Optimization of contrast-enhanced spectral mammography depending on clinical indication

Dromain, Clarisse; Canale, Sandra; Saab-Puong, Sylvie; Carton, Ann-Katherine; Muller, Serge; Fallenberg, Eva Maria

doi:10.1117/1.jmi.1.3.033506

Cited by 11 publications

(10 citation statements)

References 23 publications

(27 reference statements)

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“…Previous work from our group led to the development of the tungsten, molybdenum, and rhodium anode spectral models for mammography using interpolating polynomials (TASMIP M , MASMIP M , and RASMIP M , respectively; subscript “M” indicating application to mammography); these models used measured spectra from mammography x‐ray tubes of the past and addressed tube potentials from 20 to 42 kV. New applications in breast imaging utilize tube potentials up to 49 kV with exotic filtration — primarily for dual‐energy contrast‐enhanced imaging applications …”

Section: Introductionmentioning

confidence: 99%

“…New applications in breast imaging utilize tube potentials up to 49 kV with exotic filtration primarily for dual-energy contrast-enhanced imaging applications. [27][28][29][30] The two aforementioned mammographic spectral models do not address these higher tube potentials and modern target/filter combinations. In addition, no x-ray spectral model currently exists specifically for bCT.…”

Section: Introductionmentioning

confidence: 99%

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Generation and analysis of clinically relevant breast imaging x-ray spectra

et al. 2017

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Purpose The purpose of this work was to develop and make available x-ray spectra for some of the most widely used digital mammography (DM), breast tomosynthesis (BT), and breast CT (bCT) systems in North America. Methods The Monte Carlo code MCNP6 was used to simulate minimally-filtered (only beryllium) x-ray spectra at 8 tube potentials from 20 to 49 kV for DM/BT, and 9 tube potentials from 35 to 70 kV for bCT. Vendor-specific anode compositions, effective anode angles, focal spot sizes, source-to-detector distances, and beryllium filtration were simulated. For each 0.5 keV energy bin in all simulated spectra, the fluence was interpolated using cubic splines across the range of simulated tube potentials to produce spectra in 1 kV increments from 20 to 49 kV for DM/BT and from 35 to 70 kV for bCT. The HVL of simulated spectra with conventional filtration (at 35 kV for DM/BT and 49 kV for bCT) was used to assess spectral differences resulting from variations in: (1) focal spot size (0.1 and 0.3 mm IEC), (2) solid angle at the detector (i.e. small and large FOV size), and (3) geometrical specifications for vendors that employ the same anode composition. Results Averaged across all DM/BT vendors, variations in focal spot and FOV size resulted in HVL differences of 2.2% and 0.9%, respectively. Comparing anode compositions separately, the HVL differences for Mo (GE, Siemens) and W (Hologic, Philips, and Siemens) spectra were 0.3% and 0.6%, respectively. Both the commercial Koning and prototype “Doheny” (UC Davis) bCT systems utilize W anodes with a 0.3 mm focal spot. Averaged across both bCT systems, variations in FOV size resulted in a 2.2% difference in HVL. In addition, the Koning spectrum was slightly harder than Doheny with a 4.2% difference in HVL. Therefore to reduce redundancy, a generic DM/BT system and a generic bCT system were used to generate the new spectra reported herein. The spectral models for application to DM/BT were dubbed the Molybdenum, Rhodium, and Tungsten Anode Spectral Models using Interpolating Cubic Splines (MASMICSM-T, RASMICSM-T, and TASMICSM-T ; subscript “M-T” indicating mammography and tomosynthesis). When compared against reference models (MASMIPM, RASMIPM, and TASMIPM; subscript “M” indicating mammography), the new spectral models were in close agreement with mean differences of 1.3%, −1.3%, and −3.3%, respectively, across tube potential comparisons of 20, 30, and 40 kV with conventional filtration. TASMICSbCT-generated bCT spectra were also in close agreement with the reference TASMIP model with a mean difference of −0.8%, across tube potential comparisons of 35, 49, and 70 kV with 1.5 mm Al filtration. Conclusions The Mo, Rh, and W anode spectra for application in DM and BT (MASMICSM-T, RASMICSM-T, and TASMICSM-T) and the W anode spectra for bCT (TASMICSbCT) as described in this study should be useful for individuals interested in modeling the performance of modern breast x-ray imaging systems including dual energy mammography which extends to 49 kV. These new spectra are t...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Generation and analysis of clinically relevant breast imaging x-ray spectra

et al. 2017

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“…Today, CESM is generally being used in a diagnostic setting. However, other potential clinical indications are being considered, including assessment of extent of disease, problem solving after non conclusive mammography and ultrasonography exams, screening of high-risk women, and CESM-guided biopsy 2,3 . To understand the clinical feasibility and find optimal imaging conditions, researchers continue to explore the parameter space of this modality 3 .…”

