A comparative study of limitedâ angle coneâ beam reconstruction methods for breast tomosynthesis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134781/1/mp7543.pd

Advancing the Clinical Potential of Carbon Nanotube-enabled stationary 3D Mammography

Scope and purpose. 3D imaging has revolutionized medicine. Digital breast tomosynthesis (DBT), also recognized as 3D mammography, is a relatively recent example. stationary DBT (sDBT) is an experimental technology in which the single moving x-ray source of conventional DBT has been replaced by a fixed array of carbon nanotube (CNT)-enabled sources. Given the potential for a higher spatial and temporal resolution compared to commercially-available, moving-source DBT devices, it was hypothesized that sDBT would provide a valuable tool for breast imaging. As such, the purpose of this work was to explore the clinical potential of sDBT. To accomplish this purpose, three broad Aims were set forth: (1) study the challenges of scatter and artifact with sDBT, (2) assess the performance of sDBT relative to standard mammographic screening approaches, and (3) develop a synthetic mammography capability for sDBT. Throughout the work, developing image processing approaches to maximize the diagnostic value of the information presented to readers remained a specific goal. Data sources and methodology. Sitting at the intersection of development and clinical application, this work involved both basic experimentation and human study. Quantitative measures of image quality as well as reader preference and accuracy were used to assess the performance of sDBT. These studies imaged breast-mimicking phantoms, lumpectomy specimens, and human subjects on IRB-approved study protocols, often using standard 2D and conventional 3D mammography for reference. Key findings. Characterizing scatter and artifact allowed the development of new processing approaches to improve image quality. Additionally, comparing the performance of sDBT to standard breast imaging technologies helped identify opportunities for improvement through processing. This line of research culminated in the incorporation of a synthetic mammography capability into sDBT, yielding images that have the potential to improve the diagnostic value of sDBT. Implications. This work advanced the evolution of CNT-enabled sDBT toward a viable clinical tool by incorporating key image processing functionality and characterizing the performance of sDBT relative to standard breast imaging techniques. The findings confirmed the clinical utility of sDBT while also suggesting promising paths for future research and development with this unique approach to breast imaging.Doctor of Philosoph

The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme--a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone.

BACKGROUND: Digital breast tomosynthesis (DBT) is a three-dimensional mammography technique with the potential to improve accuracy by improving differentiation between malignant and non-malignant lesions. OBJECTIVES: The objectives of the study were to compare the diagnostic accuracy of DBT in conjunction with two-dimensional (2D) mammography or synthetic 2D mammography, against standard 2D mammography and to determine if DBT improves the accuracy of detection of different types of lesions. STUDY POPULATION: Women (aged 47-73 years) recalled for further assessment after routine breast screening and women (aged 40-49 years) with moderate/high of risk of developing breast cancer attending annual mammography screening were recruited after giving written informed consent. INTERVENTION: All participants underwent a two-view 2D mammography of both breasts and two-view DBT imaging. Image-processing software generated a synthetic 2D mammogram from the DBT data sets. RETROSPECTIVE READING STUDY: In an independent blinded retrospective study, readers reviewed (1) 2D or (2) 2D + DBT or (3) synthetic 2D + DBT images for each case without access to original screening mammograms or prior examinations. Sensitivities and specificities were calculated for each reading arm and by subgroup analyses. RESULTS: Data were available for 7060 subjects comprising 6020 (1158 cancers) assessment cases and 1040 (two cancers) family history screening cases. Overall sensitivity was 87% [95% confidence interval (CI) 85% to 89%] for 2D only, 89% (95% CI 87% to 91%) for 2D + DBT and 88% (95% CI 86% to 90%) for synthetic 2D + DBT. The difference in sensitivity between 2D and 2D + DBT was of borderline significance (p = 0.07) and for synthetic 2D + DBT there was no significant difference (p = 0.6). Specificity was 58% (95% CI 56% to 60%) for 2D, 69% (95% CI 67% to 71%) for 2D + DBT and 71% (95% CI 69% to 73%) for synthetic 2D + DBT. Specificity was significantly higher in both DBT reading arms for all subgroups of age, density and dominant radiological feature (p < 0.001 all cases). In all reading arms, specificity tended to be lower for microcalcifications and higher for distortion/asymmetry. Comparing 2D + DBT to 2D alone, sensitivity was significantly higher: 93% versus 86% (p < 0.001) for invasive tumours of size 11-20 mm. Similarly, for breast density 50% or more, sensitivities were 93% versus 86% (p = 0.03); for grade 2 invasive tumours, sensitivities were 91% versus 87% (p = 0.01); where the dominant radiological feature was a mass, sensitivities were 92% and 89% (p = 0.04) For synthetic 2D + DBT, there was significantly (p = 0.006) higher sensitivity than 2D alone in invasive cancers of size 11-20 mm, with a sensitivity of 91%. CONCLUSIONS: The specificity of DBT and 2D was better than 2D alone but there was only marginal improvement in sensitivity. The performance of synthetic 2D appeared to be comparable to standard 2D. If these results were observed with screening cases, DBT and 2D mammography could benefit to the screening programme by reducing the number of women recalled unnecessarily, especially if a synthetic 2D mammogram were used to minimise radiation exposure. Further research is required into the feasibility of implementing DBT in a screening setting, prognostic modelling on outcomes and mortality, and comparison of 2D and synthetic 2D for different lesion types. STUDY REGISTRATION: Current Controlled Trials ISRCTN73467396. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 4. See the HTA programme website for further project information.This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 4. See the HTA programme website for further project information.Gilbert FJ, Tucker L, Gillan MGC, Willsher P, Cooke J, Duncan KA, et al. The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme – a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone. Health Technol Assess 2015;19(4). © Queen’s Printer and Controller of HMSO 2015. This work was produced by Gilbert et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Applying synthetic radiography to intraoral tomosynthesis: A step towards achieving 3D imaging in the dental clinic

