Evaluation of the FUSION-X-US-II prototype to combine automated breast ultrasound and tomosynthesis.

OBJECTIVE: The FUSION-X-US-II prototype was developed to combine 3D automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device. We evaluated the performance of ABUS and tomosynthesis in a single examination in a clinical setting. METHODS: In this prospective feasibility study, digital breast tomosynthesis and ABUS were performed using the FUSION-X-US-II prototype without any change of the breast position in patients referred for clarification of breast lesions with an indication for tomosynthesis. The tomosynthesis and ABUS images of the prototype were interpreted independently from the clinical standard by a breast diagnostics specialist. Any detected lesion was classified using BI-RADS® scores, and results of the standard clinical routine workup (gold standard) were compared to the result of the separate evaluation of the prototype images. Image quality was rated subjectively and coverage of the breast was measured. RESULTS: One hundred one patients received both ABUS and tomosynthesis using the prototype. The duration of the additional ABUS acquisition was 40 to 60 s. Breast coverage by ABUS was approximately 80.0%. ABUS image quality was rated as diagnostically useful in 86 of 101 cases (85.1%). Thirty-three of 34 malignant breast lesions (97.1%) were identified using the prototype. CONCLUSION: The FUSION-X-US-II prototype allows a fast ABUS scan in combination with digital breast tomosynthesis in a single device integrated in the clinical workflow. Malignant breast lesions can be localized accurately with direct correlation of ABUS and tomosynthesis images. The FUSION system shows the potential to improve breast cancer screening in the future after further technical improvements. KEY POINTS: • The FUSION-X-US-II prototype allows the combination of automated breast ultrasound and digital breast tomosynthesis in a single device without decompression of the breast. • Image quality and coverage of ABUS are sufficient to accurately detect malignant breast lesions. • If tomosynthesis and ABUS should become part of breast cancer screening, the combination of both techniques in one device could offer practical and logistic advantages. To evaluate a potential benefit of a combination of ABUS and tomosynthesis in screening-like settings, further studies are needed.

First proof-of-concept evaluation of the FUSION-X-US-II prototype for the performance of automated breast ultrasound in healthy volunteers.

PURPOSE: The FUSION-X-US-II prototype was developed to combine 3D-automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device without decompressing the breast. We evaluated the technical function, feasibility of the examination workflow, image quality, breast tissue coverage and patient comfort of the ABUS device of the new prototype. METHODS: In this prospective feasibility study, the FUSION-X-US-II prototype was used to perform ABUS in 30 healthy volunteers without history of breast cancer. The ABUS images of the prototype were interpreted by a physician with specialization in breast diagnostics. Any detected lesions were measured and classified using BI-RADS® scores. Image quality was rated subjectively by the physician and coverage of the breast was measured. Patient comfort was evaluated by a questionnaire after the examination. RESULTS: One hundred and six scans were performed (61 × CC, 23 × ML, 22 × MLO) in 60 breasts. Image acquisition and processing by the prototype was fast and accurate. Breast coverage by ABUS was approximately 90.8%. Sixteen breast lesions (all benign, classified as BIRADS® 2) were identified. The examination was tolerated by all patients. CONCLUSION: The FUSION-X-US-II prototype allows a rapid ABUS scan with mostly high patient comfort. Technical developments resulted in an improvement of quality and coverage compared to previous prototype versions. The results are encouraging for a test of the prototype in a clinical setting in combination with tomosynthesis.

Gauging low-dose X-ray phase-contrast imaging at a single and large propagation distance.

