Breast cancer may manifest as microcalcifications (microCs) in x-ray mammography. However, the detection and visualization of microCs are often obscured by the overlapping tissue structures. The dual-energy subtraction imaging technique offers an alternative approach for imaging and visualizing microCs. With this technique, separate high- and low-energy images are acquired and their differences are used to "cancel" out the background tissue structures. However, the subtraction process could increase the statistical noise level relative to the calcification contrast. Therefore, a key issue with the dual-energy subtraction imaging technique is to weigh the benefit of removing the cluttered background tissue structure over the drawback of reduced signal-to-noise ratio in the subtracted microC images. In this report, a theoretical framework for calculating the (quantum) noise in the subtraction images is developed and the numerical computations are described. We estimate the noise levels in the dual-energy subtraction signals under various imaging conditions, including the x-ray spectra, microC size, tissue composition, and breast thickness. The selection of imaging parameters is optimized to evaluate the feasibility of using a dual-energy subtraction technique for the improved detection and visualization of microCs. We present the results and discuss its dependence on imaging parameters.

Mammographic images of small calcifications, which are often the earliest signs of breast cancer, can be obscured by overlapping fibroglandular tissue. We have developed and implemented a dual-energy digital mammography (DEDM) technique for calcification imaging under full-field imaging conditions using a commercially available aSi:H/CsI:Tl flat-panel based digital mammography system. The low- and high-energy images were combined using a nonlinear mapping function to cancel the tissue structures and generate the dual-energy (DE) calcification images. The total entrance-skin exposure and mean-glandular dose from the low- and high-energy images were constrained so that they were similar to screening-examination levels. To evaluate the DE calcification image, we designed a phantom using calcium carbonate crystals to simulate calcifications of various sizes (212-425 microm) overlaid with breast-tissue-equivalent material 5 cm thick with a continuously varying glandular-tissue ratio from 0% to 100%. We report on the effects of scatter radiation and nonuniformity in x-ray intensity and detector response on the DE calcification images. The nonuniformity was corrected by normalizing the low- and high-energy images with full-field reference images. Correction of scatter in the low- and high-energy images significantly reduced the background signal in the DE calcification image. Under the current implementation of DEDM, utilizing the mammography system and dose level tested, calcifications in the 300-355 microm size range were clearly visible in DE calcification images. Calcification threshold sizes decreased to the 250-280 microm size range when the visibility criteria were lowered to barely visible. Calcifications smaller than approximately 250 microm were usually not visible in most cases. The visibility of calcifications with our DEDM imaging technique was limited by quantum noise, not system noise.

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 mammographic imager. 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 approximately 50 microm for the aluminum thickness and approximately 0.05 for the glandular ratio.

Dual-energy digital mammography (DEDM), 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. Under ideal imaging conditions, when the mammography image data are free of scatter and other biases, DEDM could be used to determine the thicknesses of the imaged calcifications. We present quantitative evaluation of a DEDM technique for calcification imaging. The phantoms used in the evaluation were constructed by placing aluminium strips of known thicknesses (to simulate calcifications) across breast-tissue-equivalent materials of different glandular-tissue compositions. The images were acquired under narrow-beam geometry and high exposures to suppress the detrimental effects of scatter and random noise. The measured aluminium thicknesses were found to be approximately linear with the true aluminium thicknesses and independent of the underlying glandular-tissue composition. However, the dual-energy images underestimated the true aluminium thickness due to the presence of scatter from adjacent regions. Regions in the DEDM image that contained no aluminium yielded very low aluminium thicknesses (<0.07 mm). The aluminium contrast-to-noise ratio in the dual-energy images increased with the aluminium thickness and decreased with the glandular-tissue composition. The changes to the aluminium contrast-to-noise ratio and the contrast of the tissue structures between the low-energy and DEDM images are also presented.

Mammography is the only technique currently used for detecting microcalcification (MC) clusters, an early indicator of breast cancer. However, mammographic images superimpose a three-dimensional compressed breast image onto two-dimensional projection views, resulting in overlapped anatomical breast structures that may obscure the detection and visualization of MCs. One possible solution to this problem is the use of cone beam computed tomography (CBCT) with a flat-panel (FP) digital detector. Although feasibility studies of CBCT techniques for breast imaging have yielded promising results, they have not shown how radiation dose and x-ray tube voltage affect the accuracy with which MCs are detected by CBCT experimentally. We therefore conducted a phantom study using a FP-based CBCT system with various mean glandular doses and kVp values. An experimental CBCT scanner was constructed with a data acquisition rate of 7.5 frames/s. 10.5 and 14.5 cm diameter breast phantoms made of gelatin were used to simulate uncompressed breasts consisting of 100% glandular tissue. Eight different MC sizes of calcium carbonate grains, ranging from 180-200 microm to 355-425 microm, were used to simulate MCs. MCs of the same size were arranged to form a 5 x 5 MC cluster and embedded in the breast phantoms. These MC clusters were positioned at 2.8 cm away from the center of the breast phantoms. The phantoms were imaged at 60, 80, and 100 kVp. With a single scan (360 degrees), 300 projection images were acquired with 0.5 x, 1x, and 2x mean glandular dose limit for 10.5 cm phantom and with 1x, 2x, and 4x for 14.5 cm phantom. A Feldkamp algorithm with a pure ramp filter was used for image reconstruction. The normalized noise level was calculated for each x-ray tube voltage and dose level. The image quality of the CBCT images was evaluated by counting the number of visible MCs for each MC cluster for various conditions. The average percentage of the visible MCs was computed and plotted as a function of the MGD, the kVp, and the average MC size. The results showed that the MC visibility increased with the MGD significantly but decreased with the breast size. The results also showed that the x-ray tube voltage affects the detection of MCs under different circumstances. With a 50% threshold, the minimum detectable MC sizes for the 10.5 cm phantom were 348(+/-2), 288(+/-7), 257(+/-2) microm at 3, 6, and 12 mGy, respectively. Those for the 14.5 cm phantom were 355 (+/-1), 307 (+/-7), 275 (+/-5) microm at 6, 12, and 24 mGy, respectively. With a 75% threshold, the minimum detectable MC sizes for the 10.5 cm phantom were 367 (+/-1), 316 (+/-7), 265 (+/-3) microm at 3, 6, and 12 mGy, respectively. Those for the 14.5 cm phantom were 377 (+/-3), 334 (+/-5), 300 (+/-2) microm at 6, 12, and 24 mGy, respectively.

