A Pilot Study to Assess the Performance of Phase-Sensitive Breast Tomosynthesis.

Background A new modality, phase-sensitive breast tomosynthesis (PBT), may have similar diagnostic performance to conventional breast tomosynthesis but with a reduced radiation dose. Purpose To perform a pilot study of the performance of a novel PBT system compared with conventional digital breast tomosynthesis (DBT) in patients undergoing additional diagnostic imaging workup for breast lesions. Materials and Methods In a prospective study from June 2020 to March 2021, participants with suspicious breast lesions detected at screening DBT or MRI were recruited for additional PBT imaging before additional diagnostic workup or biopsy. In this pilot study, nine radiologists independently evaluated image quality and assessed the likelihood of lesion malignancy by retrospectively evaluating DBT and PBT images in two separate reading sessions. Image quality was rated subjectively using a Likert scale from 1 to 5. Areas under the receiver operating characteristic curve (AUCs) were used to compare the lesion classification (malignant vs benign) performance of the radiologists. Results Images in 50 patients (mean age, 56 years ± 12 [SD]; 49 women) with 52 evaluable lesions (28 malignant) were assessed. For image appearance and general feature visibility, DBT images had a higher total mean image quality score (3.8) than PBT images (2.9), with P < .002 for each comparison. For classification of lesions as benign or malignant, the AUCs were 0.74 for both PBT and DBT. PBT images were acquired at a 24% mean radiation dose reduction (mean, 1.78 mGy vs 2.34 mGy for DBT; P < .001). Conclusion The phase-sensitive breast tomosynthesis system had a 24% lower mean radiation dose compared with digital breast tomosynthesis, although with lower image quality. Diagnostic performance of the system remains to be determined in larger studies. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Gao and Moy in this issue.

Evaluation and comparison of a CdTe based photon counting detector with an energy integrating detector for X-ray phase sensitive imaging of breast cancer.

PURPOSE: To compare imaging performance of a cadmium telluride (CdTe) based photon counting detector (PCD) with a CMOS based energy integrating detector (EID) for potential phase sensitive imaging of breast cancer. METHODS: A high energy inline phase sensitive imaging prototype consisting of a microfocus X-ray source with geometric magnification of 2 was employed. The pixel pitch of the PCD was 55µm, while 50µm for EID. The spatial resolution was quantitatively and qualitatively assessed through modulation transfer function (MTF) and bar pattern images. The edge enhancement visibility was assessed by measuring edge enhancement index (EEI) using the acrylic edge acquired images. A contrast detail (CD) phantom was utilized to compare detectability of simulated tumors, while an American College of Radiology (ACR) accredited phantom for mammography was used to compare detection of simulated calcification clusters. A custom-built phantom was employed to compare detection of fibrous structures. The PCD images were acquired at equal, and 30% less mean glandular dose (MGD) levels as of EID images. Observer studies along with contrast to noise ratio (CNR) and signal to noise ratio (SNR) analyses were performed for comparison of two detection systems. RESULTS: MTF curves and bar pattern images revealed an improvement of about 40% in the cutoff resolution with the PCD. The excellent spatial resolution offered by PCD system complemented superior detection of the diffraction fringes at boundaries of the acrylic edge and resulted in an EEI value of 3.64 as compared to 1.44 produced with EID image. At equal MGD levels (standard dose), observer studies along with CNR and SNR analyses revealed a substantial improvement of PCD acquired images in detection of simulated tumors, calcification clusters, and fibrous structures. At 30% less MGD, PCD images preserved image quality to yield equivalent (slightly better) detection as compared to the standard dose EID images. CONCLUSION: CdTe-based PCDs are technically feasible to image breast abnormalities (low/high contrast structures) at low radiation dose levels using the high energy inline phase sensitive imaging technique.

Dual-energy phase retrieval algorithm for inline phase sensitive x-ray imaging system.

Phase retrieval is vital for quantitative x-ray phase contrast imaging. This work presents an iterative method to simultaneously retrieve the x-ray absorption and phase images from a single x-ray exposure. The proposed approach uses the photon-counting detectors' energy-resolving capability in providing multiple spectrally resolved phase contrast images from a single x-ray exposure. The retrieval method is derived, presented, and experimentally tested with a multi-material phantom in an inline phase contrast imaging setup. By separating the contributions of photoelectric absorption and Compton scattering to the attenuation, the authors divide the phase contrast image into two portions, the attenuation map arises from photoelectric absorption and a pseudo phase contrast image generated by electron density. This way one can apply the Phase Attenuation Dualiby (PAD) algorithm and Fresnel propagation for the iteration. The retrieval results from the experimental images show that this iterative method is fast, accurate, robust against noise, and thus yields noticeable enhancement in contrast to noise ratios.

