel units have higher MTF and DQE in the mid to high frequency range than standard CR systems. The highest DQE, over the whole dose range, is for the slit-scanning direct photon counting system. Dual-side read CR can overcome the inherent x-ray absorption and signal collection limitations of standard CR mammography, improving the low-frequency DQE by 40%, to the same level as full-field systems, but it does not improve the poor spatial resolution of phosphor.

Physical characterization of a scanning photon counting digital mammography system based on Si-strip detectors.

Abstract: The physical performance of a scanning multislit full field digital mammography system was determined using basic image quality parameters. The system employs a direct detection detector comprise ...

Scatter radiation in digital tomosynthesis of the breast.

Abstract: Digital tomosynthesis of the breast is being investigated as one possible solution to the problem of tissue superposition present in planar mammography. This imaging technique presents various advantages that would make it a feasible replacement for planar mammography, among them similar, if not lower, radiation glandular dose to the breast; implementation on conventional digital mammography technology via relatively simple modifications; and fast acquisition time. One significant problem that tomosynthesis of the breast must overcome, however, is the reduction of x-ray scatter inclusion in the projection images. In tomosynthesis, due to the projection geometry and radiation dose considerations, the use of an antiscatter grid presents several challenges. Therefore, the use of postacquisition software-based scatter reduction algorithms seems well justified, requiring a comprehensive evaluation of x-ray scatter content in the tomosynthesis projections. This study aims to gain insight into the behavior of x-ray scatter in tomosynthesis by characterizing the scatter point spread functions (PSFs) and the scatter to primary ratio (SPR) maps found in tomosynthesis of the breast. This characterization was performed using Monte Carlo simulations, based on the Geant4 toolkit, that simulate the conditions present in a digital tomosynthesis system, including the simulation of the compressed breast in both the cranio-caudal (CC) and the medio-lateral oblique (MLO) views. The variation of the scatter PSF with varying tomosynthesis projection angle, as well as the effects of varying breast glandular fraction and x-ray spectrum, was analyzed. The behavior of the SPR for different projection angle, breast size, thickness, glandular fraction, and x-ray spectrum was also analyzed, and computer fit equations for the magnitude of the SPR at the center of mass for both the CC and the MLO views were found. Within mammographic energies, the x-ray spectrum was found to have no appreciable effect on the scatter PSF and on the SPR. Glandular fraction and compressed breast size were found to have a small effect, while compressed breast thickness and projection angle, as expected, introduced large variations in both the scatter PSF and SPR. The presence of the breast support plate and the detector cover plate in the simulations introduced important effects on the SPR, which are also relevant to the scatter content in planar mammography.

Tomosynthesis and contrast-enhanced digital mammography: recent advances in digital mammography

Abstract: Digital mammography is more and more replacing conventional mammography. Initial concerns about an inferior image quality of digital mammography have been largely overcome and recent studies even show digital mammography to be superior in women with dense breasts, while at the same time reducing radiation exposure. Nevertheless, an important limitation of digital mammography remains: namely, the fact that summation may obscure lesions in dense breast tissue. However, digital mammography offers the option of so-called advanced applications, and two of these, contrast-enhanced mammography and tomosynthesis, are promising candidates for improving the detection of breast lesions otherwise obscured by the summation of dense tissue. Two techniques of contrast-enhanced mammography are available: temporal subtraction of images acquired before and after contrast administration and the so-called dual-energy technique, which means that pairs of low/high-energy images acquired after contrast administration are subtracted. Tomosynthesis on the other hand provides three-dimensional information on the breast. The images are acquired with different angulations of the X-ray tube while the object or detector is static. Various reconstruction algorithms can then be applied to the set of typically nine to 28 source images to reconstruct 1-mm slices with a reduced risk of obscuring pathology. Combinations of both advanced applications have only been investigated in individual experimental studies; more advanced software algorithms and CAD systems are still in their infancy and have only undergone preliminary clinical evaluation.

Dose dependence of mass and microcalcification detection in digital mammography: free response human observer studies.

