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.

Amorphous silicon/cesium iodide (a-Si:H/CsI:Tl) flat-panel (FP)-based full-field digital mammography systems have recently become commercially available for clinical use. Some investigations on physical properties and imaging characteristics of these types of detectors have been conducted and reported. In this perception study, a phantom containing simulated microcalcifications (microCs) of various sizes was imaged with four detector systems: a FP system, a small field-of-view charge coupled device (CCD) system, a high resolution computed radiography (CR) system, and a conventional mammography screen/film (SF) system. The images were reviewed by mammographers as well as nonradiologist participants. Scores reflecting confidence ratings were given and recorded for each detection task. The results were used to determine the average confidence-rating scores for the four imaging systems. Receiver operating characteristics (ROC) analysis was also performed to evaluate and compare the overall detection accuracy for the four detector systems. For calcifications of 125-140 microm in size, the FP system was found to have the best performance with the highest confidence-rating scores and the greatest detection accuracy (Az = 0.9) in the ROC analysis. The SF system was ranked second while the CCD system outperformed the CR system. The p values obtained by applying a Student t-test to the results of the ROC analysis indicate that the differences between any two systems are statistically significant (p<0.005). Differences in microC detectability for the large (150-160 microm) and small (112-125 microm) size microC groups showed a wider range of p values (not all p values are smaller than 0.005, ranging from 0.6 to <0.001) compared to the p values obtained for the medium (125-140 microm) size microC group. Using the p values to assess the statistical significance, the use of the average confidence-rating scores was not as significant as the use of the ROC analysis p value for p value.

Flat-panel (FP) based digital radiography systems have recently been introduced as a new and improved digital radiography technology; it is important to evaluate and compare this new technology with currently widely used conventional screen/film (SF) and computed radiography (CR) techniques. In this study, the low-contrast performance of an amorphous silicon/cesium iodide (aSi/Csl)-based flat-panel digital chest radiography system is compared to those of a screen/film and a computed radiography system by measuring their contrast-detail curves. Also studied were the effects of image enhancement in printing the digital images and dependence on kVp and incident exposure. It was found that the FP system demonstrated significantly better low-contrast performance than the SF or CR systems. It was estimated that a dose savings of 70%-90% could be achieved to match the low-contrast performance of the FP images to that of the SF images. This dose saving was also found to increase with the object size. No significant difference was observed in low-contrast performances between the SF and CR systems. The use of clinical enhancement protocols for printing digital images was found to be essential and result in better low-contrast performance. No significant effects were observed for different kVps. From the results of this contrast-detail phantom study, the aSi/CsI-based flat-panel digital chest system should perform better under clinical situations for detection of low-contrast objects such as lung nodules. However, proper processing prior to printing would be essential to realizing this better performance.

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The amorphous silicon/cesium iodide (a-Si:H/CsI:Tl) flat-panel imaging systems have recently become commercially available for both chest and mammographic imaging applications. This new detector technology is considered to be a significant improvement over CR techniques. In this work, we measured the image properties for two commercial flat-panel systems and compared them with those measured for CR and CCD based imaging systems. Image quality measurements related to detector properties such as linearity, MTF, NPS and DQE are presented and compared at selected chest and mammographic imaging techniques. Factors and issues related to these measurements are discussed. For chest imaging, the flat-panel system was found to have slightly lower MTFs but significantly higher DQEs than the CR system. For mammographic imaging, the CCD-based system was found to have the highest MTF, followed in order by the flat-panel and CR systems. The flat-panel system was found to have the highest DQEs, followed in the order by the CCD-based and CR systems. The DQEs of the flat-panel systems were found to increase with exposure while those of the CR systems decrease slightly with the exposure in both chest and mammographic imaging. The DQEs of the CCD-based system were found to vary little for exposures ranging from 1 to 30 mR.

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