Mathematical estimation of half-value layer thicknesses.

OBJECTIVE: The objective of this article is to introduce a simplified and swift method to satisfactorily estimate the half-value layers (HVL), quarter-value layer (QVL), and tenth-value layer (TVL) from the x-ray spectra emitted by any diagnostic radiology or kV radiotherapy x-ray tubes. METHODS: A CdTe x-ray and Gamma detector (X-123 CdTe, AmpTek Inc.) is used to measure the x-ray spectra at four different x-ray energies (low, mid, high energy x-rays) with different external filtering. The software "SpekCalc GUI" (Developed in McGill University, Montreal, Canada) is also used to obtain the simulated x-ray spectra. Both measured and simulated spectra are used to compute the HVL thicknesses of Aluminum by a mathematical method presented in this article. Next, the HVL thicknesses for corresponding tube potentials are also measured by calibrated ionization chamber and varying thicknesses of aluminum plates. Finally, the computed and measured HVL, QVL, and TVL thicknesses are compared to evaluate the efficacy of the presented method. RESULTS: The results show acceptable concordance between computed and measured quantities. The disagreement rates between measured HVL and the values derived mathematically from the x-ray spectra are 10 to 90 micrometers of Aluminum at tube potentials of 31 kV to 120 kV. As it is shown, a negligible discrepancy is observed between the analytical estimation and the experimental assessments. CONCLUSION: The HVL is an essential component in the evaluation of the quality of an x-ray beam. However, its measurement could occasionally be challenging, time-consuming, or uncertain due to some technical difficulties. Although the scope of this study is not to undermine the value of conventional and widely accepted practice to determine the HVL thickness, the introduced method provides the fast, more convenient, and comparably reliable technique to estimate the HVL, QVL, and TVL by employing the given x-ray spectrum.

Predicting fringe visibility in dual-phase grating interferometry with polychromatic X-ray sources.

Dual phase grating X-ray interferometry is radiation dose-efficient as compared to common Talbot-Lau grating interferometry. The authors developed a general quantitative theory to predict the fringe visibility in dual-phase grating X-ray interferometry with polychromatic X-ray sources. The derived formulas are applicable to setups with phase gratings of any phase modulation and with either monochromatic or polychromatic X-rays. Numerical simulations are presented to validate the derived formulas. The theory provides useful tools for design optimization of dual-phase grating X-ray interferometers.

Sample phase gradient and fringe phase shift in dual phase grating X-ray interferometry.

One of the key tasks in grating based x-ray phase contrast imaging is to accurately retrieve local phase gradients of a sample from measured intensity fringe shifts. To fulfill this task in dual phase grating interferometry, one needs to know the exact mathematical relationship between the two. In this work, using intuitive analysis of the sample-generated fringe shifts based on the beat pattern formation mechanism, the authors derived the formulas relating sample phase gradients to fringe phase shifts. These formulas provide also a design optimization tool for dual phase grating interferometry.

Clarification on generalized Lau condition for X-ray interferometers based on dual phase gratings.

To implement dual phase grating x-ray interferometry with x-ray tubes, one needs to incorporate an absorbing source grating. In order to attain good fringe visibility, the period of a source grating should be subject to a stringent condition. In literature some authors claim that the Lau-condition in Talbot-Lau interferometry can be literally transferred to dual phase grating interferometry. In this work we show that this statement in literature is incorrect. Instead, through an intuitive geometrical analysis of fringe formation, we derived a new generalized Lau-condition that provides a useful design tool for implementation of dual phase grating interferometry.

Quantitative theory of X-ray interferometers based on dual phase grating: Fringe period and visibility.

In most of grating x-ray interferometry one needs an absorbing grating as the analyzer to measure high-resolution interference fringes. Dual phase grating interferometry is a technique to get rid of the absorbing grating for radiation dose reduction. The authors present a quantitative theory of dual grating x-ray interferometry. The theory elucidates the fringe formation mechanism. The derived formulas of fringe period and fringe visibility provide useful tools for design optimization of dual phase grating interferometers.

Beam hardening correction in polychromatic x-ray grating interferometry.

