Subjective Evaluation of the In-Line Phase-Sensitive Imaging Systems in Breast Cancer Screening and Diagnosis

Breast x-ray imaging remains the gold standard screening tool despite the various imaging modalities. The phase-sensitive breast imaging is an evolving technology that may provide higher diagnostic accuracy and potentially reduce the patient radiation dose. Many studies evaluate the performance of the In-line phase-sensitive breast imaging to improve this imaging modality further. Whereas radiologists are the end-users of this imaging technology, the primary goal of this dissertation project is to investigate the performance of human observers in varying conditions for further improvement of the in-line phase-sensitive x-ray imaging system. A CDMAM phantom and an ACR mammography phantom are used in the observer performance study to compare the high-energy in-line phase-sensitive system with a mid-energy system as an alternative approach to balancing the attenuation-based image contrast with the accuracy of single-projection PAD-base phase-retrieval. Additionally, a series of ROC studies are designed by a contrast-detail phantom to evaluate the diagnostic accuracy of digital breast tomosynthesis (DBT) and the phase-sensitive prototype imaging system (PBT). The area under the ROC curves (AUC) and partial area under the ROC curves (pAUC) are estimated as a figure of merits in the two systems, delivering the equivalent radiation doses. A two-alternative-forced choice (2AFC) study is also designed to determine the preferred image in identifying the suspicious lesions within a heterogeneous pattern acquired by the DBT and PBT systems under an equivalent radiation dose. The observer performance studies show that the mid-energy system has a potential advantage in providing a relatively higher image quality while the radiation dose is reduced in the mid-energy system compared with a high-energy system. The ROC study shows that the diagnostic accuracy of observers is more significant in the prototype PBT system than in a commercial DBT system, delivering the same radiation dose. The 2AFC study also revealed that observers prefer the PBT system in detecting and distinguishing the conspicuity of tumors in the images with structural noise, and the results were statistically significant. The dissertation also introduces a mathematical approach for estimating the half-value-layer (HVL) from measured or simulated x-ray spectra. The HVL measurement is expected to be less accurate or experimentally challenging in some clinical equipment or when a quick beam quality evaluation is needed. Additionally, the impact of varying thicknesses of external filtration is subjectively and objectively investigated to evaluate the feasibility of reducing the image acquisition time in a mid-energy system without compromising the observer's performance and detectability. The preliminary results from phase-contrast images suggest that an in-line phase-sensitive system operated at 59 kV shows a comparable image quality with the x-ray beams filtered by 1.3 mm and 2.5 mm-thick aluminum filters. This finding could help shorten the exposure time by 34% in the mid-energy system, where image blurring is a concern due to patient movement in a longer image acquisition time. In summary, and as expected, the subjective analyses of the in-line phase-sensitive imaging system align with the previous findings. However, the PBT imaging system may benefit from further improvement in image processing algorithms and optimizing the system with the most appropriate x-ray beam quality, considering the acquisition time, breast glandular composition, breast thickness, and different x-ray energies. Keywords: Phase-sensitive X-ray Imaging, Breast Imaging, Image Quality, Human Observer Performance Stud

