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Purpose A clinical-prototype, dedicated, cone-beam breast computed tomography (CBBCT) system with offset detector is undergoing clinical evaluation at our institution. This study is to estimate the normalized glandular dose coefficients ( DgN CT ) that provide air kerma-to-mean glandular dose conversion factors using Monte Carlo simulations. Materials and methods The clinical prototype CBBCT system uses 49 kV x-ray spectrum with 1.39 mm 1st half-value layer thickness. Monte Carlo simulations (GATE, version 8) were performed with semi-ellipsoidal, homogeneous breasts of various fibroglandular weight fractions ( f g = 0.01 , 0.15 , 0.5 , 1 ) , chest wall diameters ( d = 8 , 10 , 14 , 18 , 20 cm), and chest wall to nipple length ( l = 0.75 d ), aligned with the axis of rotation (AOR) located at 65 cm from the focal spot to determine the DgN CT . Three geometries were considered - 40 × 30 -cm detector with no offset that served as reference and corresponds to a clinical CBBCT system, 30 × 30 -cm detector with 5 cm offset, and a 30 × 30 -cm detector with 10 cm offset. Results For 5 cm lateral offset, the DgN CT ranged 0.177 - 0.574 mGy/mGy and reduction in DgN CT with respect to reference geometry was observed only for 18 cm ( 6.4 % ± 0.23 % ) and 20 cm ( 9.6 % ± 0.22 % ) diameter breasts. For the 10 cm lateral offset, the DgN CT ranged 0.221 - 0.581 mGy/mGy and reduction in DgN CT was observed for all breast diameters. The reduction in DgN CT was 1.4 % ± 0.48 % , 7.1 % ± 0.13 % , 17.5 % ± 0.19 % , 25.1 % ± 0.15 % , and 27.7 % ± 0.08 % for 8, 10, 14, 18, and 20 cm diameter breasts, respectively. For a given breast diameter, the reduction in DgN CT with offset-detector geometries was not dependent on f g . Numerical fits of DgN CT d , l , f g were generated for each geometry. Conclusion The DgN CT and the numerical fit, D g N CT d , l , f g would be of benefit for current CBBCT systems using the reference geometry and for future generations using offset-detector geometry. There exists a potential for radiation dose reduction with offset-detector geometry, provided the same technique factors as the reference geometry are used, and the image quality is clinically acceptable.

Purpose The quality of dedicated cone-beam breast CT (CBBCT) imaging is fundamentally limited by x-ray scatter contamination due to the large irradiation volume. In this paper, we propose a scatter correction method for CBBCT using a novel forward-projection model with high correction efficacy and reliability. Method We first coarsely segment the uncorrected, first-pass, reconstructed CBBCT images into binary-object maps and assign the segmented fibroglandular and adipose tissue with the correct attenuation coefficients based on the mean x-ray energy. The modified CBBCT are treated as the prior images toward scatter correction. Primary signals are first estimated via forward projection on the modified CBBCT. To avoid errors caused by inaccurate segmentation, only sparse samples of estimated primary are selected for scatter estimation. A Fourier-Transform based algorithm, herein referred to as local filtration hereafter, is developed to efficiently estimate the global scatter distribution on the detector. The scatter-corrected images are obtained by removing the estimated scatter distribution from measured projection data. Results We evaluate the method performance on six patients with different breast sizes and shapes representing the general population. The results show that the proposed method effectively reduces the image spatial non-uniformity from 8.27 to 1.91% for coronal views and from 6.50 to 3.00% for sagittal views. The contrast-to-deviation ratio is improved by an average factor of 1.41. Comparisons on the image details reveal that the proposed scatter correction successfully preserves fine structures of fibroglandular tissues that are lost in the segmentation process. Conclusion We propose a highly practical and efficient scatter correction algorithm for CBBCT via a forward-projection model. The method is attractive in clinical CBBCT imaging as it is readily implementable on a clinical system without modifications in current imaging protocols or system hardware.

Purpose: The image quality of dedicated cone beam breast CT (CBBCT) is limited by substantial scatter contamination, resulting in cupping artifacts and contrast-loss in reconstructed images. Such effects obscure the visibility of soft-tissue lesions and calcifications, which hinders breast cancer detection and diagnosis. In this work, we propose a library-based software approach to suppress scatter on CBBCT images with high efficiency, accuracy, and reliability. Methods: The authors precompute a scatter library on simplified breast models with different sizes using the geant4-based Monte Carlo (MC) toolkit. The breast is approximated as a semiellipsoid with homogeneous glandular/adipose tissue mixture. For scatter correction on real clinical data, the authors estimate the breast size from a first-pass breast CT reconstruction and then select the corresponding scatter distribution from the library. The selected scatter distribution from simplified breast models is spatially translated to match the projection data from the clinical scan and is subtracted from the measured projection for effective scatter correction. The method performance was evaluated using 15 sets of patient data, with a wide range of breast sizes representing about 95% of general population. Spatial nonuniformity (SNU) and contrast to signal deviation ratio (CDR) were used as metrics for evaluation. Results: Since the time-consuming MC simulation for library generation is precomputed, the authors’ method efficiently corrects for scatter with minimal processing time. Furthermore, the authors find that a scatter library on a simple breast model with only one input parameter, i.e., the breast diameter, sufficiently guarantees improvements in SNU and CDR. For the 15 clinical datasets, the authors’ method reduces the average SNU from 7.14% to 2.47% in coronal views and from 10.14% to 3.02% in sagittal views. On average, the CDR is improved by a factor of 1.49 in coronal views and 2.12 in sagittal views. Conclusions: The library-based scatter correction does not require increase in radiation dose or hardware modifications, and it improves over the existing methods on implementation simplicity and computational efficiency. As demonstrated through patient studies, the authors’ approach is effective and stable, and is therefore clinically attractive for CBBCT imaging.

Purpose: High-resolution, photon-counting, energy-resolved detector with fast-framing capability can facilitate simultaneous acquisition of precontrast and postcontrast images for subtraction angiography without pixel registration artifacts and can facilitate high-resolution real-time imaging during image-guided interventions. Hence, this study was conducted to determine the spatial resolution characteristics of a hexagonal pixel array photon-counting cadmium telluride (CdTe) detector. Methods: A 650 μm thick CdTe Schottky photon-counting detector capable of concurrently acquiring up to two energy-windowed images was operated in a single energy-window mode to include photons of 10 keV or higher. The detector had hexagonal pixels with apothem of 30 μm resulting in pixel pitch of 60 and 51.96 μm along the two orthogonal directions. The detector was characterized at IEC-RQA5 spectral conditions. Linear response of the detector was determined over the air kerma rate relevant to image-guided interventional procedures ranging from 1.3 nGy/frame to 91.4 μGy/frame. Presampled modulation transfer was determined using a tungsten edge test device. The edge-spread function and the finely sampled line spread function accounted for hexagonal sampling, from which the presampled modulation transfer function(MTF) was determined. Since detectors with hexagonal pixels require resampling to square pixels for distortion-free display, the optimal square pixel size was determined by minimizing the root-mean-squared-error of the aperture functions for the square and hexagonal pixels up to the Nyquist limit. Results: At Nyquist frequencies of 8.33 and 9.62 cycles/mm along the apothem and orthogonal to the apothem directions, the modulation factors were 0.397 and 0.228, respectively. For the corresponding axis, the limiting resolution defined as 10% MTF occurred at 13.3 and 12 cycles/mm, respectively. Evaluation of the aperture functions yielded an optimal square pixel size of 54 μm. After resampling to 54 μm square pixels using trilinear interpolation, the presampled MTF at Nyquist frequency of 9.26 cycles/mm was 0.29 and 0.24 along the orthogonal directions and the limiting resolution (10% MTF) occurred at approximately 12 cycles/mm. Visual analysis of a bar pattern image showed the ability to resolve close to 12 line-pairs/mm and qualitative evaluation of a neurovascular nitinol-stent showed the ability to visualize its struts at clinically relevant conditions. Conclusions: Hexagonal pixel array photon-counting CdTe detector provides high spatial resolution in single-photon counting mode. After resampling to optimal square pixel size for distortion-free display, the spatial resolution is preserved. The dual-energy capabilities of the detector could allow for artifact-free subtraction angiography and basis material decomposition. The proposed high-resolution photon-counting detector with energy-resolving capability can be of importance for several image-guided interventional procedures as well as for pediatric applications.

Purpose: The authors experimentally investigate the effect of direct energy conversion of x-rays via selfpowered Auger- and photocurrent, potentially suitable to practical radiationdetection and dosimetry in medical applications. Experimental results are compared to computational predictions. The detector the authors consider is a thin-film multilayer device, composed of alternating disparate electrically conductive and insulating layers. This paper focuses on the experiments while a companion paper introduces the fundamental concepts of high-energy current (HEC) detectors. Methods: The energy of ionizing radiation is directly converted to detector signal via electric current induced by high-energy secondary electrons generated in the detector material by the incident primary radiation. The HEC electrons also ionize the dielectric and the resultant charge carriers are selfcollected due to the contact potential of the disparate electrodes. Thus, an electric current is induced in the conductors in two different ways without the need for externally applied bias voltage or amplification. Thus, generated signal in turn is digitized by a data acquisition system. To determine the fundamental properties of the HEC detector and to demonstrate its feasibility for medical applications, the authors used a planar geometry composed of multilayer microstructures. Various detectors with up to seven conducting layers with different combinations of materials (250 μm Al, 35 μm Cu, 100 μm Pb) and air gaps (100 μm) were exposed to nearly plane-parallel 60–120 kVp x-ray beams. For the experimental design and verification, the authors performed coupled electron–photon radiation transport computations. The detector signal was measured using a commercial data acquisition system with 24 bits dynamic range, 0.4 fC sensitivity, and 0.9 ms sampling time. Results: Measured signals for the prototype detector varied depending on the number of layers, material type, and incident photon energy, and it was in the range of 30–150 nA/cm2 for unit air kerma (1 Gy), which is viable for practical applications. The experiments had an excellent agreement with the computations. Within the examined range of 60–120 kVp, the energy dependence of the HEC (normalized to the x-ray tube output) was relatively small. Conclusions: Based on the experimental results for 100 ms sampling time, it would be possible to measure the time dependence of x-ray beams for x-ray tube current of 0.1 mA or higher. Significant advantages of the HEC device are that generation of its signal does not require external power supply, it can be made in any size and shape, including flexible curvilinear forms, and it is inexpensive. It remains to be determined, which of the potential applications in medical dosimetry (both in vivo and external), or radiation protection would benefit from such selfpowered detectors.