The beam hardening is one of the two causes of the fringe shift distortion in polychromatic X-ray grating interferometry. Based on the assumption of the uniform energy dependence, we developed a novel analytic approach to accurately retrieve the monochromatic attenuation function and fringe phase shift from the polychromatic measurement. This approach provides a useful tool for precise measurement of sample electron density distribution in X-ray grating interferometry.

Polychromatic X-ray effects on fringe phase shifts in grating interferometry.

In order to quantitatively determine the projected electron densities of a sample, one needs to extract the monochromatic fringe phase shifts from the polychromatic fringe phase shifts measured in the grating interferometry with incoherent X-ray sources. In this work the authors propose a novel analytic approach that allows to directly compute the monochromatic fringe shifts from the polychromatic fringe shifts. This approach is validated with numerical simulations of several grating interferometry setups. This work provides a useful tool in quantitative imaging for biomedical and material science applications.

Predicting visibility of interference fringes in X-ray grating interferometry.

The interference fringe visibility is a common figure of merit in designs of x-ray grating-based interferometers. Presently one has to resort to laborious computer simulations to predict fringe visibility values of interferometers with polychromatic x-ray sources. Expanding the authors' previous work on Fourier expansion of the intensity fringe pattern, in this work the authors developed a general quantitative theory to predict the intensity fringe pattern in closed-form formulas, which incorporates the effects of partial spatial coherence, spectral average and detector pixel re-binning. These formulas can be used to predict the fringe visibility of a Talbot-Lau interferometer with any geometry configuration and any source spectrum.

The impact of spectral filtration on image quality in micro-CT system.

This paper aims to evaluate the impact of spectral filtration on image quality in a microcomputed tomography (micro-CT) system. A mouse phantom comprising 11rods for modeling lung, muscle, adipose, and bones was scanned with 17 s and 2min, respectively. The current (µA) for each scan was adjusted to achieve identical entrance exposure to the phantom, providing a baseline for image quality evaluation. For each region of interest (ROI) within specific composition, CT number variations, noise levels, and contrast-to-noise ratios (CNRs) were evaluated from the reconstructed images. CT number variations and CNRs for bone with high density, muscle, and adipose were compared with theoretical predictions. The results show that the impact of spectral filtration on image quality indicators, such as CNR in a micro-CT system, is significantly associated with tissue characteristics. The findings may provide useful references for optimizing the scanning parameters of general micro-CT systems in future imaging applications.

Optimization of reconstructed quality of hard x-ray phase microtomography.

For applications of hard x-ray propagation-based phase-contrast computed microtomography (PPCT) in high-resolution biological research, high spatial resolution and high contrast-to-noise ratio are simultaneously required for tiny structural discrimination and characterization. Most existing micro-CT techniques to improve image quality are limited by high cost, physical limitations, and complexity of the experimental hardware and setup. In this work, a novel PPCT technique, which combines a wavelet-transform-based modulation transform function compensation algorithm and a generalized phase-retrieval algorithm, is proposed to optimize the reconstruction quality of tomographic slices. Our experimental results, which compared the spatial resolutions and contrast-to-noise ratios of reconstructed images, demonstrated the validity of the proposed generalized PPCT technique. The experimental results showed that the proposed generalized PPCT technique is superior to the direct PPCT and the linearized phase-retrieval PPCT techniques. This novel PPCT technique demonstrates great potential for biological imaging, especially for applications that require high spatial resolution and limit radiation exposure.

Low dose high energy x-ray in-line phase sensitive imaging prototype: Investigation of optimal geometric conditions and design parameters.