Abstract: The purpose of this study was to evaluate the effect of dose reduction in digital mammography on the detection of two lesion types-malignant masses and clusters of microcalcifications. Two free-response observer studies were performed-one for each lesion type. Ninety screening images were retrospectively selected; each image was originally acquired under automatic exposure conditions, corresponding to an average glandular dose of 1.3 mGy for a standard breast (50 mm compressed breast thickness with 50% glandularity). For each study, one to three simulated lesions were added to each of 40 images (abnormals) while 50 were kept without lesions (normals). Two levels of simulated system noise were added to the images yielding two new image sets, corresponding to simulated dose levels of 50% and 30% of the original images (100%). The manufacturer's standard display processing was subsequently applied to all images. Four radiologists experienced in mammography evaluated the images by searching for lesions and marking and assigning confidence levels to suspicious regions. The search data were analyzed using jackknife free-response (JAFROC) methodology. For the detection of masses, the mean figure-of-merit (FOM) averaged over all readers was 0.74, 0.71, and 0.68 corresponding to dose levels of 100%, 50%, and 30%, respectively. These values were not statistically different from each other (F = 1.67, p = 0.19) but showed a decreasing trend. In contrast, in the microcalcification study the mean FOM was 0.93, 0.67, and 0.38 for the same dose levels and these values were all significantly different from each other (F = 109.84, p < 0.000 1). The results indicate that lowering the present dose level by a factor of two compromised the detection of microcalcifications but had a weaker effect on mass detection.

A novel neural-genetic algorithm to find the most significant combination of features in digital mammograms

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 in this paper proposes a neural-genetic algorithm for feature selection to classify microcalcification patterns in digital mammograms. It aims to develop a step-wise algorithm to find the best feature set and a suitable neural architecture for microcalcification classification. The obtained results show that the proposed algorithm is able to find an appropriate feature subset, which also produces a high classification rate.

Does image quality matter? Impact of resolution and noise on mammographic task performance.

Abstract: The purpose of this study was to examine the effects of different resolution and noise levels on task performance in digital mammography. This study created an image set with images at three different resolution levels, corresponding to three digital display devices, and three different noise levels, with noise magnitudes similar to full clinical dose, half clinical dose, and quarter clinical dose. The images were read by five experienced breast imaging radiologists. The data were then analyzed to compute two accuracy statistics (overall classification accuracy and lesion detection accuracy) and performance at four diagnostic tasks (detection of microcalcifications, benign masses, malignant masses, and discrimination of benign and malignant masses). Human observer results showed decreasing display resolution had little effect on overall classification accuracy and individual diagnostic task performance, but increasing noise caused overall classification accuracy to decrease by a statistically significant 21% as the breast dose went to one quarter of its normal clinical value. The noise effects were most prominent for the tasks of microcalcification detection and mass discrimination. When the noise changed from full clinical dose to quarter clinical dose, the microcalcification detection performance fell from 89% to 67% and the mass discrimination performance decreased from 93% to 79%, while malignant mass detection performance remained relatively constant with values of 88% and 84%, respectively. As a secondary aim, the image set was also analyzed by two observer models to examine whether their performance was similar to humans. Observer models differed from human observers and each other in their sensitivity to resolution degradation and noise. The primary conclusions of this study suggest that quantum noise appears to be the dominant image quality factor in digital mammography, affecting radiologist performance much more profoundly than display resolution.

Digital mammography: what do we and what don’t we know?

Abstract: High-quality full-field digital mammography has been available now for several years and is increasingly used for both diagnostic and screening mammography. A number of different detector technologies exist, which all have their specific advantages and disadvantages. Diagnostic accuracy of digital mammography has been shown to be at least equivalent to film-screen mammography in a general screening population. Digital mammography is superior to screen-film mammography in younger women with dense breasts due to its ability to selectively optimize contrast in areas of dense parenchyma. This advantage is especially important in women with a genetic predisposition for breast cancer, where intensified early detection programs may have to start from 25 to 30 years of age. Tailored image processing and computer-aided diagnosis hold the potential to further improve the early detection of breast cancer. However, at present no consensus exists among radiologists on which processing is optimal for digital mammograms. Image processing may also vary significantly among vendors with so far limited interoperability. This review aims to summarize the available information regarding the impact of digital mammography on workflow and breast cancer diagnosis.