Purpose: To fabricate organic photovoltaic (OPV) cells with nanometric active layers sensitive to ionizing radiation and measure their dosimetric characteristics in clinical x-ray beams in the diagnostic tube potential range of 60–150 kVp. Methods: Experiments were designed to optimize the detector’s x-ray response and find the best parameter combination by changing the active layer thickness and the area of the electrode. The OPV cell consisted of poly (3-hexylthiophene-2,5-diyl): [6,6]-phenyl C61 butyric acid methyl ester photoactive donor and acceptor semiconducting organic materials sandwiched between an aluminum electrode as an anode and an indium tin oxide electrode as a cathode. The authors measured the radiation-induced electric current at zero bias voltage in all fabricated OPV cells. Results: The net OPV current as a function of beam potential (kVp) was proportional to kVp−0.5 when normalized to x-ray tube output, which varies with kVp. Of the tested configurations, the best combination of parameters was 270 nm active layer thicknesses with 0.7 cm2 electrode area, which provided the highest signal per electrode area. For this cell, the measured current ranged from approximately 0.7 to 2.4 nA/cm2 for 60–150 kVp, corresponding to about 0.09 nA–0.06 nA/mGy air kerma, respectively. When compared to commercial amorphous silicon thin film photovoltaic cells irradiated under the same conditions, this represents 2.5 times greater sensitivity. An additional 40% signal enhancement was observed when a 1 mm layer of plastic scintillator was attached to the cells’ beam-facing side. Conclusions: Since both OPVs can be produced as flexible devices and they do not require external bias voltage, they open the possibility for use as thin film in vivo detectors for dose monitoring in diagnostic x-ray imaging.

There is an art to writing a scientific paper so that it communicates accurately, succinctly, and comprehensively. Developing this art comes with experience, and sharing that experience with younger physicists is an obligation of senior scientists, especially those with editorial responsibilities for the journal. In this workshop, the preparation of a scientific manuscript will be dissected so participants can appreciate how each part is developed and then assembled into a complete paper. Then the review process for the paper will be discussed, including how to examine a paper and write an insightful and constructive review. Finally, we will consider the challenge of accommodating the concerns and recommendations of a reviewer in preparing a revision of the paper. A second feature of the workshop will be a discussion of the process of electronic submission of a paper for consideration by Medical Physics. The web‐based PeerX‐Press engine for manuscript submission and management will be examined, with attention to special features such as epaps and line‐referencing. Finally, new features of Medical Physics will be explained, such as Vision 20/20 manuscripts, Physics Letters and the standardized formatting of book reviews. Learning Objectives: 1. Improve the participants' abilities to write a scientific manuscript. 2. Understand the review process for Medical Physics manuscripts and how to participate in and benefit from it. 3. Appreciate the many features of the PeerX‐Press electronic management process for Medical Physics manuscripts. 4. Develop a knowledge of new features of Medical Physics.

Purpose Dedicated cone beam breast CT (CBBCT) suffers from x-ray scatter contamination. We aim to identify the source of the significant difference between the scatter distributions estimated by two recent methods proposed by our group and to investigate its effect on CBBCT image quality. Method We recently proposed two novel methods of scatter correction for CBBCT, using a library based (LB) technique and a forward projection (FP) model. Despite similar enhancement on CBBCT image qualities, these two methods obtain very different scatter distributions. We hypothesize that the off-focus radiation (OFR) is the contributor and results in nontrivial signals in x-ray projections, which is ignored in the scatter estimation via the LB method. Experiments using a thin wire test tool are designed to study the effect of OFR on CBBCT spatial resolution by measuring the point spread function (PSF) and the modulation transfer function (MTF). A narrow collimator setting is used to suppress the OFR-induced signals. In addition, "PSFs" and "MTFs" are measured on clinical CBBCT images obtained by the LB and FP methods using small calcifications as point sources. The improvement of spatial resolution achieved by suppressing OFR in the wire experiment as well as in the clinical study is quantified by the improvement ratios of PSFs and spatial frequencies at different MTF values. Our hypothesis that OFR causes the imaging difference between the FP and LB methods is verified if these ratios obtained from experimental and clinical data are consistent. Results In the wire experiment, the results show that suppression of OFR increases the maximum signal of the PSF by about 14% and reduces the full-width-at-half-maximum (FWHM) by about 12.0%. Similar improvement on spatial resolution is achieved by the FP method compared with the LB method in the patient study. The improvement ratios of spatial frequencies at different MTF values without OFR match very well in both studies at a level of around 16%, with an average root-mean-square difference of 0.47%. Conclusion The results of the wire experiment and the clinical study indicate that the main difference between the LB and FP methods is whether the OFR-induced signals are included after scatter correction. Our study further shows that OFR significantly affects the image spatial resolution of CBBCT, indicating that the visualization of micro-calcifications is susceptible to OFR contamination. Our finding is therefore important in further improvement of diagnostic performance of CBBCT.

High-resolution, photon-counting, energy-resolved detector with fast-framing capability can facilitate simultaneous acquisition of precontrast and postcontrast images for subtraction angiography without pixel registration artifacts and can facilitate high-resolution real-time imaging during image-guided interventions. Hence, this study was conducted to determine the spatial resolution characteristics of a hexagonal pixel array photon-counting cadmium telluride (CdTe) detector.A 650 μm thick CdTe Schottky photon-counting detector capable of concurrently acquiring up to two energy-windowed images was operated in a single energy-window mode to include photons of 10 keV or higher. The detector had hexagonal pixels with apothem of 30 μm resulting in pixel pitch of 60 and 51.96 μm along the two orthogonal directions. The detector was characterized at IEC-RQA5 spectral conditions. Linear response of the detector was determined over the air kerma rate relevant to image-guided interventional procedures ranging from 1.3 nGy/frame to 91.4 μGy/frame. Presampled modulation transfer was determined using a tungsten edge test device. The edge-spread function and the finely sampled line spread function accounted for hexagonal sampling, from which the presampled modulation transfer function (MTF) was determined. Since detectors with hexagonal pixels require resampling to square pixels for distortion-free display, the optimal square pixel size was determined by minimizing the root-mean-squared-error of the aperture functions for the square and hexagonal pixels up to the Nyquist limit.At Nyquist frequencies of 8.33 and 9.62 cycles/mm along the apothem and orthogonal to the apothem directions, the modulation factors were 0.397 and 0.228, respectively. For the corresponding axis, the limiting resolution defined as 10% MTF occurred at 13.3 and 12 cycles/mm, respectively. Evaluation of the aperture functions yielded an optimal square pixel size of 54 μm. After resampling to 54 μm square pixels using trilinear interpolation, the presampled MTF at Nyquist frequency of 9.26 cycles/mm was 0.29 and 0.24 along the orthogonal directions and the limiting resolution (10% MTF) occurred at approximately 12 cycles/mm. Visual analysis of a bar pattern image showed the ability to resolve close to 12 line-pairs/mm and qualitative evaluation of a neurovascular nitinol-stent showed the ability to visualize its struts at clinically relevant conditions.Hexagonal pixel array photon-counting CdTe detector provides high spatial resolution in single-photon counting mode. After resampling to optimal square pixel size for distortion-free display, the spatial resolution is preserved. The dual-energy capabilities of the detector could allow for artifact-free subtraction angiography and basis material decomposition. The proposed high-resolution photon-counting detector with energy-resolving capability can be of importance for several image-guided interventional procedures as well as for pediatric applications.

The authors experimentally investigate the effect of direct energy conversion of x-rays via selfpowered Auger- and photocurrent, potentially suitable to practical radiation detection and dosimetry in medical applications. Experimental results are compared to computational predictions. The detector the authors consider is a thin-film multilayer device, composed of alternating disparate electrically conductive and insulating layers. This paper focuses on the experiments while a companion paper introduces the fundamental concepts of high-energy current (HEC) detectors.The energy of ionizing radiation is directly converted to detector signal via electric current induced by high-energy secondary electrons generated in the detector material by the incident primary radiation. The HEC electrons also ionize the dielectric and the resultant charge carriers are selfcollected due to the contact potential of the disparate electrodes. Thus, an electric current is induced in the conductors in two different ways without the need for externally applied bias voltage or amplification. Thus, generated signal in turn is digitized by a data acquisition system. To determine the fundamental properties of the HEC detector and to demonstrate its feasibility for medical applications, the authors used a planar geometry composed of multilayer microstructures. Various detectors with up to seven conducting layers with different combinations of materials (250 μm Al, 35 μm Cu, 100 μm Pb) and air gaps (100 μm) were exposed to nearly plane-parallel 60-120 kVp x-ray beams. For the experimental design and verification, the authors performed coupled electron-photon radiation transport computations. The detector signal was measured using a commercial data acquisition system with 24 bits dynamic range, 0.4 fC sensitivity, and 0.9 ms sampling time.Measured signals for the prototype detector varied depending on the number of layers, material type, and incident photon energy, and it was in the range of 30-150 nA/cm(2) for unit air kerma (1 Gy), which is viable for practical applications. The experiments had an excellent agreement with the computations. Within the examined range of 60-120 kVp, the energy dependence of the HEC (normalized to the x-ray tube output) was relatively small.Based on the experimental results for 100 ms sampling time, it would be possible to measure the time dependence of x-ray beams for x-ray tube current of 0.1 mA or higher. Significant advantages of the HEC device are that generation of its signal does not require external power supply, it can be made in any size and shape, including flexible curvilinear forms, and it is inexpensive. It remains to be determined, which of the potential applications in medical dosimetry (both in vivo and external), or radiation protection would benefit from such selfpowered detectors.

Purpose: To determine the mean and range of volumetric glandular fraction (VGF) of the breast in a diagnostic population using a high-resolution flat-panel cone-beam dedicated breast CT system. This information is important for Monte Carlo-based estimation of normalized glandular dose coefficients and for investigating the dependence of VGF on breast dimensions, race, and pathology. Methods: Image data from a clinical trial investigating the role of dedicated breast CT that enrolled 150 women were retrospectively analyzed to determine the VGF. The study was conducted in adherence to a protocol approved by the institutional human subjects review boards and written informed consent was obtained from all study participants. All participants in the study were assigned BI-RADS{sup Registered-Sign} 4 or 5 as per the American College of Radiology assessment categories after standard diagnostic work-up and underwent dedicated breast CT exam prior to biopsy. A Gaussian-kernel based fuzzy c-means algorithm was used to partition the breast CT images into adipose and fibroglandular tissue after segmenting the skin. Upon determination of the accuracy of the algorithm with a phantom, it was applied to 137 breast CT volumes from 136 women. VGF was determined for each breast and the mean and range were determined. Pathology resultsmore » with classification as benign, malignant, and hyperplasia were available for 132 women, and were used to investigate if the distributions of VGF varied with pathology. Results: The algorithm was accurate to within {+-}1.9% in determining the volume of an irregular shaped phantom. The study mean ({+-} inter-breast SD) for the VGF was 0.172 {+-} 0.142 (range: 0.012-0.719). VGF was found to be negatively correlated with age, breast dimensions (chest-wall to nipple length, pectoralis to nipple length, and effective diameter at chest-wall), and total breast volume, and positively correlated with fibroglandular volume. Based on pathology, pairwise statistical analysis (Mann-Whitney test) indicated that at the 0.05 significance level, there was no significant difference in distributions of VGF without adjustment for age between malignant and nonmalignant breasts (p= 0.41). Pairwise comparisons of the distributions of VGF in increasing order of mammographic breast density indicated all comparisons were statistically significant (p < 0.002). Conclusions: This study used a different clinical prototype breast CT system than that in previous studies to image subjects from a different geographical region, and used a different algorithm for analysis of image data. The mean VGF estimated from this study is within the range reported in previous studies, indicating that the choice of 50% glandular weight fraction to represent an average breast for Monte Carlo-based estimation of normalized glandular dose coefficients in mammography needs revising. In the study, the distributions of VGF did not differ significantly with pathology.« less