Section: Introductionmentioning

confidence: 99%

Assessment of mass detection performance in contrast enhanced digital mammography

Carton¹,

Carvalho²,

et al. 2015

Medical Imaging 2015: Image Perception, Observer Performance, and Technology Assessment

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We address the detectability of contrast-agent enhancing masses for contrast-agent enhanced spectral mammography (CESM), a dual-energy technique providing functional projection images of breast tissue perfusion and vascularity using simulated CESM images. First, the realism of simulated CESM images from anthropomorphic breast software phantoms generated with a software x-ray imaging platform was validated. Breast texture was characterized by power-law coefficients calculated in data sets of real clinical and simulated images. We also performed a 2-alternative forced choice (2-AFC) psychophysical experiment whereby simulated and real images were presented side-by-side to an experienced radiologist to test if real images could be distinguished from the simulated images. It was found that texture in our simulated CESM images has a fairly realistic appearance. Next, the relative performance of human readers and previously developed mathematical observers was assessed for the detection of iodine-enhancing mass lesions containing different contrast agent concentrations. A four alternative-forced-choice (4 AFC) task was designed; the task for the model and human observer was to detect which one of the four simulated DE recombined images contained an iodineenhancing mass. Our results showed that the NPW and NPWE models largely outperform human performance. After introduction of an internal noise component, both observers approached human performance. The CHO observer performs slightly worse than the average human observer. There is still work to be done in improving model observers as predictors of human-observer performance. Larger trials could also improve our test statistics. We hope that in the future, this framework of software breast phantoms, virtual image acquisition and processing, and mathematical observers can be beneficial to optimize CESM imaging techniques.

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“…Despite the promising results of CEM, there are concerns over radiation exposure and the potential for contrast reactions. Studies have shown CEM delivers an average glandular dose that is 20-80% higher than that of FFDM with a per-view average glandular dose range 0.43-2.65 mGy but below the United States Food and Drug Administration limit of 3 mGy specified by the Mammography Quality Standards Act regulations [30][31][32][33]. The adverse reaction rate to intravenous contrast agents is similar to that reported for CT; one meta-analysis found a 0.82% pooled rate of adverse reactions, of which 87% were mild reactions, and only one severe reaction occurred in 14,012 patients [33].…”

Section: Introductionmentioning

confidence: 99%

Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery

Gluskin

Saccarelli

Avendaño

et al. 2020

Cancers

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To investigate the value of contrast-enhanced mammography (CEM) compared to full-field digital mammography (FFDM) in screening breast cancer patients after breast-conserving surgery (BCS), this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective, single-institution study included 971 CEM exams in 541 asymptomatic patients treated with BCS who underwent screening CEM between January 2013 and November 2018. Histopathology, or at least a one-year follow-up, was used as the standard of reference. Twenty-one of 541 patients (3.9%) were diagnosed with ipsi- or contralateral breast cancer: six (28.6%) cancers were seen with low-energy images (equivalent to FFDM), an additional nine (42.9%) cancers were detected only on iodine (contrast-enhanced) images, and six interval cancers were identified within 365 days of a negative screening CEM. Of the 10 ipsilateral cancers detected on CEM, four were detected on low-energy images (40%). Of the five contralateral cancers detected on CEM, two were detected on low-energy images (40%). Overall, the cancer detection rate (CDR) for CEM was 15.4/1000 (15/971), and the positive predictive value (PPV3) of the biopsies performed was 42.9% (15/35). For findings seen on low-energy images, with or without contrast, the CDR was 6.2/1000 (6/971), and the PPV3 of the biopsies performed was 37.5% (6/16). In the post-BCS screening setting, CEM has a higher CDR than FFDM.

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Optimization of contrast-enhanced spectral mammography depending on clinical indication

Cited by 11 publications

References 23 publications

Generation and analysis of clinically relevant breast imaging x-ray spectra

Generation and analysis of clinically relevant breast imaging x-ray spectra

Assessment of mass detection performance in contrast enhanced digital mammography

Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery

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