X-ray mammography of the compressed breast is well recognized as the "gold standard" for early detection of breast cancer, but its performance is not ideal. One limitation of screening mammography is tissue superposition, particularly for dense breasts. Since 2001, several research groups in the USA and in the European Union have developed computed tomography (CT) systems with digital detector technology dedicated to x-ray imaging of the uncompressed breast (breast CT or BCT) for breast cancer screening and diagnosis. This CT technology--tracing back to initial studies in the 1970s--allows some of the limitations of mammography to be overcome, keeping the levels of radiation dose to the radiosensitive breast glandular tissue similar to that of two-view mammography for the same breast size and composition. This paper presents an evaluation of the research efforts carried out in the invention, development, and improvement of BCT with dedicated scanners with state-of-the-art technology, including initial steps toward commercialization, after more than a decade of R&D in the laboratory and/or in the clinic. The intended focus here is on the technological/engineering aspects of BCT and on outlining advantages and limitations as reported in the related literature. Prospects for future research in this field are discussed.

The aim of the SYRMA-CT collaboration is to set-up the first clinical trial of phase-contrast breast CT with synchrotron radiation (SR). In order to combine high image quality and low delivered dose a number of innovative elements are merged: a CdTe single photon counting detector, state-of-the-art CT reconstruction and phase retrieval algorithms. To facilitate an accurate exam optimization, a Monte Carlo model was developed for dose calculation using GEANT4. In this study, high isotropic spatial resolution (120 μm)(3) CT scans of objects with dimensions and attenuation similar to a human breast were acquired, delivering mean glandular doses in the range of those delivered in clinical breast CT (5-25 mGy). Due to the spatial coherence of the SR beam and the long distance between sample and detector, the images contain, not only absorption, but also phase information from the samples. The application of a phase-retrieval procedure increases the contrast-to-noise ratio of the tomographic images, while the contrast remains almost constant. After applying the simultaneous algebraic reconstruction technique to low-dose phase-retrieved data sets (about 5 mGy) with a reduced number of projections, the spatial resolution was found to be equal to filtered back projection utilizing a four fold higher dose, while the contrast-to-noise ratio was reduced by 30%. These first results indicate the feasibility of clinical breast CT with SR.

We investigated the influence of model assumptions in GEANT4 Monte Carlo (MC) simulations for the calculation of monoenergetic and polyenergetic normalized glandular dose coefficients (DgN) in mammography, focussing on the effect of the skin thickness and composition, of the role of compression paddles and of the bremsstrahlung processes. We showed that selecting a skin thickness of 4 mm instead of 1.45 mm produced DgN values with deviations from 9% to 32% for x-ray spectra routinely adopted in mammography. Consideration of the bremsstrahlung radiation had a weak influence on monoenergetic DgN. Simulations (in the range 8-40 kVp) which included consideration of bremsstrahlung radiation, a skin thickness of 1.45 mm and a 2 mm thick compression paddles produced polyenergetic DgN coefficients up to 19% higher than corresponding literature data. Adding a 2 mm thick adipose layer between the skin layer and the radiosensitive portion of the breast produces polyenergetic DgN values up to 15% higher than those routinely adopted. These findings provide a quantitative estimate of the influence of model parameters on the calculation of the mean glandular dose in mammography.

We investigated the dose-response of the external beam therapy 3 (EBT3) films for proton and carbon ion clinical beams, in comparison with conventional radiotherapy beams; we also measured the film response along the energy deposition-curve in water. We performed measurements at three hadrontherapy centres by delivering monoenergetic pencil beams (protons: 63-230 MeV; carbon ions: 115-400 MeV/u), at 0.4-20 Gy dose to water, in the plateau of the depth-dose curve. We also irradiated the films to clinical MV-photon and electron beams. We placed the EBT3 films in water along the whole depth-dose curve for 148.8 MeV protons and 398.9 MeV/u carbon ions, in comparison with measurements provided by a plane-parallel ionization chamber. For protons, the response of EBT3 in the plateau of the depth-dose curve is not different from that of photons, within experimental uncertainties. For carbon ions, we observed an energy dependent under-response of EBT3 film, from 16% to 29% with respect to photon beams. Moreover, we observed an under-response in the Bragg peak region of about 10% for 148.8 MeV protons and of about 42% for 398.9 MeV/u carbon ions. For proton and carbon ion clinical beams, an under-response occurs at the Bragg peak. For carbon ions, we also observed an under-response of the EBT3 in the plateau of the depth-dose curve. This effect is the highest at the lowest initial energy of the clinical beams, a phenomenon related to the corresponding higher LET in the film sensitive layer. This behavior should be properly modeled when using EBT3 films for accurate 3D dosimetry.