Purpose: Dedicated breast CT prototypes used in clinical investigations utilize single circular source trajectory and cone-beam geometry with flat-panel detectors that do not satisfy data-sufficiency conditions and could lead to cone beam artifacts. Hence, this work investigated the glandular dose characteristics of a circle-plus-line trajectory that fulfills data-sufficiency conditions for image reconstruction in dedicated breast CT. Methods: Monte Carlo-based computer simulations were performed using the GEANT4 toolkit and was validated with previously reported normalized glandular dose coefficients for one prototype breast CT system. Upon validation, Monte Carlo simulations were performed to determine the normalized glandular dose coefficients as a function of x-ray source position along the line scan. The source-to-axis of rotation distance and the source-to-detector distance were maintained constant at 65 and 100 cm, respectively, in all simulations. The ratio of the normalized glandular dose coefficient at each source position along the line scan to that for the circular scan, defined as relative normalized glandular dose coefficient (RD{sub g}N), was studied by varying the diameter of the breast at the chest wall, chest-wall to nipple distance, skin thickness, x-ray beam energy, and glandular fraction of the breast. Results: The RD{sub g}N metric when stated as a function of sourcemore » position along the line scan, relative to the maximum length of line scan needed for data sufficiency, was found to be minimally dependent on breast diameter, chest-wall to nipple distance, skin thickness, glandular fraction, and x-ray photon energy. This observation facilitates easy estimation of the average glandular dose of the line scan. Polynomial fit equations for computing the RD{sub g}N and hence the average glandular dose are provided. Conclusions: For a breast CT system that acquires 300-500 projections over 2{pi} for the circular scan, the addition of a line trajectory with equal source spacing and constant x-ray beam quality (kVp and HVL) and mAs matched to the circular scan, will result in less than 0.18% increase in average glandular dose to the breast per projection along the line scan.« less

Purpose: This work presents an improved algorithm for the generation of 3D breast software phantoms and its evaluation for mammography. Methods: The improved methodology has evolved from a previously presented 3D noncompressed breast modeling method used for the creation of breast models of different size, shape, and composition. The breast phantom is composed of breast surface, duct system and terminal ductal lobular units, Cooper's ligaments, lymphatic and blood vessel systems, pectoral muscle, skin, 3D mammographic background texture, and breast abnormalities. The key improvement is the development of a new algorithm for 3D mammographic texture generation. Simulated images of the enhanced 3D breast model without lesions were produced by simulating mammographic image acquisition and were evaluated subjectively and quantitatively. For evaluation purposes, a database with regions of interest taken from simulated and real mammograms was created. Four experienced radiologists participated in a visual subjective evaluation trial, as they judged the quality of the simulated mammograms, using the new algorithm compared to mammograms, obtained with the old modeling approach. In addition, extensive quantitative evaluation included power spectral analysis and calculation of fractal dimension, skewness, and kurtosis of simulated and real mammograms from the database. Results: The results from the subjective evaluation stronglymore » suggest that the new methodology for mammographic breast texture creates improved breast models compared to the old approach. Calculated parameters on simulated images such as {beta} exponent deducted from the power law spectral analysis and fractal dimension are similar to those calculated on real mammograms. The results for the kurtosis and skewness are also in good coincidence with those calculated from clinical images. Comparison with similar calculations published in the literature showed good agreement in the majority of cases. Conclusions: The improved methodology generated breast models with increased realism compared to the older model as shown in evaluations of simulated images by experienced radiologists. It is anticipated that the realism will be further improved using an advanced image simulator so that simulated images may be used in feasibility studies in mammography.« less

Breast imaging is largely indicated for detection, diagnosis, and clinical management of breast cancer and for evaluation of the integrity of breast implants. In this work, a prospective view of techniques for breast cancer detection and diagnosis is provided based on an assessment of current trends. The potential role of emerging techniques that are under various stages of research and development is also addressed. It appears that the primary imaging tool for breast cancer screening in the next decade will be high-resolution, high-contrast, anatomical x-ray imaging with or without depth information. MRI and ultrasonography will have an increasingly important adjunctive role for imaging high-risk patients and women with dense breasts. Pilot studies with dedicated breast CT have demonstrated high-resolution three-dimensional imaging capabilities, but several technological barriers must be overcome before clinical adoption. Radionuclide based imaging techniques and x-ray imaging with intravenously injected contrast offer substantial potential as a diagnostic tools and for evaluation of suspicious lesions. Developing optical and electromagnetic imaging techniques hold significant potential for physiologic information and they are likely to be of most value when integrated with or adjunctively used with techniques that provide anatomic information. Experimental studies with breast specimens suggest that phase-sensitive x-ray imaging techniques can provide edge enhancement and contrast improvement but more research is needed to evaluate their potential role in clinical breast imaging. From the technological perspective, in addition to improvements within each modality, there is likely to be a trend towards multi-modality systems that combine anatomic with physiologic information. We are also likely to transition from a standardized screening, where all women undergo the same imaging exam (mammography), to selection of a screening modality or modalities based an individual-risk or other classification.

Digital tomosynthesis of the breast is being investigated as one possible solution to the problem of tissue superposition present in planar mammography. This imaging technique presents various advantages that would make it a feasible replacement for planar mammography, among them similar, if not lower, radiation glandular dose to the breast; implementation on conventional digital mammography technology via relatively simple modifications; and fast acquisition time. One significant problem that tomosynthesis of the breast must overcome, however, is the reduction of x-ray scatter inclusion in the projection images. In tomosynthesis, due to the projection geometry and radiation dose considerations, the use of an antiscatter grid presents several challenges. Therefore, the use of postacquisition software-based scatter reduction algorithms seems well justified, requiring a comprehensive evaluation of x-ray scatter content in the tomosynthesis projections. This study aims to gain insight into the behavior of x-ray scatter in tomosynthesis by characterizing the scatter point spread functions (PSFs) and the scatter to primary ratio (SPR) maps found in tomosynthesis of the breast. This characterization was performed using Monte Carlo simulations, based on the Geant4 toolkit, that simulate the conditions present in a digital tomosynthesis system, including the simulation of the compressed breast in both the cranio-caudal (CC) and the medio-lateral oblique (MLO) views. The variation of the scatter PSF with varying tomosynthesis projection angle, as well as the effects of varying breast glandular fraction and x-ray spectrum, was analyzed. The behavior of the SPR for different projection angle, breast size, thickness, glandular fraction, and x-ray spectrum was also analyzed, and computer fit equations for the magnitude of the SPR at the center of mass for both the CC and the MLO views were found. Within mammographic energies, the x-ray spectrum was found to have no appreciable effect on the scatter PSF and on the SPR. Glandular fraction and compressed breast size were found to have a small effect, while compressed breast thickness and projection angle, as expected, introduced large variations in both the scatter PSF and SPR. The presence of the breast support plate and the detector cover plate in the simulations introduced important effects on the SPR, which are also relevant to the scatter content in planar mammography.

Tomosynthesis of the breast is currently a topic of intense interest as a logical next step in the evolution of digital mammography. This study reports on the computation of glandular radiation dose in digital tomosynthesis of the breast. Previously, glandular dose estimations in tomosynthesis have been performed using data from studies of radiation dose in conventional planar mammography. This study evaluates, using Monte Carlo methods, the normalized glandular dose (DgN) to the breast during a tomosynthesis study, and characterizes its dependence on breast size, tissue composition, and x-ray spectrum. The conditions during digital tomosynthesis imaging of the breast were simulated using a computer program based on the Geant4 toolkit. With the use of simulated breasts of varying size, thickness and tissue composition, the DgN to the breast tissue was computed for varying x-ray spectra and tomosynthesis projection angle. Tomosynthesis projections centered about both the cranio-caudal (CC) and medio-lateral oblique (MLO) views were simulated. For each projection angle, the ratio of the glandular dose for that projection to the glandular dose for the zero degree projection was computed. This ratio was denoted the relative glandular dose (RGD) coefficient, and its variation under different imaging parameters was analyzed. Within mammographic energies, the RGD was found to have a weak dependence on glandular fraction and x-ray spectrum for both views. A substantial dependence on breast size and thickness was found for the MLO view, and to a lesser extent for the CC view. Although RGD values deviate substantially from unity as a function of projection angle, the RGD averaged over all projections in a complete tomosynthesis study varies from 0.91 to 1.01. The RGD results were fit to mathematical functions and the resulting equations are provided.

In this paper, the performance of an 8 cm x 8 cm three-side buttable charge-coupled device (CCD)-based imager specially designed for high-resolution fluoroscopy and operating in fluoroscopic (30 frames/second) mode is presented in terms of the presampling modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE). The 8 cm x 8 cm CCD imager is coupled to a 450 microm thick CsI:Tl scintillator by nondemagnifying (straight, 1:1) fiberoptics. The CCD imager has a fundamental pixel pitch of 39 microm and incorporates an optically opaque interline (data) channel. The CCD imager was operated at 156 microm pixel pitch by binning 4 x 4 adjacent pixels prior to readout. The fluoroscopic image lag was measured and accounted for in the DQE estimate to provide lag-corrected DQE. The measured limiting spatial resolution at 10% presampling MTF with the imager operated at 156 microm pixel pitch (Nyquist sampling limit: 3.21 cy/mm) was 3.6 cy/mm. In the pulsed fluoroscopic mode, the first-frame image lag was less than 0.9%. The lag-corrected DQE(0) of approximately 0.62 was achieved even at a low fluoroscopic exposure rate of 1 microR/frame. Grid phantom measurements indicate no appreciable distortion. Results from DQE and image lag measurements at fluoroscopic exposure rates combined with the high spatial resolution observed from the MTF suggest that this type of imager or its variants may be a potential candidate for high-resolution neuro-interventional imaging, cardiovascular imaging, pediatric angiography, and small animal imaging. Since the CCD is three-side buttable, four such CCD modules can be joined to form a 2 x 2 matrix providing a field of view of 16 cm x 16 cm.