Mammography machine compression paddle movement andobserver performance analysis

Full field digital mammography (FFDM) was introduced into the United Kingdom (UK) as a replacement for screen-film mammography (SFM) in 2005. Since then, individual breast screening centres have begun to report blurred images through local audits. Blurring was probably present in SFM as well, however the improvement in contrast resolution in FFDM may have made it more apparent. The sources of blurring include improper imaging techniques, patient movement caused by breathing and heart motion,the viscoelastic motion of the breast, and paddle motion. This thesis aims to test the hypothesis that paddle motion might cause image blur. It investigates whether blurring can be detected visually on technical review monitors and reporting grade monitors.The thesis presents a method to minimise paddle motion during X-ray exposure. Six papers have been published. Two of these (papers 1 and 2) investigated paddle displacement using linear potentiometers. Three investigated the influence of paddle motion on image quality. Paper 3 investigated whether paddle motion can cause image blur; paper 4 determined the minimum amount of simulated motion required for the visual detection of blurring; and paper 5 evaluated the practitioner’s ability to identify blurring on monitors with different resolutions (2.3 MP and 5 MP). The final research paper (paper 6) investigated a way to reduce paddle displacement settling time; this involved the use of a closed-loop control system.Results: In papers 1 and 2 paddle displacement followed a bi-exponential function with a settling time of approximately 40 s. The use of average paddle displacement to estimate the amount of paddle motion would underestimate the worst case of the threedifferent runs of the experiment. The estimated paddle motion would be greatly reduced if the time of exposure is delayed from 5 to 10 s. In paper 3 all metal ball bearings shown increased in diameters and the range of magnification varied from 1.04 to 1.21. T-test results shown that there was a significant difference (p < 0.05) in the ball bearing diameters between the intensity thresholding and the edge detection methods for all paddle/ compression force combinations. The ball bearing diameters calculated by the intensity thresholding method had higher variability than the edge detection method.In paper 4 the soft-edged mask method best represented the physical process that caused the blurring effect and was chosen as the standard simulation approach for motion blurring. The ratio between the vertical paddle motion and the horizontal breast motion estimated by the mathematical model is approximately 1:0.3.In paper 5 the angular size calculation shown that for a viewing distance of 75 cm the screen resolution for 5 MP and 12 MP monitors was better than the observer eyes' resolution. For a viewing distance of 30 cm the observer eyes' resolution was betterthan the screen resolution for 2.3 MP, 5 MP and 12 MP monitors. Among all three monitors, image displayed on the 12 MP monitor has the lowest loss in image quality after interpolation. In paper 6 the simulation results shown that force overshoot is possible for position control system. Force overshoot occurred almost instantaneously for step input and its magnitude is about 10 times larger than the ramp input. Force overshoot and steadystateerror can be eliminated by the use of force control system.Conclusion: The magnitude of calculated paddle motion is much lower than the minimum amount of simulated motion required for the visual detection of blurring. Mathematical models have shown that vertical paddle motion caused a smaller horizontal breast displacement when compressed. Therefore, there is no sufficientevidence to support the hypothesis that paddle motion is a cause of image blurring in FFDM

Design, development and use of a deformable breast phantom to assess the relationship between thickness and lesion visibility in full field digital mammography

Aim of research:This research aimed to design and develop a synthetic anthropomorphic breast phantom with cancer mimicking lesions and use this phantom to assess the relationship between lesion visibility and breast thickness in mammography. Due to the risk of cancer induction associated with the use of ionising radiation on breast tissues, experiments on human breast tissue was not practical. Therefore, a synthetic anthropomorphic breast phantom with cancer mimicking lesions was needed to be designed and developed in order to provide a safe platform to evaluate the relationship between lesion visibility and breast thickness in mammography. Method: As part of this research custom Polyvinyl alcohol (PVAL) breast phantoms with embedded PVAL lesions doped with contrast agent were fabricated and utilised. These breast phantoms exhibited mechanical and X-ray properties which were similar to female breast/breast cancer tissues. In order for this research to be useful for human studies, patient safety factors have constrained the extent of this research. These factors include compression force and radiation dose. After acquiring mammograms of phantoms with varying thicknesses, the image quality of the embedded lesions were evaluated both perceptually and mathematically.The two-alternative forced choice (2AFC) perceptual method was used to evaluate image quality of the lesions. For mathematical evaluation the following methods were utilised: line profile analysis, contrast-to noise ratio (CNR), signal-to noise ratio (SNR) and figure of merit (FOM).Results: The results of the visual perception analysis of the mammograms demonstrate that as breast compressed thickness reduces the image quality increases. Additionally, the results display a correlation in the reduction in the level of noise with the reduction in breast thickness. This noise reduction was also demonstrated in the profile plots of the lesions. The line profile analysis, in agreement with visual perception, shows improvement of sharpness of the lesion edge in relation to the reduction of the phantom thickness. The intraclass correlation coefficient (ICC) has shown a great consistency and agreement among the observers for visibility, sharpness, contrast and noise. The ICC results are not as conclusive for the size criterion. Mathematical evaluation results also show a correlation of improvement in the image quality with the reduction in breast thickness. The results show that for the measures CNR, SNR, and FOM, the increase in image quality has a threshold after which the image quality ceases to improve and instead begins to reduce. CNR and FOM dropped when the breast phantom thickness was reduced approximately 40% of its initial thickness. This consistently happened at the point where the filter changed from rhodium (Rh) to molybdenum (Mo). Conclusion: This breast phantom study successfully designed and developed an anthropomorphic compressible breast phantom with cancer mimicking lesions with mechanical and X-ray properties similar to human breast tissue. This study also demonstrates that as breast compressed thickness reduces the visibility of the perceived lesion increases. The radiation dose generally decreases up to the point that the filter changes from rhodium to molybdenum. After this point, the radiation dose increases regardless of the phantom thickness. The results from this thesis are likely to have implications for clinical practice, as they support the need for compression/thickness reduction to enhance lesion visibilit