No Arabic abstract
Spectral imaging is a method in medical x-ray imaging to extract information about the object constituents by the material-specific energy dependence of x-ray attenuation. Contrast-enhanced spectral imaging has been thoroughly investigated, but unenhanced imaging may be more useful because it comes as a bonus to the conventional non-energy-resolved absorption image at screening; there is no additional radiation dose and no need for contrast medium. We have used a previously developed theoretical framework and system model that include quantum and anatomical noise to characterize the performance of a photon-counting spectral mammography system with two energy bins for unenhanced imaging. The theoretical framework was validated with synthesized images. Optimal combination of the energy-resolved images for detecting large unenhanced tumors corresponded closely, but not exactly, to minimization of the anatomical noise, which is commonly referred to as energy subtraction. In that case, an ideal-observer detectability index could be improved close to 50% compared to absorption imaging. Optimization with respect to the signal-to-quantum-noise ratio, commonly referred to as energy weighting, deteriorated detectability. For small microcalcifications or tumors on uniform backgrounds, however, energy subtraction was suboptimal whereas energy weighting provided a minute improvement. The performance was largely independent of beam quality, detector energy resolution, and bin count fraction. It is clear that inclusion of anatomical noise and imaging task in spectral optimization may yield completely different results than an analysis based solely on quantum noise.
Spectral imaging is the acquisition of multiple images of an object at different energy spectra. In mammography, dual-energy imaging (spectral imaging with two energy levels) has been investigated for several applications, in particular material decomposition, which allows for quantitative analysis of breast composition and quantitative contrast-enhanced imaging. Material decomposition with dual-energy imaging is based on the assumption that there are two dominant photon interaction effects that determine linear attenuation: the photoelectric effect and Compton scattering. This assumption limits the number of basis materials, i.e. the number of materials that are possible to differentiate between, to two. However, Rayleigh scattering may account for more than 10% of the linear attenuation in the mammography energy range. In this work, we show that a modified version of a scanning multi-slit spectral photon-counting mammography system is able to acquire three images at different spectra and can be used for triple-energy imaging. We further show that triple-energy imaging in combination with the efficient scatter rejection of the system enables measurement of Rayleigh scattering, which adds an additional energy dependency to the linear attenuation and enables material decomposition with three basis materials. Three available basis materials have the potential to improve virtually all applications of spectral imaging.
Phase-contrast imaging is an emerging technology that may increase the signal-difference-to-noise ratio in medical imaging. One of the most promising phase-contrast techniques is Talbot interferometry, which, combined with energy-sensitive photon-counting detectors, enables spectral differential phase-contrast mammography. We have evaluated a realistic system based on this technique by cascaded-systems analysis and with a task-dependent ideal-observer detectability index as a figure-of-merit. Beam-propagation simulations were used for validation and illustration of the analytical framework. Differential phase contrast improved detectability compared to absorption contrast, in particular for fine tumor structures. This result was supported by images of human mastectomy samples that were acquired with a conventional detector. The optimal incident energy was higher in differential phase contrast than in absorption contrast when disregarding the setup design energy. Further, optimal weighting of the transmitted spectrum was found to have a weaker energy dependence than for absorption contrast. Taking the design energy into account yielded a superimposed maximum on both detectability as a function of incident energy, and on optimal weighting. Spectral material decomposition was not facilitated by phase contrast, but phase information may be used instead of spectral information.
Beam quality optimization in mammography traditionally considers detection of a target obscured by quantum noise on a homogenous background. It can be argued that this scheme does not correspond well to the clinical imaging task because real mammographic images contain a complex superposition of anatomical structures, resulting in anatomical noise that may dominate over quantum noise. Using a newly developed spectral mammography system, we measured the correlation and magnitude of the anatomical noise in a set of mammograms. The results from these measurements were used as input to an observer-model optimization that included quantum noise as well as anatomical noise. We found that, within this framework, the detectability of tumors and microcalcifications behaved very differently with respect to beam quality and dose. The results for small microcalcifications were similar to what traditional optimization methods would yield, which is to be expected since quantum noise dominates over anatomical noise at high spatial frequencies. For larger tumors, however, low-frequency anatomical noise was the limiting factor. Because anatomical structure has similar energy dependence as tumor contrast, optimal x-ray energy was significantly higher and the useful energy region wider than traditional methods suggest. Measurements on a tissue phantom confirmed these theoretical results. Furthermore, since quantum noise constitutes only a small fraction of the noise, the dose could be reduced substantially without sacrificing tumor detectability. Exposure settings used clinically are therefore not necessarily optimal for this imaging task. The impact of these findings on the mammographic imaging task as a whole is, however, at this stage unclear.
Chromatic properties of the multi-prism and prism-array X-ray lenses (MPL and PAL) can potentially be utilized for efficient energy filtering and dose reduction in mammography. The line-shaped foci of the lenses are optimal for coupling to photon-counting silicon strip detectors in a scanning system. A theoretical model was developed and used to investigate the benefit of two lenses compared with an absorption-filtered reference system. The dose reduction of the MPL filter was ~15% compared with the reference system at matching scan time, and the spatial resolution was higher. The dose of the PAL-filtered system was found to be ~20% lower than for the reference system at equal scan time and resolution, and only ~20% higher than for a monochromatic beam. An investigation of some practical issues remains, including the feasibility of brilliant-enough X-ray sources and manufacturing of a polymer PAL.
Knowledge of x-ray attenuation is essential for developing and evaluating x-ray imaging technologies. For instance, techniques to distinguish between cysts and solid tumours at mammography screening would be highly desirable to reduce recalls, but the development requires knowledge of the x-ray attenuation for cysts and tumours. We have previously measured the attenuation of cyst fluid using photon-counting spectral mammography. Data on x-ray attenuation for solid breast lesions are available in the literature, but cover a relatively wide range, likely caused by natural spread between samples, random measurement errors, and different experimental conditions. In this study, we have adapted the previously developed spectral method to measure the linear attenuation of solid breast lesions. A total of 56 malignant and 5 benign lesions were included in the study. The samples were placed in a holder that allowed for thickness measurement. Spectral (energy-resolved) images of the samples were acquired and the image signal was mapped to equivalent thicknesses of two known reference materials, which can be used to derive the x-ray attenuation as a function of energy. The spread in equivalent material thicknesses was relatively large between samples, which is likely to be caused mainly by natural variation and only to a minor extent by random measurement errors and sample inhomogeneity. No significant difference in attenuation was found between benign and malignant solid lesions, or between different types of malignant lesions. The separation between cyst-fluid and tumour attenuation was, however, significant, which suggests it may be possible to distinguish cystic from solid breast lesions, and the results lay the groundwork for a clinical trial. [cropped]