Cascaded linear systems based modeling techniques have been used in the past to predict important system parameters that have a direct impact on image quality. Such models are also useful in optimizing system parameters to improve image quality. In this work, detailed analysis of a solid-state fluoroscopic imaging system intended for high-resolution angiography is presented with the use of such a model. The imaging system analyzed through this model uses four 8 x 8 cm three-side buttable interlined charge-coupled devices (CCDs) specifically designed for high-resolution angiography and tiled in a seamless fashion to achieve a field of view (FOV) of 16 x 16 cm. Larger FOVs can be achieved by tiling more CCDs in a similar manner. The system employs a CsI:Tl scintillator coupled to the CCDs by straight (nontapering) fiberoptics and can potentially be operated in 78, 156, or 234 microm pixel pitch modes. The system parameters analyzed through this model include presampling modulation transfer function, noise power spectrum, and detective quantum efficiency (DQE). The results of the simulations performed indicate that DQE(0) in excess of 0.6 is achievable, with the imager operating at 156 microm pixel pitch, 30 frames/s, and employing a 450-microm-thick CsI:Tl scintillator, even at a low fluoroscopic exposure rate of 1 microR/frame. Further, at a nominal fluoroscopic exposure rate of 2.5 microR/frame there was no noticeable degradation of the DQE even at the 78 microm pixel pitch mode suggesting that it is feasible to perform high-resolution angiography hitherto unattainable in clinical practice.

The physical characteristics of a clinical charge coupled device (CCD)-based imager (Senovision, GE Medical Systems, Milwaukee, WI) for small-field digital mammography have been investigated. The imager employs a MinR 2000 (Eastman Kodak Company, Rochester, NY) scintillator coupled by a 1:1 optical fiber to a front-illuminated 61 x 61 mm CCD operating at a pixel pitch of 30 microns. Objective criteria such as modulation transfer function (MTF), noise power spectrum (NPS), detective quantum efficiency (DQE), and noise equivalent quanta (NEQ) were employed for this evaluation. The results demonstrated a limiting spatial resolution (10% MTF) of 10 cy/mm. The measured DQE of the current prototype utilizing a 28 kVp, Mo-Mo spectrum beam hardened with 4.5 cm Lucite is approximately 40% at close to zero spatial frequency at an exposure of 8.2 mR, and decreases to approximately 28% at a low exposure of 1.1 mR. Detector element nonuniformity and electronic gain variations were not significant after appropriate calibration and software corrections. The response of the imager was linear and did not exhibit signal saturation under tested exposure conditions.

The objectives of this research are to analyze geometrical distortions introduced by relaylenses in optically coupled digital x-ray imaging systems and to introduce an algorithm to correct such distortions. Methods: The radial and tangential errors introduced by a relay lens in digital x-ray imaging were experimentally measured, using a lens-coupled CCD(charge coupled device) prototype. An algorithm was introduced to correct these distortions. Based on an x-rayimage of a standard calibration grid, the algorithm first identified the location of the optical axis, then corrected the radial and tangential distortions using polynomial transformation technique. Results: Lens distortions were classified and both radial and tangential distortions introduced by lenses were corrected using polynomial transformation. For the specific lens-CCD prototype investigated, the mean positional error caused by the relay lens was reduced by the correction algorithm from about eight pixels (0.69 mm) to less than 1.8 pixels (0.15 mm). Our investigation also shows that the fourth order of polynomial for the correction algorithm provided the best correction result. Conclusions: Lens distortions should be considered in position-dependant, quantitative x-ray imaging and such distortions can be minimized in CCDx-ray imaging by appropriate algorithm, as demonstrated in this paper.

Suggestions for topics suitable for these Point/Counterpoint debates should be addressed to Colin G. Orton, ProfessorEmeritus, Wayne State University, Detroit: ortonc@comcast.net. Persons participating in Point/Counterpoint discussions areselected for their knowledge and communicative skill. Their positions for or against a proposition may or may notreflect their personal opinions or the positions of their employers.

Purpose: Several commercial and non-commercial software and techniques are available for determining breast density from mammograms. However, where mandated by law the breast density information communicated to the subject/patient is based on radiologist's interpretation of breast density from mammograms. Several studies have reported on the concordance among radiologists in interpreting mammographic breast density. In this work, we investigated the accuracy of radiologist's interpretation of breast density. Methods: Volumetric breast density (VBD) determined from 134 unilateral dedicated breast CT scans from 134 subjects was considered the truth. An MQSA-qualified study radiologist with more than 20 years of breast imaging experience reviewed the DICOM “for presentation” standard 2-view mammograms of the corresponding breasts and assigned BIRADS breast density categories. For statistical analysis, the breast density categories were dichotomized in two ways; fatty vs. dense breasts where “fatty” corresponds to BIRADS breast density categories A/B, and “dense” corresponds to BIRADS breast density categories C/D, and extremely dense vs. fatty to heterogeneously dense breasts, where extremely dense corresponds to BIRADS breast density category D and BIRADS breast density categories A through C were grouped as fatty to heterogeneously dense breasts. Logistic regression models (SAS 9.3) were used to determine the association between radiologist's interpretation of breast density and VBD from breast CT, from which the area under the ROC (AUC) was determined. Results: Both logistic regression models were statistically significant (Likelihood Ratio test, p

To determine the x-ray photon energy dependence of the anatomic power spectrum of the breast when imaged with dedicated breast computed tomography (CT).A theoretical framework for scaling the empirically determined anatomic power spectrum at one x-ray photon energy to that at any given x-ray photon energy when imaged with dedicated breast CT was developed. Theory predicted that when the anatomic power spectrum is fitted with a power curve of the form k f(-β), where k and β are fit coefficients and f is spatial frequency, the exponent β would be independent of x-ray photon energy (E), and the amplitude k scales with the square of the difference in energy-dependent linear attenuation coefficients of fibroglandular and adipose tissues. Twenty mastectomy specimens based numerical phantoms that were previously imaged with a benchtop flat-panel cone-beam CT system were converted to 3D distribution of glandular weight fraction (f(g)) and were used to verify the theoretical findings. The 3D power spectrum was computed in terms of f(g) and after converting to linear attenuation coefficients at monoenergetic x-ray photon energies of 20-80 keV in 5 keV intervals. The 1D power spectra along the axes were extracted and fitted with a power curve of the form k f(-β). The energy dependence of k and β were analyzed.For the 20 mastectomy specimen based numerical phantoms used in the study, the exponent β was found to be in the range of 2.34-2.42, depending on the axis of measurement. Numerical simulations agreed with the theoretical predictions that for a power-law anatomic spectrum of the form k f(-β), β was independent of E and k(E) = k(1)[μ(g)(E) - μ(a)(E)](2), where k(1) is a constant, and μ(g)(E) and μ(a)(E) represent the energy-dependent linear attenuation coefficients of fibroglandular and adipose tissues, respectively.Numerical simulations confirmed the theoretical predictions that in dedicated breast CT, the spatial frequency dependence of the anatomic power spectrum will be independent of x-ray photon energy, and the amplitude of the anatomic power spectrum scales by the square of difference in linear attenuation coefficients of fibroglandular and adipose tissues.

Purpose: Scatter contamination is detrimental to image quality in dedicated cone-beam breast CT (CBBCT), resulting in cupping artifacts and loss of contrast in reconstructed images. Such effects impede visualization of breast lesions and the quantitative accuracy. Previously, we proposed a library-based software approach to suppress scatter on CBBCT images. In this work, we quantify the efficacy and stability of this approach using datasets from 15 human subjects. Methods: A pre-computed scatter library is generated using Monte Carlo simulations for semi-ellipsoid breast models and homogeneous fibroglandular/adipose tissue mixture encompassing the range reported in literature. Projection datasets from 15 human subjects that cover 95 percentile of breast dimensions and fibroglandular volume fraction were included in the analysis. Our investigations indicate that it is sufficient to consider the breast dimensions alone and variation in fibroglandular fraction does not significantly affect the scatter-to-primary ratio. The breast diameter is measured from a first-pass reconstruction; the appropriate scatter distribution is selected from the library; and, deformed by considering the discrepancy in total projection intensity between the clinical dataset and the simulated semi-ellipsoidal breast. The deformed scatter-distribution is subtracted from the measured projections for scatter correction. Spatial non-uniformity (SNU) and contrast-to-noise ratio (CNR) were used as quantitative metrics to evaluate the results. Results: On the 15 patient cases, our method reduced the overall image spatial non-uniformity (SNU) from 7.14%±2.94% (mean ± standard deviation) to 2.47%±0.68% in coronal view and from 10.14%±4.1% to 3.02% ±1.26% in sagittal view. The average contrast to noise ratio (CNR) improved by a factor of 1.49±0.40 in coronal view and by 2.12±1.54 in sagittal view. Conclusion: We demonstrate the robustness and effectiveness of a library-based scatter correction method using patient datasets with large variability in breast dimensions and composition. The high computational efficiency and simplicity in implementation make this attractive for clinical implementation. Supported partly by NIH R21EB019597, R21CA134128 and R01CA195512.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Purpose: To optimize the cesium iodide (CsI:Tl) scintillator thickness in a complimentary metal-oxide semiconductor (CMOS)-based detector for use in dedicated cone-beam breast CT. Methods: The imaging task considered was the detection of a microcalcification cluster comprising six 220µm diameter calcium carbonate spheres, arranged in the form of a regular pentagon with 2 mm spacing on its sides and a central calcification, similar to that in ACR-recommended mammography accreditation phantom, at a mean glandular dose of 4.5 mGy. Generalized parallel-cascades based linear systems analysis was used to determine Fourier-domain image quality metrics in reconstructed object space, from which the detectability index inclusive of anatomical noise was determined for a non-prewhitening numerical observer. For 300 projections over 2π, magnification-associated focal-spot blur, Monte Carlo derived x-ray scatter, K-fluorescent emission and reabsorption within CsI:Tl, CsI:Tl quantum efficiency and optical blur, fiberoptic plate transmission efficiency and blur, CMOS quantum efficiency, pixel aperture function and additive noise, and filtered back-projection to isotropic 105µm voxel pitch with bilinear interpolation were modeled. Imaging geometry of a clinical prototype breast CT system, a 60 kV Cu/Al filtered x-ray spectrum from 0.3 mm focal spot incident on a 14 cm diameter semi-ellipsoidal breast were used to determine the detectability index for 300–600 µm thick (75µm increments) CsI:Tl. The CsI:Tl thickness that maximized the detectability index was considered optimal. Results: The limiting resolution (10% modulation transfer function, MTF) progressively decreased with increasing CsI:Tl thickness. The zero-frequency detective quantum efficiency, DQE(0), in projection space increased with increasing CsI:Tl thickness. The maximum detectability index was achieved with 525µm thick CsI:Tl scintillator. Reduced MTF at mid-to-high frequencies for 600µm thick CsI:Tl lowered the detectability index than 525µm CsI:Tl. Conclusion: For the x-ray spectrum and imaging conditions considered, a 525µm thick CsI:Tl scintillator integrated with the CMOS detector is optimal for detecting microcalcification cluster. Funding support: Supported in part by NIH R01 CA195512. The contents are solely the responsibility of the authors and do not reflect the official views of the NIH or the NCI. Disclosures: SV, GV and AK - Research collaboration, Koning Corp., West Henrietta, NY.