The interactions of a beam of hard and spatio-temporally coherent X-rays with a soft-matter sample primarily induce a transverse distribution of exit phase variations δϕ (retardations or advancements in pieces of the wave front exiting the object compared to the incoming wave front) whose free-space propagation over a distance z gives rise to intensity contrast gz. For single-distance image detection and |δϕ| ≪ 1 all-order-in-z phase-intensity contrast transfer is linear in δϕ. Here we show that ideal coherence implies a decay of the (shot-)noise-to-signal ratio in gz and of the associated phase noise as z(-1/2) and z(-1), respectively. Limits on X-ray dose thus favor large values of z. We discuss how a phase-scaling symmetry, exact in the limit δϕ → 0 and dynamically unbroken up to |δϕ| ∼ 1, suggests a filtering of gz in Fourier space, preserving non-iterative quasi-linear phase retrieval for phase variations up to order unity if induced by multi-scale objects inducing phase variations δϕ of a broad spatial frequency spectrum. Such an approach continues to be applicable under an assumed phase-attenuation duality. Using synchrotron radiation, ex and in vivo microtomography on frog embryos exemplifies improved resolution compared to a conventional single-distance phase-retrieval algorithm.

Towards a biomechanical breast model to simulate and investigate breast compression and its effects in mammography and tomosynthesis.

Objective. In mammography, breast compression forms an essential part of the examination and is achieved by lowering a compression paddle on the breast. Compression force is mainly used as parameter to estimate the degree of compression. As the force does not consider variations of breast size or tissue composition, over- and undercompression are a frequent result. This causes a highly varying perception of discomfort or even pain in the case of overcompression during the procedure. To develop a holistic, patient specific workflow, as a first step, breast compression needs to be thoroughly understood. The aim is to develop a biomechanical finite element breast model that accurately replicates breast compression in mammography and tomosynthesis and allows in-depth investigation. The current work focuses thereby, as a first step, to replicate especially the correct breast thickness under compression.Approach. A dedicated method for acquiring ground truth data of uncompressed and compressed breasts within magnetic resonance (MR) imaging is introduced and transferred to the compression within x-ray mammography. Additionally, we created a simulation framework where individual breast models were generated based on MR images.Main results. By fitting the finite element model to the results of the ground truth images, a universal set of material parameters for fat and fibroglandular tissue could be determined. Overall, the breast models showed high agreement in compression thickness with a deviation of less than ten percent from the ground truth.Significance. The introduced breast models show a huge potential for a better understanding of the breast compression process.

Clinical prototype implementation enabling an improved day-to-day mammography compression.

PURPOSE: In mammography, breast compression is achieved by lowering a compression paddle on the breast. Despite the directive that compression is needed, there is no concrete guideline on its execution. To estimate the degree of compression, current mammography units only provide compression force and breast thickness as parameters. Therefore, radiographers could be induced to mainly determine the level of compression based on compression force and apply the same value to all breast sizes. In this case, smaller breast sizes are exposed to higher pressure. This results in a highly varying perception of discomfort or even pain during the procedure, depending on the breast size. METHODS: To overcome this imbalance, current research results suggest that pressure might be a more qualified parameter for a more uniform compression among all breast sizes. To utilize pressure, the contact area between breast and compression paddle must be determined. In this paper, we present an easy-to-implement prototype enabling a real-time pressure-based measure without the need of direct patient contact. Using an optical camera, the contact area between the breast and the compression paddle is automatically segmented by a deep learning model. RESULTS: The model provides a mean pixel accuracy of 96.7% (SD: 2.3%), mean frequency-weighted intersection over union of 88.5% (SD: 6.3%), and a Dice score of 93.6% (SD: 2.2%). The subsequent pressure display is updated more than five times per second which enables the use in clinical routines to set the compression level. CONCLUSION: This prototype could help guiding to an improved breast compression routine in mammography procedures.

Comprehensive Comparison of Image Quality Aspects Between Conventional and Plane-Wave Imaging Methods on a Commercial Scanner.