Digital Mammographic Computer Aided Diagnosis (CAD) using Adaptive Level Set Segmentation

Abstract: We present a mammographic computer aided diagnosis (CAD) system, which uses an adaptive level set segmentation method (ALSSM), which segments suspicious masses in the polar domain and adaptively adjusts the border threshold at each angle to provide high-quality segmentation results. The primary contribution of this paper is the adaptive speed function for controlling level set segmentation. To assess the efficacy of the system, 60 relatively difficult cases (30 benign, 30 malignant) from the Digital Database of Screening Mammography (DDSM) are analyzed. The segmentation efficacy is analyzed qualitatively via visual inspection and quantitatively via the area under the receiver operating characteristics (ROC) curve (Az) and classification accuracies. For the ALSSM, the best results are 87% overall accuracy, Az=0.9687 with 28/30 malignant cases detected. The qualitative and quantitative results show that the ALSSM provides excellent segmentation and classification results and compares favorably to previous CAD systems in the literature which also used the DDSM database.

Effect of Computer-Aided Detection on Independent Double Reading of Paired Screen-Film and Full-Field Digital Screening Mammograms

Abstract: OBJECTIVE. The purpose of this study was to evaluate the performance and potential contribution of computer-aided detection (CAD) to independent double reading of paired screen-film and full-field digital screening mammograms.MATERIALS AND METHODS. The cases of 3,683 women who underwent both screen-film mammography and full-field digital mammography (FFDM) with independent double reading for each technique were followed for 2 years to include cancers detected in the interval between screening rounds and cancers detected at the next screening round. Fifty-five biopsy-proven cancers were diagnosed. The baseline screening mammograms of the 55 cancers were defined as having positive findings if at least one of two independent readers scored it 2 or higher on a 5-point rating scale. The baseline mammograms of interval (n = 10) or secondround (n = 16) cancers were retrospectively classified as overlooked (n = 2), minimal sign actionable (n = 8), minimal sign nonactionable (n = 5), and normal (n = 11). The basel...

Digital mammography: effects of reduced radiation dose on diagnostic performance.

Abstract: Purpose: To experimentally determine the relationship between radiation dose and observer accuracy in the detection and discrimination of simulated lesions for digital mammography. Materials and Methods: This HIPAA-compliant study received institutional review board approval; the informed consent requirement was waived. Three hundred normal craniocaudal images were selected from an existing database of digital mammograms. Simulated mammographic lesions that mimicked benign and malignant masses and clusters of microcalcifications (3.3–7.4 cm in diameter) were then superimposed on images. Images were rendered without and with added radiographic noise to simulate effects of reducing the radiation dose to one half and one quarter of the clinical dose. Images were read by five experienced breast imaging radiologists. Results were analyzed to determine effects of reduced dose on overall interpretation accuracy, detection of microcalcifications and masses, discrimination between benign and malignant masses, and ...

Digital mammography system with improved workflow

Abstract: A method for supporting diagnostic workflow from a medical imaging apparatus. A set of at least two images are obtained from a patient and displayed according to a user-specified image display layout selected from a plurality of image display layouts. One or more markers are associated with a region of interest in the displayed images. A list of regions of interest is generated, each having an entry for each associated marker. A classification is assigned to each entry in the list of regions of interest according to health risk.

Dual-energy contrast enhanced digital mammography using a new approach for breast tissue canceling

Abstract: In this study, we propose a novel approach to dual-energy contrast-enhanced digital mammography, with the development of a dual-energy recombination algorithm based on an image chain model and the determination of the associated optimal low and high-energy techniques. Our method produces clutter-free iodine-equivalent images and includes thickness correction near the breast border. After the algorithm description, the optimal low and high-energy acquisition techniques are determined to obtain a compromise between image quality and glandular dose. The low and high-energy techniques were chosen to minimize the glandular dose for a target Signal Difference to Noise Ratio (SDNR) in the dual-energy recombined image. The theoretical derivation of the iodine SDNR in the recombined image allowed the prediction of the optimal low and high-energy techniques. Depending on the breast thickness and glandular percentage, the optimal low-energy kVp and mAs ranged from 24kVp (Mo/Mo or Mo/Rh) to 35kVp (Rh/Rh), and from 60 to 90mAs respectively, and the high-energy kVp and mAs ranged from 40kVp to 47kVp (Mo/Cu), and from 80mAs to 290mAs. We proved the better performance of our algorithm compared to the classic weighted logarithmic subtraction method in terms of patient dose and also in terms of texture cancelation, through the use of artificial textured images. Values of iodine contrast measured on phantom were close to the expected iodine thickness. Good correlation was found between the measured and theoretical iodine SDNR in the dual-energy images, which validates our theoretical optimization of the acquisition techniques.