Mammography-based screening has been a valuable imaging tool for the early detection of non-palpable lesions and has contributed to significant reduction in breast cancer associated mortality. However, the breast imaging community recognizes that mammography is not ideal, and in particular is inferior for women with dense breasts. Also, the 2-D projection of a 3-D organ results in tissue superposition contributing to false-positives. The sensitivity of mammography is breast-density dependent. Its sensitivity, especially in dense breasts, is low due to overlapping tissue and the fact that normal breast tissue, benign lesions and breast cancers all have similar “densities”, making lesion detection more difficult. We ideally need 3-D imaging for imaging the 3-D breast. MRI is 3-D, whole breast ultrasound is 3-D, digital breast tomosynthesis is called 3-D but is really “pseudo 3-D” due to poor resolution along the depth-direction. Also, and importantly, we need to be able to administer intravenous contrast agents for optimal imaging, similar to other organ systems in the body. Dedicated breast CT allows for 3-D imaging of the uncompressed breast. In current designs, the patient is positioned prone on the table and the breast is pendant through an aperture and the scan takes approximately 10 seconds [O’Connell et al., AJR 195: 496–509, 2010]. Almost on the heels of the invention of CT itself, work began on the development of dedicated breast CT. These early breast CT systems were used in clinical trials and the results from comparative performance evaluation of breast CT and mammography for 1625 subjects were reported in 1980 [Chang et al., Cancer 46: 939–46, 1980]. However, the technological limitations at that time stymied clinical translation for decades. Subsequent to the landmark article in 2001 [Boone et al., Radiology 221: 657–67, 2001] that demonstrated the potential feasibility in terms of radiation dose, multiple research groups are actively investigating dedicated breast CT. The development of large-area flat-panel detectors with field-of-view sufficient to image the entire breast in each projection enabled development of flat-panel cone-beam breast CT. More recently, the availability of complimentary metal-oxide semiconductor (CMOS) detectors with lower system noise and finer pixel pitch, combined with the development of x-ray tubes with focal spot dimensions similar to mammography systems, has shown improved spatial resolution and could improve visualization of microcalcifications. These technological developments promise clinical translation of low-dose cone-beam breast CT. Dedicated photon-counting breast CT (pcBCT) systems represent a novel detector design, which provide high spatial resolution (∼ 100µm) and low mean glandular dose (MGD). The CdTe-based direct conversion detector technology was previously evaluated and confirmed by simulations and basic experiments on laboratory setups [Kalender et al., Eur Radiol 22: 1–8, 2012]. Measurements of dose, technical image quality parameters, and surgical specimens on a pcBCT scanner have been completed. Comparative evaluation of surgical specimens showed that pcBCT outperformed mammography and digital breast tomosynthesis with respect to 3D spatial resolution, detectability of calcifications, and soft tissue delineation. Major barriers to widespread clinical use of BCT relate to radiation dose, imaging of microcalcifications, and adequate coverage of breast tissue near the chest wall. Adequate chest wall coverage is also technically challenging but recent progress in x-ray tube, detector and table design now enables full breast coverage in the majority of patients. At this time, BCT has been deemed to be suitable for diagnostic imaging but not yet for screening. The mean glandular dose (MGD) from BCT has been reported to be between 5.7 to 27.8 mGy, and this range is comparable to, and within the range of, the MGD of 2.6 to 31.6 mGy in diagnostic mammography. In diagnostic studies, the median MGD from BCT and mammography were 12.6 and 11.1 mGy, respectively [Vedantham et al., Phys Med Biol. 58: 7921–36, 2013]. Moreover, in diagnostic imaging of the breast the location of the lesion is known and therefore characterization and not detection is by far the primary consideration. The role of bCT is particularly compelling for diagnostic imaging of the breast because it may replace in part the multiple mammographic views of the breast under vigorous compression. Other non-screening potential applications of bCT include the assessment of response to neoadjuvant therapy [Vedantham et al., J Clin Imaging Sci 4, 64, 2014] and pre-surgical evaluation. Learning Objectives: 1. To understand the metrics used to evaluate screening and diagnostic imaging 2. To understand the benefits and limitations of current clinical modalities 3. To understand how breast CT can improve over current clinical modalities 4. To note the early attempts to translate breast CT to the clinic in 1970s-1990s 5. To understand the recent developments in low-dose cone-beam breast CT 6. To understand the recent developments in photon-counting breast CT 7. To understand the radiation dose, clinical translation, and recent developments in diagnostic imaging with breast CT Supported in part by NIH grants R21 CA134128, R01 CA128906 and R01 CA195512. The contents are solely the responsibility of the authors and do not reflect the official views of the NIH or the NCI.; S. Vedantham, Funding sources: Supported in part by NIH/NCI grants R01 CA128906 and R01 CA195512. The contents are solely the responsibility of the authors and do not reflect the official views of the NIH/NCI. Disclosures: Research collaboration with Koning Corporation, West Henrietta, NY. Conflicts of Interest: J. Boone, This research was supported in part by NIH grant R01CA181081; W. Kalender, WK is founder and CEO of CT Imaging GmbH Erlangen, Germany.; A. Karellas, NIH R21 CA134128, R01 CA128906, and R01 CA195512 and Research collaboration with Koning Corporation.

Purpose: The image quality of dedicated cone-beam breast CT (CBBCT) is fundamentally limited by substantial x-ray scatter contamination, resulting in cupping artifacts and contrast-loss in reconstructed images. Such effects obscure the visibility of soft-tissue lesions and calcifications, which hinders breast cancer detection and diagnosis. In this work, we propose to suppress x-ray scatter in CBBCT images using a deterministic forward projection model. Method: We first use the 1st-pass FDK-reconstructed CBBCT images to segment fibroglandular and adipose tissue. Attenuation coefficients are assigned to the two tissues based on the x-ray spectrum used for imaging acquisition, and is forward projected to simulate scatter-free primary projections. We estimate the scatter by subtracting the simulated primary projection from the measured projection, and then the resultant scatter map is further refined by a Fourier-domain fitting algorithm after discarding untrusted scatter information. The final scatter estimate is subtracted from the measured projection for effective scatter correction. In our implementation, the proposed scatter correction takes 0.5 seconds for each projection. The method was evaluated using the overall image spatial non-uniformity (SNU) metric and the contrast-to-noise ratio (CNR) with 5 clinical datasets of BI-RADS 4/5 subjects. Results: For the 5 clinical datasets, our method reduced the SNU from 7.79% to 1.68% in coronal view and from 6.71% to 3.20% in sagittal view. The average CNR is improved by a factor of 1.38 in coronal view and 1.26 in sagittal view. Conclusion: The proposed scatter correction approach requires no additional scans or prior images and uses a deterministic model for efficient calculation. Evaluation with clinical datasets demonstrates the feasibility and stability of the method. These features are attractive for clinical CBBCT and make our method distinct from other approaches. Supported partly by NIH R21EB019597, R21CA134128 and R01CA195512.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Purpose: In digital breast tomosynthesis (DBT) systems capable of digital mammography (DM), Al filters are used during DBT and K-edge filters during DM. The potential for standardizing the x-ray filters with Al, instead of K-edge filters, was investigated with intent to reduce exposure duration and to promote a simpler system design. Methods: Analytical computations of the half-value thickness (HVT) and the photon fluence per mAs (photons/mm2/mAs) for K-edge filters (50µm Rh; 50µm Ag) were compared with Al filters of varying thickness. Two strategies for matching the HVT from K-edge and Al filtered spectra were investigated: varying the kVp for fixed Al thickness, or varying the Al thickness at matched kVp. For both strategies, Al filters were an order of magnitude thicker than K-edge filters. Hence, Monte Carlo simulations were conducted with the GEANT4 toolkit to determine if the scatter-to-primary ratio (SPR) and the point spread function of scatter (scatter PSF) differed between Al and K-edge filters. Results: Results show the potential for replacing currently used Kedge filters with Al. For fixed Al thickness (700µm), ±1 kVp and +(1–3) kVp change, matched HVT of Rh and Ag filtered spectra. At matched kVp, Al thickness range (650,750)µm and (750,860)µm matched the HVT from Rh and Ag filtered spectra. Photon fluence/mAs with Al filters were 1.5–2.5 times higher, depending on kVp and Al thickness, compared to K-edge filters. Although Al thickness was an order higher than K-edge filters, neither the SPR nor the scatter PSF differed from K-edge filters. Conclusion: The use of Al filters for digital mammography is potentially feasible. The increased fluence/mAs with Al could decrease exposure duration for the combined DBT+DM exam and simplify system design. Effect of x-ray spectrum change due to Al filtration on radiation dose, signal, noise, contrast and related metrics are being investigated. Funding support: Supported in part by NIH R21CA176470 and R01CA195512. The contents are solely the responsibility of the authors and do not reflect the official views of the NIH or NCI.

Purpose: In Contrast Enhanced Spectral Mammography (CESM), Rh filter is often used during low-energy image acquisition. The potential for using Ag, In and Sn filters, which exhibit K-edge closer to, and just below that of Iodine, instead of the Rh filter, was investigated for the low-energy image acquisition. Methods: Analytical computations of the half-value thickness (HVT) and the photon fluence per mAs (photons/mm2/mAs) for 50µm Rh were compared with other potential K-edge filters (Ag, In and Sn), all with K-absorption edge below that of Iodine. Two strategies were investigated: fixed kVp and filter thickness (50µm for all filters) resulting in HVT variation, and fixed kVp and HVT resulting in variation in Ag, In and Sn thickness. Monte Carlo simulations (GEANT4) were conducted to determine if the scatter-to-primary ratio (SPR) and the point spread function of scatter (scatter PSF) differed between Rh and other K-edge filters. Results: Ag, In and Sn filters (50µm thick) increased photon fluence/mAs by 1.3–1.4, 1.8–2, and 1.7–2 at 28-32 kVp compared to 50µm Rh, which could decrease exposure time. Additionally, the fraction of spectra closer to and just below Iodine's K-edge increased with these filters, which could improve post-subtraction image contrast. For HVT matched to 50µm Rh filtered spectra, the thickness range for Ag, In, and Sn were (41,44)µm, (49,55)µm and (45,53)µm, and increased photon fluence/mAs by 1.5–1.7, 1.6–2, and 1.6–2.2, respectively. Monte Carlo simulations showed that neither the SPR nor the scatter PSF of Ag, In and Sn differed from Rh, indicating no additional detriment due to x-ray scatter. Conclusion: The use of Ag, In and Sn filters for low-energy image acquisition in CESM is potentially feasible and could decrease exposure time and may improve post-subtraction image contrast. Effect of these filters on radiation dose, contrast, noise and associated metrics are being investigated. Funding Support: Supported in part by NIH R01CA195512. The contents are solely the responsibility of the authors and do not reflect the official views of the NIH or NCI.