Breast physical phantoms are a basic tool for the assessment and verification of performance standards in daily clinical practice of x-ray breast imaging modalities. They are also invaluable in testing and evaluation of new x-ray breast modalities to be potentially established, e.g. breast computed tomography, dual-energy breast CT and phase-contrast mammography and tomography. Nowadays, there is a lack or there are only a limited number of breast physical phantoms available for this purpose.The aim of this study is to explore a range of 3D printing materials such as resins, PLA, ABS, Nylon etc, to determine their attenuation and refractive properties, and to finally compare them to the properties of the breast tissues: adipose, glandular and skin.To achieve this goal, step-wedge phantoms were computationally modeled and then manufactured using stereolithographic and fused-deposition modeling technologies. X-ray images of the phantoms were acquired, using monochromatic beam at ID17, ESRF, Grenoble for three energies-30 keV, 45 keV and 60 keV. Experimental data were further processed to obtain the linear attenuation coefficients of these materials. Comparison with theoretical data for the linear attenuation coefficients and the refractive indexes for breast tissues was performed.From the studied materials, most of the resins, Nylon, Hybrid, PET-G show absorption properties close to the glandular tissue, while ABS shows absorption characteristics close to these of the adipose tissue. For phase-contrast imaging, it turns out that the ABS combined with resin-based materials to represent the adipose and glandular tissues, respectively may be a good combination for manufacturing of a phantom suitable for these studies.These results can be used for the design and the construction of a new physical anthropomorphic phantom of the breast with improved anatomical and radiological characteristics dedicated for advanced mammography imaging techniques implemented at higher photon energies.

A dataset of monoenergetic and polyenergetic DgN coefficients for BCT was provided. Patient specific breast models showed a different volume distribution of glandular dose and determined a DgN 8% lower, on average, than homogeneous breast model.

Mean glandular dose (MGD) is the main dosimetric quantity in mammography. MGD evaluation is obtained by multiplying the entrance skin air kerma (ESAK) by normalized glandular dose (DgN) coefficients. While ESAK is an empirical quantity, DgN coefficients can only be estimated with Monte Carlo (MC) methods. Thus, a MC parameters benchmark is needed for effectively evaluating DgN coefficients. GEANT4 is a MC toolkit suitable for medical purposes that offers to the users several computational choices. In this work we investigate the GEANT4 performances testing the main PhysicsLists for medical applications. Four electromagnetic PhysicsLists were implemented: the linear attenuation coefficients were calculated for breast glandularity 0%, 50%, 100% in the energetic range 8-50 keV and DgN coefficients were evaluated. The results were compared with published data. Fit equations for the estimation of the G-factor parameter, introduced by the literature for converting the dose delivered in the heterogeneous medium to that in the glandular tissue, are proposed and the application of this parameter interaction-by-interaction or retrospectively is discussed. G4EmLivermorePhysicsList shows the best agreement for the linear attenuation coefficients both with theoretical values and published data. Moreover, excellent correlation factor (r2>0.99) is found for the DgN coefficients with the literature. The final goal of this study is to identify, for the first time, a benchmark of parameters that could be useful for future breast dosimetry studies with GEANT4.

Breast computed tomography (BCT) is an emerging application of X‐ray tomography in radiological practice. A few clinical prototypes are under evaluation in hospitals and new systems are under development aiming at improving spatial and contrast resolution and reducing delivered dose. At the same time, synchrotron‐radiation phase‐contrast mammography has been demonstrated to offer substantial advantages when compared with conventional mammography. At Elettra, the Italian synchrotron radiation facility, a clinical program of phase‐contrast BCT based on the free‐space propagation approach is under development. In this paper, full‐volume breast samples imaged with a beam energy of 32 keV delivering a mean glandular dose of 5 mGy are presented. The whole acquisition setup mimics a clinical study in order to evaluate its feasibility in terms of acquisition time and image quality. Acquisitions are performed using a high‐resolution CdTe photon‐counting detector and the projection data are processed via a phase‐retrieval algorithm. Tomographic reconstructions are compared with conventional mammographic images acquired prior to surgery and with histologic examinations. Results indicate that BCT with monochromatic beam and free‐space propagation phase‐contrast imaging provide relevant three‐dimensional insights of breast morphology at clinically acceptable doses and scan times.