Breast compression for digital mammography, tomosynthesis and other modalities

Abstract: A breast x-ray imaging method and system that is particularly suited for tomosynthesis imaging but also is useful for conventional mammography. A fluid containing pillow or bag is placed between the breast and a paddle that compresses the breast against a breast platform covering an imaging device, to enhance patient comfort and provide other benefits. Alternatives include a flexible sheet compressing the breast, and a compressible foam, preferably contoured to accommodate a patient's breast.

Screening for breast cancer: current recommendations and future directions.

Abstract: Breast cancer is one of the most significant health concerns in the United States. Recent reviews have questioned the value of traditional breast cancer screening methods. Breast self-examination has been shown not to improve cancer-specific or all-cause mortality in large studies, but it is commonly advocated as a noninvasive screen. Patients who choose to perform self-examination should be trained in appropriate technique and follow-up. The contribution of the clinical breast examination to early detection is difficult to determine, but studies show that sensitivity is highly dependent on time taken to do the examination. Up to 10 percent of cancers are mammographically silent but evident on clinical breast examination. The U.S. Preventive Services Task Force recommends mammography for women older than 40 years who are in good health, but physicians should consider that sensitivity is lower for younger women. Digital mammography is somewhat more sensitive in younger women and women with dense breasts, but outcome studies are lacking. Although magnetic resonance imaging shows promise as a screening tool in some high-risk women, it is not currently recommended for general screening because of high false-positive rates and cost. The American Cancer Society recommends annual magnetic resonance imaging as an adjunct to screening mammography in high-risk women 30 years and older.

Clinical applications for stereoscopic 3-D displays

Abstract: — Stereoscopic 3-D digital imaging holds the promise of improving the detection, diagnosis, and treatment of disease as well as enhancing the training and preparation of medical professionals through use of stereoscopic 3-D displays in concert with the many volumetric visualization techniques/modalities developed in recent years. While so-called 3-D graphics have improved the state of computer visualization in general, 3-D displays make full use of the human-visual perception, and thus can provide critical insight in complex computer-generated and video 3-D data. The stereo 3-D applications reviewed in this paper include screening of breast cancer and diabetic retinopathy, visualization for minimally invasive surgery, and the teaching of anatomy. Also included is a discussion of ground-breaking results from a stereo digital mammography clinical trial under way at Emory University.

Clinical mammography at the SYRMEP beam line

Abstract: The synchrotron radiation (SR) clinical mammography, using as detector a commercial screen-film system, is a further crucial step of the SYRMEP (Synchrotron Radiation for Medical Physics) Project. In March and April of this year, mammographic examinations on nine patients have been carried out with X-rays from ELETTRA, the SR laboratory in Trieste, Italy. The facility for Phase Contrast (PhC) SR mammography is now operative in patient mode and is used for patient examinations, producing breast images in different projections. The entire procedure is automated and is able to achieve the correct exposure on the film taking into consideration the requested limits on the applied dose, as a function of the thickness and glandularity of the breast. The SR mammography shows a higher spatial resolution and contrast detail visibility, in comparison with the conventional analog or digital mammography, with a comparable or lower dose. In some cases of these first nine patients, the radiologists have clarified the ambiguity of the previous examinations. These preliminary results are encouraging and a complete evaluation of the clinical impact of the new method is in progress.

A Glass‐Ceramic Plate for Mammography

Abstract: We developed translucent glass-ceramic image plates for digital mammography. The glass ceramics are based on europium-doped fluorozirconate glasses, which were additionally doped with chlorine to initiate the nucleation of barium chloride nano-particles therein. The X-ray image is stored in the form of stable electron-hole pairs, which can be read out afterwards with a scanning laser beam in a "photostimulated luminescence" (PSL) process. Measurements of the required stimulating exposure, integrated PSL signal, and optical light spreading of the stimulating laser light were performed to allow projection of the detective quantum efficiency (DQE) for the proposed X-ray storage phosphor system. The projected DQE is compared with commercially available electronic mammography systems.

