Lesion characterization in spectral photon-counting tomosynthesis

It has previously been shown that 2D spectral mammography can be used to discriminate between (likely benign) cystic and (potentially malignant) solid lesions in order to reduce unnecessary recalls in mammography. One limitation of the technique is, however, that the composition of overlapping tissue needs to be interpolated from a region surrounding the lesion. The purpose of this investigation was to demonstrate that lesion characterization can be done with spectral tomosynthesis, and to investigate whether the 3D information available in tomosynthesis can reduce the uncertainty from the interpolation of surrounding tissue. A phantom experiment was designed to simulate a cyst and a tumor, where the tumor was overlaid with a structure that made it mimic a cyst. In 2D, the two targets appeared similar in composition, whereas spectral tomosynthesis revealed the exact compositional difference. However, the loss of discrimination signal due to spread from the plane of interest was of the same strength as the reduction of anatomical noise. Results from a preliminary investigation on clinical tomosynthesis images of solid lesions yielded results that were consistent with the phantom experiments, but were still to some extent inconclusive. We conclude that lesion characterization is feasible in spectral tomosynthesis, but more data, as well as refinement of the calibration and discrimination algorithms, are needed to draw final conclusions about the benefit compared to 2D.

Observer model optimization of a spectral mammography system

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.

Contrast-enhanced dual-energy subtraction imaging using electronic spectrum-splitting and multi-prism x-ray lenses

Dual-energy subtraction imaging (DES) is a method to improve the detectability of contrast agents over a lumpy background. Two images, acquired at x-ray energies above and below an absorption edge of the agent material, are logarithmically subtracted, resulting in suppression of the signal from the tissue background and a relative enhancement of the signal from the agent. Although promising, DES is still not widely used in clinical practice. One reason may be the need for two distinctly separated x-ray spectra that are still close to the absorption edge, realized through dual exposures which may introduce motion unsharpness. In this study, electronic spectrum-splitting with a silicon-strip detector is theoretically and experimentally investigated for a mammography model with iodinated contrast agent. Comparisons are made to absorption imaging and a near-ideal detector using a signal-to-noise ratio that includes both statistical and structural noise. Similar to previous studies, heavy absorption filtration was needed to narrow the spectra at the expense of a large reduction in x-ray flux. Therefore, potential improvements using a chromatic multi-prism x-ray lens (MPL) for filtering were evaluated theoretically. The MPL offers a narrow tunable spectrum, and we show that the image quality can be improved compared to conventional filtering methods.

Prism-array lenses for energy filtering in medical x-ray imaging

Conventional energy filters for x-ray imaging are based on absorbing materials which attenuate low energy photons, sometimes combined with an absorption edge, thus also discriminating towards photons of higher energies. These filters are fairly inefficient, in particular for photons of higher energies, and other methods for achieving a narrower bandwidth have been proposed. Such methods include various types of monochromators, based on for instance mosaic crystals or refractive multi-prism x-ray lenses (MPLs). Prism-array lenses (PALs) are similar to MPLs, but are shorter, have larger apertures, and higher transmission. A PAL consists of a number of small prisms arranged in columns perpendicular to the optical axis. The column height decreases along the optical axis so that the projection of lens material is approximately linear with a Fresnel phase-plate pattern superimposed on it. The focusing effect is one dimensional, and the lens is chromatic. Hence, unwanted energies can be blocked by placing a slit in the image plane of a desired energy. We present the first experimental and theoretical results on an energy filter based on a silicon PAL. The study includes an evaluation of the spectral shaping properties of the filter as well as a quantification of the achievable increase in dose efficiency compared to standard methods. Previously, PALs have been investigated with synchrotron radiation, but in this study a medical imaging setup, based on a regular x-ray tube, is considered.

Energy resolution of a photon-counting silicon strip detector

A photon-counting silicon strip detector with two energy thresholds was investigated for spectral X-ray imaging in a mammography system. Preliminary studies already indicate clinical benefit of the detector, and the purpose of the present study is optimization with respect to energy resolution. Factors relevant for the energy response were measured, simulated, or gathered from previous studies, and used as input parameters to a cascaded detector model. Threshold scans over several X-ray spectra were used to calibrate threshold levels to energy, and to validate the model. The energy resolution of the detector assembly was assessed to range over DeltaE/E = 0.12-0.26 in the mammography region. Electronic noise dominated the peak broadening, followed by charge sharing between adjacent detector strips, and a channel-to-channel threshold spread. The energy resolution may be improved substantially if these effects are reduced to a minimum. Anti-coincidence logic mitigated double counting from charge sharing, but erased the energy resolution of all detected events, and optimization of the logic is desirable. Pile-up was found to be of minor importance at typical mammography rates.

Energy filtering with X-ray lenses: optimization for photon-counting mammography

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.

An efficient pre-object collimator based on an x-ray lens

A multi-prism lens (MPL) is a refractive x-ray lens with one-dimensional focusing properties. If used as a pre-object collimator in a scanning system for medical x-ray imaging, it reduces the divergence of the radiation and improves on photon economy compared to a slit collimator. Potential advantages include shorter acquisition times, a reduced tube loading, or improved resolution. We present the first images acquired with an MPL in a prototype for a scanning mammography system. The lens showed a gain of flux of 1.32 compared to a slit collimator at equal resolution, or a gain in resolution of 1.31-1.44 at equal flux. We expect the gain of flux in a clinical set-up with an optimized MPL and a custom-made absorption filter to reach 1.67, or 1.45-1.54 gain in resolution.