KEYWORDS: Digital breast tomosynthesis, Mammography, Breast, X-rays, Modulation transfer functions, Imaging systems, Tomosynthesis, Spatial resolution, Breast cancer
Digital breast tomosynthesis (DBT) enables significantly higher cancer detection rates compared to full-field digital mammography (FFDM) without compromising the recall rate. However, regarding microcalcification assessment established tomosynthesis system concepts still tend to be inferior to FFDM. To further boost the clinical role of DBT in breast cancer screening and diagnosis, a system concept was developed that enables fast wide-angle DBT with the unique in-plane resolution capabilities known from FFDM. The concept comprises a novel x-ray tube concept that incorporates an adaptive focal spot position, fast flat-panel detector technology, and innovative algorithmic concepts for image reconstruction. We have built a DBT system that provides tomosynthesis image stacks and synthetic mammograms from 50° tomosynthesis scans realized in less than five seconds. In this contribution, we motivate the design of the system concept, present a physics characterization of its imaging performance, and outline the algorithmic concepts used for image processing. We conclude with illustrating the potential clinical impact by means of clinical case examples from first evaluations in Europe.
In a clinical pilot study, we evaluated the impact of a radiolucent, inflatable air cushion during tomosynthesis breast imaging. 101 patients were included to quantify the degree of reduction in discomfort as well as the impact on image quality, patient positioning and applied compression force. All underwent tomosynthesis examination in two different settings, routine compression and compression including the cushion without exposing them to additional acquisitions. The cushion had the same size for all breasts and was placed directly on the patient support table of the mammography unit. In the study, the cushion was inflated with air after the standard compression to a breast-individual level. Due to inflation of the cushion, the contact area between breast and compression paddle increased and additional force was therefore added. We expected a decrease in the peak pressure and, due to increased contact area an increase in the desirable spreading of the breast tissue. After examination, patients were asked to complete a questionnaire to rate the tolerability of compression with and without the cushion. The deployment of the cushion decreased the negative perception significantly, lowering it by 18.4% and only 2.0% (p < 0.001, ∝ = 0.05) of patients left to experience a discomfort during compression. When comparing the two compression settings, the increase in comfort did not have a negative impact on image quality, positioning, and the ability to detect all pertinent anatomy. Design and usability of the cushion as well as more sophisticated compression routines will be further investigated, analyzed, and discussed.
Talbot-Lau X-ray imaging (TLXI) provides information about scattering and refractive features of objects – in addition to the well-known conventional X-ray attenuation image. We investigated the potential of TLXI for the detection of hairline fractures in bones, which are often initially occult in conventional 2D X-ray images. For this purpose, hairline fractures were extrinsically provoked in a porcine trotter (post-mortem) and scanned with a TLXI system. In the examined case, hairline fractures caused dark-field and differential-phase signals, whereas they were not evident in the conventional X-ray image. These findings motivate a comprehensive and systematic investigation of the applicability of TLXI for diagnosing hairline fractures.
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