objectives: A practical approach to three-dimensional (3D) intraoral imaging would have many potential applications in clinical dentistry. Stationary intraoral tomosynthesis (sIOT) is an experimental 3D imaging technology that holds promise. The purpose of this study was to explore synthetic radiography as a tool to improve the clinical utility of the images generated by an sIOT scan. Methods: Extracted tooth specimens containing either caries adjacent to restorations (CAR) or vertical root fractures (VRF) were imaged by sIOT and standard dental radiography devices. Qualitative assessments were used to compare the conspicuity of these pathologies in the standard radiographs and in a set of multi-view synthetic radiographs generated from the information collected by sIOT. Results: The sIOT-based synthetic 2D radiographs contained less artefact than the image slices in the reconstructed 3D stack, which is the conventional approach to displaying information from a tomosynthesis scan. As a single sIOT scan can be used to generate synthetic radiographs from multiple viewing angles, the interproximal space was less likely to be obscured in the synthetic images compared to the standard radiograph. Additionally, the multi-view synthetic radiographs can potentially improve the display of CAR and VRFs as compared to a single standard radiograph. conclusions: This preliminary experience combining synthetic radiography and sIOT in extracted tooth models is encouraging and supports the ongoing study of this promising approach to 3D intraoral imaging with many potential applications

Image reconstruction and processing for stationary digital tomosynthesis systems

Digital tomosynthesis (DTS) is an emerging x-ray imaging technique for disease and cancer screening. DTS takes a small number of x-ray projections to generate pseudo-3D images, it has a lower radiation and a lower cost compared to the Computed Tomography (CT) and an improved diagnostic accuracy compared to the 2D radiography. Our research group has developed a carbon nanotube (CNT) based x-ray source. This technology enables packing multiple x-ray sources into one single x-ray source array. Based on this technology, our group built several stationary digital tomosynthesis (s-DTS) systems, which have a faster scanning time and no source motion blur. One critical step in both tomosynthesis and CT is image reconstruction, which generates a 3D image from the 2D measurement. For tomosynthesis, the conventional reconstruction method runs fast but fails in image quality. A better iterative method exists, however, it is too time-consuming to be used in clinics. The goal of this work is to develop fast iterative image reconstruction algorithm and other image processing techniques for the stationary digital tomosynthesis system, improving the image quality affected by the hardware limitation. Fast iterative reconstruction algorithm, named adapted fan volume reconstruction (AFVR), was developed for the s-DTS. AFVR is shown to be an order of magnitude faster than the current iterative reconstruction algorithms and produces better images over the classical filtered back projection (FBP) method. AFVR was implemented for the stationary digital breast tomosynthesis system (s-DBT), the stationary digital chest tomosynthesis system (s-DCT) and the stationary intraoral dental tomosynthesis system (s-IOT). Next, scatter correction technique for stationary digital tomosynthesis was investigated. A new algorithm for estimating scatter profile was developed, which has been shown to improve the image quality substantially. Finally, the quantitative imaging was investigated, where the s-DCT system was used to assess the coronary artery calcium score.Doctor of Philosoph

A New Stationary Digital Breast Tomosynthesis System: Implementation and Characterization

Digital breast tomosynthesis systems (DBT) use a single thermionic x-ray source that moves around the breast in a fixed angular span. As a result, all current DBT system requires the mechanical motion of the x-ray source during the scan, limiting image quality either due to the focal spot blurring or a long scan time. This causes an unfavorable reduction in the in-plane resolution compared to 2D mammography. Our research group developed and demonstrated a first generation stationary digital breast tomosynthesis (s-DBT) system that uses a linear carbon nanotube (CNT) x-ray source array. Since the stationary sources are not subject to focal spot blurring, and images can be acquired rapidly, the in-plane system resolution is improved. Additionally, image acquisition time is independent of angular span since there is no motion, allowing for large angular spans, and increased depth resolution. The improved resolution of the first generation s-DBT system over continuous motion (CM) DBT has been demonstrated with image evaluation phantoms and a human specimen study. The first generation s-DBT is currently undergoing clinical trials at the University of North Carolina Cancer Hospital. Limitations associated with the first generation system, such as limited tube flux, and limited x-ray energy, placed limitations on our clinical trials and future clinical implementation. Also, the limited angular span could be improved for increased depth resolution, as there is no cost on patient imaging time. The goal of this thesis work was to design construct and characterize a second generation s-DBT system, capable of faster image acquisition times, and higher depth resolution than our first generation system. The second generation s-DBT system was built using a newly designed distributed CNT x-ray source array. The system was then characterized and compared to the first generation system and two commercially available DBT systems. Using physical measurements that are used in medical imaging, the system showed significant improvement in resolution over the first generation system and both commercially available systems, coupled with equal or faster image acquisition times. A separate study investigating the feasibility of contrast enhanced (CE) imaging was conducted, where the system showed capability in both temporal subtraction (TS) and dual energy (DE) imaging.Doctor of Philosoph

Application of boundary detection information in breast tomosynthesis reconstruction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135006/1/mp1968.pd