The objective of this study was to investigate the optimization of a high energy in-line phase sensitive x-ray imaging prototype under different geometric and operating conditions for mammography application. A phase retrieval algorithm based on phase attenuation duality (PAD) was applied to the phase contrast images acquired by the prototype. Imaging performance was investigated at four magnification values of 1.67, 2, 2.5 and 3 using an acrylic edge, an American College of Radiology (ACR) mammography phantom and contrast detail (CD) phantom with tube potentials of 100, 120 and 140 kVp. The ACR and CD images were acquired at the same mean glandular dose (MGD) of 1.29 mGy with a computed radiography (CR) detector of 43.75 µm pixel pitch at a fixed source to image distance (SID) of 170 cm. The x-ray tube focal spot size was kept constant as 7 µm while a 2.5 mm thick aluminum (Al) filter was used for beam hardening. The performance of phase contrast and phase retrieved images were compared with computer simulations based on the relative phase contrast factor (RPF) at high x-ray energies. The imaging results showed that the x-ray tube operated at 100 kVp under the magnification of 2.5 exhibits superior imaging performance which is in accordance to the computer simulations. As compared to the phase contrast images, the phase retrieved images of the ACR and CD phantoms demonstrated improved imaging contrast and target discrimination. We compared the CD phantom images acquired in conventional contact mode with and without the anti-scatter grid using the same prototype at 1.295 mGy and 2.59 mGy using 40 kVp, a 25 µm rhodium (Rh) filter. At the same radiation dose, the phase sensitive images provided improved detection capabilities for both the large and small discs, while compared to the double dose image acquired in conventional mode, the observer study also indicated that the phase sensitive images provided improved detection capabilities for the large discs. This study therefore validates the potential of using high energy phase contrast x-ray imaging to improve lesion detection and reduce radiation dose for clinical applications such as mammography.

Image quality and dose efficiency of high energy phase sensitive x-ray imaging: phantom studies.

The goal of this preliminary study was to perform an image quality comparison of high energy phase sensitive imaging with low energy conventional imaging at similar radiation doses. The comparison was performed with the following phantoms: American College of Radiology (ACR), contrast-detail (CD), acrylic edge and tissue-equivalent. Visual comparison of the phantom images indicated comparable or improved image quality for all phantoms. Quantitative comparisons were performed through ACR and CD observer studies, both of which indicated higher image quality in the high energy phase sensitive images. The results of this study demonstrate the ability of high energy phase sensitive imaging to overcome existing challenges with the clinical implementation of phase contrast imaging and improve the image quality for a similar radiation dose as compared to conventional imaging near typical mammography energies. In addition, the results illustrate the capability of phase sensitive imaging to sustain the image quality improvement at high x-ray energies and for breast simulating phantoms, both of which indicate the potential to benefit fields such as mammography. Future studies will continue to investigate the potential for dose reduction and image quality improvement provided by high energy phase sensitive imaging.

X-ray phase-shifts-based method of volumetric breast density measurement.

PURPOSE: The high breast density is one of the biggest risk factors for breast cancer. Identifying patient having persistent high breast density is important for breast cancer screening and prevention. In this work the authors propose for the first time an x-ray phase-shifts-based method of breast density measurement. METHODS: When x ray traverses the breast, x ray gets not only its intensity attenuated but also its phase shifted. Studying the x-ray phase-shifts generated by the breast tissues, we derived a general formula for determining the volumetric breast density from the breast phase map. The volumetric breast density is reconstructed by retrieving the breast phase map from just a single phase-sensitive projection of the breast, through the use of an innovative phase retrieval method based on the phase-attenuation duality. In order to numerically validate this phase-shifts-based method for measuring the volumetric breast density, the authors performed computer simulations with a digitally simulated anthropomorphic breast phantom. RESULTS: Using the proposed phase-shifts-based method, we reconstructed the breast phantom's volumetric breast density, which differs from the phantom's intrinsic breast density by only 0.06%. In the presence of noises in the projection image, the reconstructed volumetric breast density differs from the phantom's intrinsic breast density by only 1.79% for a projection signal-to-noise-ratio (SNR) of 34. The error in reconstructed breast density is further reduced to 1.61% and 1.55% for SNR = 68 and SNR = 134, respectively, achieving good accuracies in the breast density determination. CONCLUSIONS: The authors proposed an x-ray phase-shifts-based method of measuring the volumetric breast density. The simulation results numerically validated the proposed method as a novel method of breast density measurement with good accuracies.

Phase retrieval for hard X-ray computed tomography of samples with hybrid compositions.

X-ray tomography of samples containing both weakly and strongly absorbing materials are necessary in material and biomedical imaging. Extending the validity of the phase-attenuation duality (PAD) method, the propagation-based phase-contrast computed tomography (PPCT) of a sample with hybrid compositions of both the light and dense components with 60 keV of synchrotron radiation is investigated. The experimental results show that the PAD-based PPCT is effective in imaging both the weakly and strongly absorbing components simultaneously. Compared with the direct PPCT technique, the PAD-based PPCT technique demonstrates its excellent capability in material discrimination and characterization. In addition, the PAD-based PPCT exhibits a striking performance on the image contrast enhancement and noise suppression. Therefore, this technique is useful for material and biomedical imaging applications, especially when the radiation dose involved imposes a serious constraint.