Coherent plane-wave compound imaging (CPWCI) is used as alternative for conventional focused imaging (CFI) to increase frame rates linearly with the ratio number of imaging lines to steering angles. In this study, the image quality was compared between CPWCI and CFI, and the effect of steering angles (range and number) and beamforming strategies was evaluated in CPWCI. In automated breast volume scanners (ABVSs), which suffer from reduced volume rates, CPWCI might be an excellent candidate to replace CFI. Therefore, the image quality of CFI currently in ABVS and CPWCI was also compared in an in vivo breast lesion. Images were obtained by a Siemens Sequoia ultrasound system, and two transducers (14L5 and 10L4) in a CIRS multipurpose phantom (040GSE) and a breast lesion. Phantom results showed that contrast sensitivity and resolution, axial resolution, and generalized contrast-to-noise ratio (gCNR; imaging depths <45 mm) were similar for most imaging sequences. CNR (imaging depths ≥45 mm), penetration, and lateral resolution were significantly improved for CPWCI (15 angles) compared to CFI for both transducers. In CPWCI, certain combinations of steering angles and beamforming methods yielded improved gCNR (small angles and delay-and-sum) or lateral resolution (large angles and Lu's-fk). Image quality seemed similar between CPWCI and CFI (three angles incoherent compounded as in ABVS) by visual inspection of the in vivo breast lesion images.

Photon-Counting CT: High-Resolution Imaging of Coronary Stents.

PURPOSE: The aim of this study was to investigate computed tomography (CT) imaging characteristics of coronary stents using a novel photon-counting detector (PCD) in comparison with a conventional energy-integrating detector (EID). MATERIALS AND METHODS: In this in vitro study, 18 different coronary stents were expanded in plastic tubes of 3 mm diameter, were filled with contrast agent (diluted to an attenuation of 250 Hounsfield units [HU] at 120 kVp), and were sealed. Stents were placed in an oil-filled custom phantom calibrated to an attenuation of -100 HU at 120 kVp for resembling pericardial fat. The phantom was positioned in the gantry at 2 different angles at 0 degree and 90 degrees relative to the z axis, and was imaged in a research dual-source PCD-CT scanner. Detector subsystem "A" used a standard 64-row EID, while detector subsystem "B" used a PCD, allowing high-resolution scanning (detector pixel-size 0.250 × 0.250 mm in the isocenter). Images were obtained from both detector systems at identical tube voltage (100 kVp) and tube current-time product (100 mA), and were both reconstructed using a typical convolution kernel for stent imaging (B46f) and using the same reconstruction parameters. Two independent, blinded readers evaluated in-stent visibility and measured noise, intraluminal stent diameter, and in-stent attenuation for each detector subsystem. Differences in noise, intraluminal stent diameter, and in-stent attenuation where tested using a paired t test; differences in subjective in-stent visibility were evaluated using a Wilcoxon signed-rank test. RESULTS: Best results for in-stent visibility, noise, intraluminal stent diameter, and in-stent attenuation in EID and PCD were observed at 0-degree phantom position along the z axis, suggesting higher in-plane compared with through-plane resolution. Subjective in-stent visibility was superior in coronary stent images obtained from PCD compared with EID (P < 0.001). Mean in-stent diameter was 28.8% and 8.4% greater in PCD (0.85 ± 0.24 mm; 0.83 ± 0.14 mm) as compared with EID acquisitions (0.66 ± 0.21 mm; 0.76 ± 0.13 mm) for both 0-degree and 90-degree phantom positions, respectively. Average noise was significantly lower (P < 0.001) for PCD (5 ± 0.2 HU) compared with EID (8.3 ± 0.2 HU). The increase in in-stent attenuation (0 degree: Δ 245 ± 163 HU vs Δ 156.5 ± 126 HU; P = 0.006; 90 degrees: Δ 194 ± 141 HU vs Δ 126 ± 78 HU; P = 0.001) was significantly lower for PCD compared with EID acquisitions. CONCLUSIONS: At matched CT scan protocol settings and identical image reconstruction parameters, the PCD yields superior in-stent lumen delineation of coronary artery stents as compared with conventional EID arrays.