In cone beam breast computed tomography (CT), scattered radiation leads to nonuniform biasing of CT numbers known as a cupping artifact. Besides being visual distractions, cupping artifacts appear as background nonuniformities, which impair efficient gray scale windowing and pose a problem in threshold based volume visualization/segmentation. To overcome this problem, we have developed a background nonuniformity correction method specifically designed for cone beam breast CT. With this technique, the cupping artifact is modeled as an additive background signal profile in the reconstructed breast images. Due to the largely circularly symmetric shape of a typical breast, the additive background signal profile was also assumed to be circularly symmetric. The radial variation of the background signals was estimated by measuring the spatial variation of adipose tissue signals in front view breast images. To extract adipose tissue signals in an automated manner, a signal sampling scheme in polar coordinates and a background trend fitting algorithm were implemented. The background fits compared with targeted adipose tissue signal value (constant throughout the breast volume) to get an additive correction value for each tissue voxel. To test the accuracy, we applied the technique to cone beam CT images of mastectomy specimens. After correction, the images demonstrated significantly improved signal uniformity in both front and side view slices. The reduction of both intraslice and interslice variations in adipose tissue CT numbers supported our observations.

Use of role-play scenarios in the classroom is just one of a number of active learning techniques that are being used more and more frequently to convey the more abstract concepts of international relations (IR) to students in a meaningful way. This paper examines the value of two specific role-play exercises used in an introduction to international relations course on the topics of peacekeeping and foreign policy decision making. The value of such interactive exercises is laid out in a section examining what learning objectives can be achieved by using role-play scenarios. These include promoting student interaction and input, and promoting student curiosity and creativity. The preparations necessary for conducting such an exercise are laid out, followed by a description of the exercises as they were conducted in the classroom. Finally, an assessment of the exercises provides useful feedback on the degree to which specific learning objectives were achieved, and how such exercises can be modified to be even more effective.

OBJECTIVE-The purpose of this study was to investigate the feasibility of diagnostic breast imaging using a flat-panel detector-based cone-beam CT system. CONCLUSION-Imaging of 12 mastectomy specimens was performed at 50-80 kVp with a voxel size of 145 or 290 μm. Our study shows that cone-beam breast CT images have exceptional tissue contrast and can potentially reduce examination time with comparable radiation dose.Keywords breast neoplasm; CT radiography; mastectomy; radiation dose; specimen radiography Mammography is an important tool for the screening, diagnosis, and management of breast cancers. The effectiveness of mammography is compromised by fundamental problems including radiation scatter, noise, and the over-lapping of cancers with breast anatomy. Tomosynthesis may partially overcome this limitation, but its image quality suffers from crude depth resolution and associated artifacts [1]. Cone-beam CT, on the other hand, can provide true 3D breast images with isotropic resolution (145 μm or smaller) and radiation dose comparable to two-view mammography [2]. Conventional fan-beam CT applied to breast cancer imaging in the 1970s suffered from limitations including high patient dose, low spatial resolution, long scanning time, large slice thickness, and cardiac and respiratory motion [3,4]. The advantages of cone-beam CT include a flatpanel digital detector, true 3D images with isotropic resolution, reduced motion artifacts, breast-only exposure to radiation, greater efficiency in use of the X-ray beam, no overlapping structures in the breast, and high contrast resolution. We constructed a flat-panel detector-based cone-beam CT system to investigate the feasibility for dedicated breast imaging [5]. Materials and MethodsThe experimental system consists of a general radiography tube pointing at a 30 × 40 cm amorphous silicon (a-Si/CsI) flat-panel digital detector (Paxscan 4030CB, Varian Medical Systems). A motor-driven rotation stage is used to position and rotate the specimen to simulate dedicated breast CT in which the patient would lie on a table in the prone position with one breast drawn downward through an opening to allow the X-ray tube and detector to rotate around and scan the breast beneath the table (Fig. 1).A total of 12 mastectomy specimens were acquired fresh from the pathology laboratory in our institution with institutional review board approval. Each specimen was placed in a receptacle formulated from an inverted soda bottle, and the holder was placed on the rotation stage. Scanning was performed at 50-80 kVp with reconstructed voxel size of 145 or 290 μm. The exposures in air at the isocenter of the cone-beam CT system were measured with a pencil-probe ion chamber, resulting in calculated dose levels equivalent to 6-24 mGy for the breast, which correspond to 1-4 times the mean glandular dose limits for two-view mammograms of a 5-cm-thick compressed breast. ResultsThe mean scanning time was 12 seconds for low-resolution (binning) mode, which was adequate for visualizing tissue struc...