Research papers authored by Medical Physicists address a large spectrum of oncologic, imaging, or basic research problems; exploit a wide range of physical and engineering methodologies; and often describe the efforts of a multidisciplinary research team. Given dozens of competing journals accepting medical physics articles, it may not be clear to an individual author which journal is the best venue for disseminating their work to the scientific community. Relevant factors usually include the Journal’s audience and scientific impact, but also such factors as perceived acceptance rate, interest in their topic, and quality of service. The purpose of this symposium is to provide the medical physics community with an overview of scope, review processes, and article guidelines for the following journals: Radiology, Medical Physics, International Journal of Radiation Biology and Physics, Journal of Applied Clinical Medical Physics, and Practical Radiation Oncology. Senior members of the editorial board for each journal will provide details as to the journals review process, for example: single blind versus double blind reviews; open access policies, the hierarchy of the review process in terms of editorial board structure; the reality of acceptance, in terms of acceptance rate; and the types of research the journal prefers to publish. Other journals will be discussed as well. The goal is to provide for authors guidance before they begin to write their papers, not only for proper formatting, but also that the readership is appropriate for the particular paper, hopefully increasing the quality and impact of the paper and the likelihood of publication. Learning Objectives: 1. To review each Journal’s submission and review process 2. Guidance as to how to increase quality, impact and chances of acceptance 3. To help decipher which journal is appropriate for a given work A. Karellas, Research collaboration with Koning, Corporation.

Medical Physics 2.0 is a bold vision for an existential transition of clinical imaging physics in face of the new realities of value-based and evidencebased medicine, comparative effectiveness, and meaningful use. It speaks to how clinical imaging physics can expand beyond traditional insular models of inspection and acceptance testing, oriented toward compliance, towards team-based models of operational engagement, prospective definition and assurance of effective use, and retrospective evaluation of clinical performance. Organized into four sessions of the AAPM, this particular session focuses on three specific modalities as outlined below. Radiography 2.0: The development of electronic capture in recent years has changed the landscape and spurred reinvestment by healthcare providers. The radiography presentation will explore how the diagnostic medical physicist must adapt to these changes to support radiographic imaging, and how she/he can add value in radiography practice over the next 5-10 years. Topics of discussion include new metrology of evaluation, new models of clinical engagement, and effective integration of new technologies. Mammography 2.0: Mammography has been an interesting testing ground on the effectiveness of close involvement of medical physicists with equipment in the past twenty years. The outcomes have clearly shown major improvements in image quality and significant reduction in the average glandular dose. However, the medical physicist's role in mammography has been largely focused to annual surveys and with limited input on operational issues with image artifacts, optimal mammographic acquisition mode and problems with image quality. This mammography presentation will address why and how medical physicists must be prepared to address the new models of practice that include new metrics of performance and the integration of new technologies (DBT, syncretized mammograms, contrast mammography, breast CT) into clinical practice. Fluoroscopy 2.0: Physics support of fluoroscopy should be operationally as opposed to compliance focused. Testing protocols must address new hardware, acquisition methods, and image processing. Future available tools are discussed. Proper configuration of acquisition parameters (focal spot size, voltage and added filter, tube current, pulse width, pulse rate, scatter removal) as a function of patient size from the neonate to bariatric patient is key to providing diagnostic image quality at properly managed radiation doses. Learning Objectives: 1. Appreciate the limitations of the currently available tools and techniques in clinical medical physics in radiography, mammography, and fluoroscopy, and ways to improve upon current deficiencies. 2. Appreciate the changing environment of imaging practice and the need for the medical physicist to be an expert consultant and educator in a capacity that extends beyond the annual survey of equipment. 3. Understand the status of the rapidly changing environment in breast imaging from planar imaging to tomosynthesis and possibly to breast CT. 4. Identify appropriate configuration of acquisition parameters as a function of patient size to manage radiation dose and ensure diagnostic image quality.

Purpose: To fabricate and test nanometric organic photovoltaic (OPV) cells made of various active-layer/electrode thicknesses and sizes; to determine the optimal material combinations and geometries suitable for dose measurements in clinical kilovoltage x-ray beams. Methods: The OPV consisted of P3HT:PCBM photoactive materials sandwiched between aluminum and Indium Tin Oxide (ITO) electrodes. Direct conversion of xrays in the active layer composed of donor and acceptor semiconducting organic materials generated signal in photovoltaic mode (without external voltage bias). OPV cells were fabricated with different active layer thicknesses (150, 270, 370 nm) and electrode areas (0.4, 0.7, 0.9, 1.4, 2.6 cm{sup 2}). A series of experiments were preformed in the energy range of 60–150 kVp. The net current per unit area (nA/cm{sup 2}) was measured using 200 mAs time-integrated beam current. Results: The net OPV current as function of beam energy (kVp) was proportional to ∼E{sup 0,4} {sup 5} when adjusted for beam output. The best combination of parameters for these cells was 270 nm active layer thicknesses for 0.7 cm{sup 2} electrode area. The measured current ranged from 0.69 to 2.43 nA/cm{sup 2} as a function of x-ray energy between 60 and 150 kVp, corresponding to 0.09 – 0.06 nA/cm{sup 2}/mGy, respectively,more » when adjusted for the beam output. Conclusion: The experiments indicate that OPV detectors possessing 270 nm active layer and 0.7 cm{sup 2} Al electrode areas have sensitivity by a factor of 2.5 greater than commercial aSi thin film PV. Because OPV can be made flexible and they do not require highvoltage bias supply, they open the possibility for using as in-vivo detectors in radiation safety in x-ray imaging beams.« less

Tomosynthesis of the breast is currently a topic of intense interest as a logical next step in the evolution of digital mammography. This study reports on the computation of glandular radiation dose in digital tomosynthesis of the breast. Previously, glandular dose estimations in tomosynthesis have been performed using data from studies of radiation dose in conventional planar mammography. This study evaluates, using Monte Carlo methods, the normalized glandular dose (DgN) to the breast during a tomosynthesis study, and characterizes its dependence on breast size, tissue composition, and x-ray spectrum. The conditions during digital tomosynthesis imaging of the breast were simulated using a computer program based on the Geant4 toolkit. With the use of simulated breasts of varying size, thickness and tissue composition, the DgN to the breast tissue was computed for varying x-ray spectra and tomosynthesis projection angle. Tomosynthesis projections centered about both the cranio-caudal (CC) and medio-lateral oblique (MLO) views were simulated. For each projection angle, the ratio of the glandular dose for that projection to the glandular dose for the zero degree projection was computed. This ratio was denoted the relative glandular dose (RGD) coefficient, and its variation under different imaging parameters was analyzed. Within mammographic energies, the RGD was found to have a weak dependence on glandular fraction and x-ray spectrum for both views. A substantial dependence on breast size and thickness was found for the MLO view, and to a lesser extent for the CC view. Although RGD values deviate substantially from unity as a function of projection angle, the RGD averaged over all projections in a complete tomosynthesis study varies from 0.91 to 1.01. The RGD results were fit to mathematical functions and the resulting equations are provided.

Purpose: Detectors with hexagonal pixels require resampling to square pixels for distortion-free display of acquired images. In this work, the presampling modulation transfer function (MTF) of a hexagonal pixel array photon-counting CdTe detector for region-of-interest fluoroscopy was measured and the optimal square pixel size for resampling was determined. Methods: A 0.65mm thick CdTe Schottky sensor capable of concurrently acquiring up to 3 energy-windowed images was operated in a single energy-window mode to include ≥10 KeV photons. The detector had hexagonal pixels with apothem of 30 microns resulting in pixel spacing of 60 and 51.96 microns along the two orthogonal directions. Images of a tungsten edge test device acquired under IEC RQA5 conditions were double Hough transformed to identify the edge and numerically differentiated. The presampling MTF was determined from the finely sampled line spread function that accounted for the hexagonal sampling. The optimal square pixel size was determined in two ways; the square pixel size for which the aperture function evaluated at the Nyquist frequencies along the two orthogonal directions matched that from the hexagonal pixel aperture functions, and the square pixel size for which the mean absolute difference between the square and hexagonal aperture functions was minimized over all frequencies up to the Nyquist limit. Results: Evaluation of the aperture functions over the entire frequency range resulted in square pixel size of 53 microns with less than 2% difference from the hexagonal pixel. Evaluation of the aperture functions at Nyquist frequencies alone resulted in 54 microns square pixels. For the photon-counting CdTe detector and after resampling to 53 microns square pixels using quadratic interpolation, the presampling MTF at Nyquist frequency of 9.434 cycles/mm along the two directions were 0.501 and 0.507. Conclusion: Hexagonal pixel array photon-counting CdTe detector after resampling to square pixels provides high-resolution imaging suitable for fluoroscopy.

Purpose: To design a 3 -D beam-shaping filter for cone-beam breast CT for equalizing x-ray photon fluence incident on the detector along both fan and cone angle directions. Methods: The 3-D beam-shaping filter was designed as the sum of two filters: a bow-tie filter assuming cylindrical breast and a 3D difference filter equivalent to the difference in projected thickness between the cylinder and the real breast. Both filters were designed with breast-equivalent material and converted to Al for the targeted x-ray spectrum. The bow-tie was designed for the largest diameter cylindrical breast by determining the fan-angle dependent path-length and the filter thickness needed to equalize the fluence. A total of 23,760 projections (180 projections of 132 binary breast CT volumes) were averaged, scaled for the largest breast, and subtracted from the projection of the largest diameter cylindrical breast to provide the 3D difference filter. The 3 -D beam shaping filter was obtained by summing the two filters. Numerical simulations with semi-ellipsoidal breasts of 10–18 cm diameter (chest-wall to nipple length=0.75 x diameter) were conducted to evaluate beam equalization. Results: The proposed 3-D beam-shaping filter showed a 140% -300% improvement in equalizing the photon fluence along the chest-wall to nipple (cone-angle) direction compared to a bow-tie filter. The improvement over bow-tie filter was larger for breasts with longer chest-wall to nipple length. Along the radial (fan-angle) direction, the performance of the 3-D beam shaping filter was marginally better than the bow-tie filter, with 4%-10% improvement in equalizing the photon fluence. For a ray traversing the chest-wall diameter of the breast, the filter transmission ratio was >0.95. Conclusion: The 3-D beam shaping filter provided substantial advantage over bow-tie filter in equalizing the photon fluence along the cone-angle direction. In conjunction with a 2-axis positioner, the filter can accommodate breasts of varying dimensions and chest-wall inclusion. Supported in part by NIH R01 CA128906 and R21 CA134128. The contents are solely the responsibility of the authors and do not reflect the official views of the NIH or NCI.