Automated ultrasound scanning on a dual-modality breast imaging system: coverage and motion issues and solutions.

Abstract: Objective. We are developing an automated ultrasound imaging-mammography system wherein a digital mammography unit has been augmented with a motorized ultrasound transducer carriage above a special compression paddle. Challenges of this system are acquiring complete coverage of the breast and minimizing motion. We assessed these problems and investigated methods to increase coverage and stabilize the compressed breast. Methods. Visual tracings of the breast-to-paddle contact area and breast periphery were made for 10 patients to estimate coverage area. Various motion artifacts were evaluated in 6 patients. Nine materials were tested for coupling the paddle to the breast. Fourteen substances were tested for coupling the transducer to the paddle in lateral-to-medial and medial-to-lateral views and filling the gap between the peripheral breast and paddle. In-house image registration software was used to register adjacent ultrasound sweeps. Results. The average breast contact area was 56%. The average percentage of the peripheral air gap filled with ultrasound gel was 61%. Shallow patient breathing proved equivalent to breath holding, whereas speech and sudden breathing caused unacceptable artifacts. An adhesive spray that preserves image quality was found to be best for coupling the breast to the paddle and minimizing motion. A highly viscous ultrasound gel proved most effective for coupling the transducer to the paddle for lateral-to-medial and medial-to-lateral views and for edge fill-in. Conclusions. The challenges of automated ultrasound scanning in a multimodality breast imaging system have been addressed by developing methods to fill in peripheral gaps, minimize patient motion, and register and reconstruct multisweep ultrasound image volumes.

Optimization of detector operation and imaging geometry for breast tomosynthesis

Abstract: In breast tomosynthesis there are tradeoffs between resolution, noise and acquisition speed for a given glandular dose. The purpose of the present work is to investigate the dependence of tomosynthesis imaging performance on system configuration, which includes detector operational modes and image acquisition geometry. A prototype Siemens breast tomosynthesis system with maximum angular range of +/- 25 degrees was used in our investigation. The system was equipped with an amorphous selenium (a-Se) full field digital mammography detector with pixel size of 85µm. The detector can be read out with full resolution or 2x1 binning (binning in the tube travel direction), which increases the image readout rate and decreases the degradation effect of electronic noise. The total number of views can be varied from 11 to 49, and filtered back projection (FBP) method was used to reconstruct the tomosynthesis images. We investigated the effects of detector operational modes (binning) and imaging geometry (view angle and number) on temporal performance and spatial resolution of the projection images. The focal spot blur due to continuous tube travel was measured for different acquisition geometry, and its effect on in-plane presampling modulation transfer function (MTF) was compared to that due to pixel binning. A three-dimensional cascaded linear system model was developed for tomosynthesis to predict the 3D MTF, NPS and DQE. The results were compared with experimental measurements, and reasonable agreement was achieved. The understanding of the relationship between the 3D and projection image quality will lead to optimization of the x-ray spectrum, imaging geometry and reconstruction filters for digital breast tomosynthesis.

Dual-energy contrast enhanced digital breast tomosynthesis: concept, method, and evaluation on phantoms

Abstract: In this paper, we present the development of dual-energy Contrast-Enhanced Digital Breast Tomosynthesis (CEDBT). A method to produce background clutter-free slices from a set of low and high-energy projections is introduced, along with a scheme for the determination of the optimal low and high-energy techniques. Our approach consists of a dual-energy recombination of the projections, with an algorithm that has proven its performance in Contrast-Enhanced Digital Mammography 1 (CEDM), followed by an iterative volume reconstruction. The aim is to eliminate the anatomical background clutter and to reconstruct slices where the gray level is proportional to the local iodine volumetric concentration. Optimization of the low and high-energy techniques is performed by minimizing the total glandular dose to reach a target iodine Signal Difference to Noise Ratio (SDNR) in the slices. In this study, we proved that this optimization could be done on the projections, by consideration of the SDNR in the projections instead of the SDNR in the slices, and verified this with phantom measurements. We also discuss some limitations of dual-energy CEDBT, due to the restricted angular range for the projection views, and to the presence of scattered radiation. Experiments on textured phantoms with iodine inserts were conducted to assess the performance of dual-energy CEDBT. Texture contrast was nearly completely removed and the iodine signal was enhanced in the slices.