A phantom-based calibration method for digital x-ray tomosynthesis.

OBJECTIVE: The purpose of this study was to develop a phantom-based experimental calibration method to minimize the reconstruction artifacts for the geometric misalignments of the digital tomosynthesis prototype. METHODS: A calibration phantom with ten fiducial markers was designed. Using this calibration phantom, the projection matrices of an experimental digital tomosynthesis prototype were acquired from each projection view under a series of misalignment conditions. The American College of Radiology mammography phantom was imaged and reconstructed with and without using the correction of the corresponding calibration projection matrices. The effectiveness of the calibration technique was then quantitatively analyzed through comparison of the calibrated and uncalibrated images. RESULTS: As the isocenter horizontal-shift increases, the reconstruction artifacts become clearly distinguishable. Using the calibration technique, the reconstruction artifacts resulting from the isocenter horizontal-shift were effectively minimized for the prototype. CONCLUSIONS: For the specific experimental conditions utilized in this study, the phantom-based calibration method effectively reduced reconstruction artifacts for the prototype investigated in this study. The calibration method holds potential to benefit other tomosynthesis applications.

Robustness of phase retrieval methods in X-ray phase contrast imaging: a comparison.

PURPOSE: The robustness of the phase retrieval methods is of critical importance for limiting and reducing radiation doses involved in x-ray phase contrast imaging. This work is to compare the robustness of two phase retrieval methods by analyzing the phase maps retrieved from the experimental images of a phantom. METHODS: Two phase retrieval methods were compared. One method is based on the transport of intensity equation (TIE) for phase contrast projections, and the TIE-based method is the most commonly used method for phase retrieval in the literature. The other is the recently developed attenuation-partition based (AP-based) phase retrieval method. The authors applied these two methods to experimental projection images of an air-bubble wrap phantom for retrieving the phase map of the bubble wrap. The retrieved phase maps obtained by using the two methods are compared. RESULTS: In the wrap's phase map retrieved by using the TIE-based method, no bubble is recognizable, hence, this method failed completely for phase retrieval from these bubble wrap images. Even with the help of the Tikhonov regularization, the bubbles are still hardly visible and buried in the cluttered background in the retrieved phase map. The retrieved phase values with this method are grossly erroneous. In contrast, in the wrap's phase map retrieved by using the AP-based method, the bubbles are clearly recovered. The retrieved phase values with the AP-based method are reasonably close to the estimate based on the thickness-based measurement. The authors traced these stark performance differences of the two methods to their different techniques employed to deal with the singularity problem involved in the phase retrievals. CONCLUSIONS: This comparison shows that the conventional TIE-based phase retrieval method, regardless if Tikhonov regularization is used or not, is unstable against the noise in the wrap's projection images, while the AP-based phase retrieval method is shown in these experiments to be superior to the TIE-based method for the robustness in performing the phase retrieval.

Estimated radiation dose associated with low-dose chest CT of average-size participants in the National Lung Screening Trial.

OBJECTIVE: The objective of our study was to determine the distribution of effective dose associated with a single low-dose CT chest examination of average-size participants in the National Lung Screening Trial. Organ doses were also investigated. MATERIALS AND METHODS: Thirty-three sites nationwide provided volume CT dose index (CTDI(vol)) data annually for the 97 MDCT scanners used to image 26,724 participants during the trial. The dose data were representative of the imaging protocols used by the sites for average-size participants. Effective doses were estimated first using the product of the dose-length product (CTDI(vol) × 35-cm scan length) and a published conversion factor, "k." The commercial software product CT-Expo was then used to estimate organ doses to males and females from the average CTDI(vol). Applying tissue-weighting factors from both publication 60 and the more recent publication 103 of the International Commission on Radiological Protection (ICRP) allowed comparisons of effective doses to males and to females. RESULTS: The product of DLP and the k factor resulted in a mean effective dose of 1.4 mSv (SD = 0.5 mSv) for a low-dose chest examination across all scanners. The CT-Expo results based on ICRP 60 tissue-weighting factors yielded effective doses of 1.6 and 2.1 mSv for males and females, respectively, whereas CT-Expo results based on ICRP 103 tissue-weighting factors resulted in effective doses of 1.6 and 2.4 mSv, respectively. CONCLUSION: Acceptable chest CT screening can be accomplished at an overall average effective dose of approximately 2 mSv as compared with an average effective dose of 7 mSv for a typical standard-dose chest CT examination.