Breast imaging technology is advancing on several fronts. In digital mammography, the major technological trend has been on optimization of approaches for performing combined mammography and tomosynthesis using the same system. In parallel, photon-counting slot-scan mammography is now in clinical use and more efforts are directed towards further development of this approach for spectral imaging. Spectral imaging refers to simultaneous acquisition of two or more energy-windowed images. Depending on the detector and associated electronics, there are a number of ways this can be accomplished. Spectral mammography using photon-counting detectors can suppress electronic noise and importantly, it enables decomposition of the image into various material compositions of interest facilitating quantitative imaging. Spectral imaging can be particularly important in intravenously injected contrast mammography and eventually tomosynthesis. The various approaches and applications of spectral mammography are discussed. Digital breast tomosynthesis relies on the mechanical movement of the x-ray tube to acquire a number of projections in a predefined arc, typically from 9 to 25 projections over a scan angle of +/−7.5 to 25 degrees depending on the particular system. The mechanical x-ray tube motion requires relatively long acquisition time, typically between 3.7 to 25 seconds depending on the system. Moreover, mechanical scanning may have an effect on the spatial resolution due to internal x-ray filament or external mechanical vibrations. New x-ray source arrays have been developed and they are aimed at replacing the scanned x-ray tube for improved acquisition time and potentially for higher spatial resolution. The potential advantages and challenges of this approach are described. Combination of digital mammography and tomosynthesis in a single system places increased demands on certain functional aspects of the detector and overall performance, particularly in the tomosynthesis mode due to lower photon fluence per projection. This may require fast-frame acquisition and symmetric or asymmetric pixel binning in some systems. Recent studies investigated the performance of increased conversion layer thickness for contrast-enhanced imaging of the breast in dual-energy acquisition mode. In other direct conversion detectors operating in the avalanche mode, sensitivities close to the single photon response are also explored for mammography and breast tomosynthesis. The potential advantages and challenges of this approach are described. Dedicated breast CT brings x-ray imaging of the breast to true tomographic 3D imaging. It can eliminate the tissue superposition problem and does not require physical compression of the breast. Using cone beam geometry and a flat-panel detector, several hundred projections are acquired and reconstructed to near isotropic voxels. Multiplanar reconstruction facilitates viewing the breast volume in any desired orientation. Ongoing clinical studies, the current state-of-the art, and research to advance the technology are described. Learning Objectives: 1. To understand the ongoing developments in x-ray imaging of the breast 2. To understand the approaches and applications of spectral mammography 3. To understand the potential advantages of distributed x-ray source arrays for digital breast tomosynthesis 4. To understand the ongoing developments in detector technology for digital mammography and breast tomosynthesis 5. To understand the current state-of-the-art for dedicated cone-beam breast CT and research to advance the technology. Research collaboration with Koning Corporation.

Purpose: To determine the spatial distribution of x-ray scatter and scatter-to-primary ratio (SPR) in projections during cone-beam breast CT (CBBCT) with laterally-shifted detector that results in coronal (fan-angle) truncation. Methods: We hypothesized that CBBCT with coronal truncation would lower SPR due to reduction in irradiated breast volume, and that the location of maximum x-ray scatter fluence (scatter-peak) in the detector plane can be determined from the ratio of irradiated-to-total breast volume, breast dimensions and system geometry. Monte Carlo simulations (GEANT4) reflecting a prototype CBBCT system were used to record the position-dependent primary and scatter x-ray photon fluence incident on the detector without coronal truncation (full fan-angle, 2f=24-degrees) and with coronal truncation (fan-angle, f+ f=12+2.7-degrees). Semi-ellipsoidal breasts (10/14/18-cm diameter, chest-wall to nipple length: 0.75xdiameter, 2%/14%/100% fibroglandular content) aligned with the axis-of-rotation (AOR) were modeled. Mono-energy photons were simulated and weighted for 2 spectra (49kVp, 1.4-mm Al HVL; 60kVp, 3.76-mm Al HVL). In addition to SPR, the scatter maps were analyzed to identify the location of the scatter-peak. Results: For CBBCT without fan-angle truncation, the scatter-peaks were aligned with the projection of the AOR onto the detector for all breasts. With truncated fan-beam, the scatter-peaks were laterally-shifted from the projection of the AOR along the fan-angle direction by 14/38/70-pixels for 10/14/18-cm diameter breasts. The corresponding theoretical shifts were 14.8/39.7/68-pixels (p=0.47, 2-tailed paired-ratio t-test). Along the cone-angle, the shift in scatter-peaks between truncated and full-fan angle CBBCT were 2/2/4 -pixels for 10/14/18-cm diameter breasts. CBBCT with fan-angle truncation reduced SPR by 14/22/28% for 10/14/18-cm diameter breasts. 60kVp reduced SPR by 21–25% compared to 49kVp. Peak SPR for CBBCT with fan-angle truncation (60kVp) were 0.09/0.25/0.73 for 10/14/18-cm diameter breasts. Conclusion: CBBCT with laterally-shifted detector geometry and with appropriate kVp/beam quality reduces SPR. If residual scatter needs correction, the location corresponding to scatter-peak can be analytically computed. This work was supported in part by NIH R01 CA128906. The contents are solely the responsibility of the authors and do not reflect the official views of the NIH or NCI.

Breast imaging technology is advancing on several fronts. In digital mammography, the major technological trend has been on optimization of approaches for performing combined mammography and tomosynthesis using the same system. In parallel, photon-counting slot-scan mammography is now in clinical use and more efforts are directed towards further development of this approach for spectral imaging. Spectral imaging refers to simultaneous acquisition of two or more energy-windowed images. Depending on the detector and associated electronics, there are a number of ways this can be accomplished. Spectral mammography using photon-counting detectors can suppress electronic noise and importantly, it enables decomposition of the image into various material compositions of interest facilitating quantitative imaging. Spectral imaging can be particularly important in intravenously injected contrast mammography and eventually tomosynthesis. The various approaches and applications of spectral mammography are discussed. Digital breast tomosynthesis relies on the mechanical movement of the x-ray tube to acquire a number of projections in a predefined arc, typically from 9 to 25 projections over a scan angle of +/−7.5 to 25 degrees depending on the particular system. The mechanical x-ray tube motion requires relatively long acquisition time, typically between 3.7 to 25 seconds depending on the system. Moreover, mechanical scanning may have an effect on the spatial resolution due to internal x-ray filament or external mechanical vibrations. New x-ray source arrays have been developed and they are aimed at replacing the scanned x-ray tube for improved acquisition time and potentially for higher spatial resolution. The potential advantages and challenges of this approach are described. Combination of digital mammography and tomosynthesis in a single system places increased demands on certain functional aspects of the detector and overall performance, particularly in the tomosynthesis mode due to lower photon fluence per projection. This may require fast-frame acquisition and symmetric or asymmetric pixel binning in some systems. Recent studies investigated the performance of increased conversion layer thickness for contrast-enhanced imaging of the breast in dual-energy acquisition mode. In other direct conversion detectors operating in the avalanche mode, sensitivities close to the single photon response are also explored for mammography and breast tomosynthesis. The potential advantages and challenges of this approach are described. Dedicated breast CT brings x-ray imaging of the breast to true tomographic 3D imaging. It can eliminate the tissue superposition problem and does not require physical compression of the breast. Using cone beam geometry and a flat-panel detector, several hundred projections are acquired and reconstructed to near isotropic voxels. Multiplanar reconstruction facilitates viewing the breast volume in any desired orientation. Ongoing clinical studies, the current state-of-the art, and research to advance the technology are described. Learning Objectives: 1. To understand the ongoing developments in x-ray imaging of the breast 2. To understand the approaches and applications of spectral mammography 3. To understand the potential advantages of distributed x-ray source arrays for digital breast tomosynthesis 4. To understand the ongoing developments in detector technology for digital mammography and breast tomosynthesis 5. To understand the current state-of-the-art for dedicated cone-beam breast CT and research to advance the technology. Research collaboration with Koning Corporation.

Purpose: To investigate the radiation dose reduction and the effect of weighting schemes on image quality in cone‐beam dedicated breast CT acquired with coronal truncated projections that is similar in concept as extended field‐of‐view imaging with laterally‐shifted flat‐panel detectors. Methods: Three pre‐weighting schemes were implemented in conjunction with filtered backprojection (FBP) reconstruction to study the effect of coronal truncation in dedicated breast CT. If the fan‐angle of the non‐truncated projections is represented as 2f (24‐degrees), then coronal truncations corresponding to f+0.25, f+1.5, and f+2.7‐degrees were investigated. Monte Carlo simulations using the GEANT4 toolkit were used to determine the radiation dose reduction at the aforementioned truncations. Projection images of a numerical phantom with dimensions representative of an average pendant breast containing six spherical signal objects in a homogenous background were reconstructed without and with truncation. Cone‐beam projections from a diagnostic dedicated breast CT exam acquired with fan‐angle of 2f were truncated at the aforementioned fan‐angles and reconstructed. Phantom and clinical images were analyzed for artifacts and the visibility of signal features. Results: For an average 14‐cm diameter, 15% fibroglandular breast, the estimated dose reduction at fan‐angles of f+0.25, f+1.5, and f+2.7‐degrees were 47%, 34% and 21%, respectively. The severity of artifacts increased with decreasing fan‐angle. The choice of weighting scheme does not appear to have a substantial effect on mitigating artifacts. At fan‐angles of f+1.5 and above, shading artifacts were subtle and could not be easily discerned. The signal objects in the phantom and the microcalcification in the clinical images were discernible. For 10, 14 and 18 cm diameter, 15% fibroglandular breasts, the radiation dose reduction at fan‐angle of f+1.5‐degrees were 27%, 34% and 37%, respectively. Conclusion: There exists a potential to reduce radiation dose by approximately 30% from cone‐beam dedicated breast CT acquired with coronal truncated projections. Supported in part by the National Institutes of Health (NIH) grants R01 CA128906 and R21 CA134128. The contents are solely the responsibility of the authors and do not represent the official views of the NIH or the NCI.

Purpose: To determine the spatial distribution and amount of goldnanoparticles (GNPs) within small‐animal‐sized objects using polychromatic cone‐beam x‐ray fluorescencecomputed tomography (XFCT) under realistic constraints on x‐ray dose, scan time, and image resolution. Methods: 6‐mm‐diameter cylindrical tubes containing saline solution and 0.5–2.0 wt. % of GNPs were inserted into a cylindrical polymethyl methacrylate (PMMA) phantom, 3 cm in diameter and 5 cm in height. The phantom was irradiated by a cone‐beam of polychromatic 105 kVp x‐rays filtered by 0.9 mm of tin. Energy‐sensitive cadmium telluride detectors behind a 2.5 mm diameter lead pinhole collimator collected the spectrum of emitted gold K‐shell fluorescence and Compton scattered photons at an angle of 90° relative to the beam central axis as the phantom was rotated to a series of 60 projection angles in 6° steps. Sinograms of goldfluorescencephoton signals were constructed by extracting the goldfluorescence peak height from the Compton background, and the image of GNP location and concentration was reconstructed using a maximum likelihood iterative reconstruction algorithm. Results: Using the measured sinograms, XFCT images of GNP‐loaded objects were successfully reconstructed, accurately determining both the GNP location and concentration. The x‐ray dose delivered during the XFCT scanning was measured using the AAPM TG‐61 protocol, and it was determined that, using an array detector, it would be possible to acquire these images in one hour with a tissue dose of approximately 20 cGy. Conclusions: With a few easily achievable modifications, the current benchtop setup would be capable of producing useful XFCT images of small animals injected with GNPs with the total scanning time and a tissue dose comparable to other modalities currently available for routine pre‐clinical in‐vivo imaging such as micro‐CT. Supported in part by NIH/NCI grant 1R01CA155446. Supported in part by NIH/NCI grant 1R01CA155446

Purpose: Phase contrast breast imaging has the potential to improve visualization of anatomic structures. While the physics is well‐understood, there are several choices for implementation. In order to evaluate these choices, it is essential to design a phantom for phase contrastimaging with appropriate breast‐equivalent materials.Methods: Phantoms for mammography use materials that mimic the x‐ray attenuation properties of breast tissue. Hence, the refractive index decrement (delta) was determined for breast tissues of varying glandular fraction [Hammerstein, Radiology 130(2):485–91, 1979] for the energy range (5–100 KeV) relevant to mammography and breast CT using XOP software (Version 2.3, ESRF, France) and compared to that of commonly used phantom materials. Delta for 50% and 70% glandular breast‐equivalent material (CIRS Inc., Norfolk, VA), solid water, BR‐12, polymethyl methacrylate (PMMA), beeswax (C46H92O2, density: 0.97 g/cm3) and paraffin wax (C25H52, density: 0.95 g/cm3) were determined. Microcalcifications in vivo are either of oxalate or phosphate composition. Delta of calcium oxalate monohydrate (COM) and calcium hydroxyapatite (CH) were determined and compared with that of calciumcarbonate,gold and aluminum.Results: In terms of delta, paraffin wax (4% higher) and beeswax (4% higher) best simulated 50% and 100% glandular breast, respectively. Delta of other commonly used phantom materials such as 50% and 70% glandular breast‐equivalent material, solid water, and BR‐12 were two orders of magnitude higher, and that of PMMA was 28% higher, than 50% glandular breast tissue. For microcalcifications, delta of gold was 4.6 to 6.5 times higher than that of COM and CH, respectively. Delta of aluminum and calciumcarbonate were found to straddle that of COM and CH. Conclusions: For phase contrastimaging, a phantom comprising paraffin wax to simulate 50% glandular background tissue, beeswax to simulate a mass equivalent to 100% glandular tissue, and calciumcarbonate or aluminum to simulate microcalcifications is appropriate. Supported in part by the National Institutes of Health (NIH) grants R01 CA128906 and R21 CA134129. The contents are solely the responsibility of the authors and do not represent the official views of the NIH or NCI.

Purpose: Cone‐beam CT with circular trajectory is susceptible to cone‐angle related artifacts that affect quantitative imaging. These artifacts were quantified under conditions relevant to dedicated breast CT for full and short‐scans. Methods: Three sets of numerical phantoms (0.2‐mm voxels) were used: (1) cylindrical Defrise phantom of 14‐cm diameter and 10.6‐cm length inclusive of 2‐mm skin, with alternating 4‐mm coronal layers of fixed (0.15) and variable (0 to 1, in steps of 0.1) glandular fraction breast tissue; (2) semi‐ellipsoidal Defrise phantom with dimensions matched to the cylindrical phantom for a realistic pendant‐breast geometry; (3) 20 surgical mastectomy specimens based numerical phantoms. Source‐to‐rotational axis and source‐to‐detector distances of 65‐cm and 100‐cm, respectively, were used. Noise‐free simulations were performed at 30‐keV, with the phantoms co‐aligned to rotational axis, using an ideal detector (0.4‐mm pixels), and without the confounding effects of focal spot blur (point source) and x‐ray scatter. Constant angular sampling of 1.2‐degrees was used resulting in 300 and 165 projections for full‐scan and short‐scan (198‐ degrees). Reconstructions were performed using Hamming‐windowed FDK‐algorithm with short‐scan using Parker weights. For the Defrise phantoms, the cone‐angle dependence of the artifacts was analyzed using percent difference at the rotational axis between the reconstructions and phantoms, and by visual inspection. For the mastectomy specimens, power spectral analysis was performed. Results: For Defrise phantoms, increasing attenuation difference between layers resulted in higher inaccuracies (artifacts). Cylinder resulted in higher inaccuracies compared to semi‐ ellipsoid particularly near maximum cone‐angle. Visual inspection and power spectral analysis indicate that the spatial distribution of these artifacts is different between full and short‐scans. Conclusions: Cone‐beam artifacts at breast CT relevant conditions are observed. They depend on object shape, and attenuation difference of the tissues within the object. These artifacts must be remediated as they may impact task‐specific assessment and can profoundly affect quantitative imaging. Supported by NIH/NCI R01CA128906. The contents are sole responsibility of the authors and do not represent the official views of the NIH or NCI. SG: Research contract with Toshiba Medical Research Institute.

Purpose: To measure the volumetric breast density (VBD) from digital breast tomosynthesis (DBT) reconstructions and compare with estimates from mammography. Methods: A kernel-based fuzzy c-means algorithm developed to segment DBT reconstructed slices to provide anatomic priors for near-infrared spectroscopy (NIRS) in a multimodality NIRS/DBT clinical-prototype imaging system was used to quantitate VBD. The VBD was determined from 17 DBT reconstructions of 11 breasts from 9 subjects (6 subjects—unilateral 2-view, 1 subject—unilateral craniocaudal (CC) view, 2 subjects—bilateral CC view) who underwent multimodality NIRS/DBT imaging. VBD from mammography (Quantra, Hologic Inc.) matched for subject, breast laterality and view was used for comparison. To account for differences in compressed breast thickness (T) between the modalities, the metric normalized VBD (nVBD = VBD/T) was considered. Results: All data satisfied normality assumption (Shapiro-Wilks, p>0.06). Pearson's correlation (r) and paired t-tests were used for analysis. The normalized VBD (nVBD) was statistically correlated (r=0.66, p

Perspective on the Developing Modalities for Breast CancerImagingDigital mammography has already become the new standard, replacing screen‐film for breast cancer screening, and for diagnostic work‐up of suspicious findings. New digital imaging technologies may use x‐ray beam characteristics such as tungsten target, silver filtration, and higher kVp; in ways that represent a departure from the long established screen‐film techniques. Representing a logical evolution from two‐dimensional to tomographic and 3D imaging of the breast, breast tomosynthesis and dedicated breast CT are currently investigated as potential replacements or adjuncts to mammography.Mammography (screen‐film or digital) is the single most effective tool for the detection of occult breast cancer with an overall sensitivity as high as about 85% for older women and about 60% or lower for women under the age of 50 years (Rosenberg RD et al. Radiology. 1998;209:511–8, Pisano E et al. N. Engl. J. Med. 2005;353: 1773–83). Attempts to increase sensitivity have included the use of intravenously injected (IV) contrast with digital mammography,tomosynthesis or breast CT but these efforts are in the research stage. With improved hardware and image acquisition techniques, the role of IVcontrast injected MRI is gradually expanding as a diagnostic tool, and it is also recommended for screening of high risk patients, due to its high sensitivity. Ultrasound, a well established modality for diagnostic work‐up is evolving from the conventional pulse echo‐based approach to elasticity imaging and ultrasoundCT of the breast. Breast scintigraphy with a dedicated camera is now in clinical use and it receives much attention as an adjunct to mammography. Other technologies that include diffuse optical tomography as a stand‐alone modality or in conjunction with MRI or with x‐ray imaging are currently under investigation. We are likely to see an increasing use of alternative imaging approaches in conjunction with mammography,ultrasound and MRI, the three essential modalities for breast cancer detection and for diagnostic work‐up of positive findings. Learning Objectives: 1. Appreciate recent advances in the physics and engineering in x‐ray detector technology that contributed to the development of digital mammography,tomosynthesis and dedicated breast CT. 2. Recognize the potential quantitative applications and important limitations of the x‐ray based breast imaging modalities. 3. Appreciate recent technological developments in current clinical non‐x‐ray modalities such as MRI and ultrasound and their increasingly important role in breast cancerimaging. 4. Gain perspective on some emerging modalities such as optical diffuse tomography and their potential role in the detection and diagnosis of breast cancer.

Purpose: To investigate post acquisition scatter correction for digital tomosynthesis breast imaging.Method and Materials:Images of a composite phantom that was fabricated for evaluating digital breast tomosynthesis and used in a previous contrast‐detail (CD) study [Suryanarayanan et al., Acad Radiol 7: 1085–1097, 2000] were used to test the scatter correction method. These images were acquired using a prototype full‐field digital mammography (FFDM) system (GEMedical Systems, Milwaukee, WI) without an anti‐scatter grid. The phantom comprised of a centrally placed CD insert (MedOptics, Tucson, AZ), blocks of cluttered paraffin and polymethyl methacrylate (PMMA), and beeswax surrounding it to provide a total phantom thickness of 54 mm. A set of 7 projection images of the phantom were acquired over an angular range of ± 18° at 60 intervals at 26 kVp, MoMo, and 32 mAs/view. The projection data sets were corrected for scatter using the scatter correction technique described by Trotter et al. [Proc. SPIE, vol. 4682: 469–478, 2002] and processed with an adaptive noise filter. The projection images were then reconstructed using back‐projection and iterative restoration methods using Tuned Aperture Computed Tomography (TACT) [Webber et al., J. Digit. Imaging, 13: 90–97, 2000] software (developed by R.L. Webber, Wake Forest University, NC). The contrast‐to‐noise (CNR) ratio, signal‐to‐noise ratio (SNR), and % contrast were computed for one of the targets (2.32 mm diameter and 0.24 mm depth). Results: The uncorrected projection data set reconstructed with back‐projection resulted in CNR = 3.0, SNR = 30.4, and % contrast = 11.1, while the scatter corrected and processed projection images yielded CNR = 10.2, SNR =60.7, and %contrast = 20.2. Conclusion: The results of this study indicate improved SNR,CNR, and % contrast after scatter correction in tomosynthesis. We are currently implementing and evaluating other scatter correction and reconstruction methods for digital tomosynthesis.

Purpose: To determine the x‐ray scatter content in differential phase‐contrast imaging of the breast using a gratings‐based interferometer. Methods: X‐ray scatter during small field‐of‐view (9.6×5‐cm) differential phase‐contrast breast imaging with a gratings‐based interferometer (25‐keV design) was determined using GEANT4 Monte Carlo (MC) toolkit. The duty‐cycles of source (G0), phase (G1) and analyzer (G2) gratings were 0.25, 0.5 and 0.5, respectively. All gratings were planar and fabricated from 0.675‐mm thick silicon wafers. MC estimated transmission efficiencies of the gratings in parallel‐beam geometry were validated with theoretical estimates. After validation, their transmission efficiencies were determined in cone‐beam geometry. Position‐independent estimates of scatter and primary photons at the detector plane were obtained with 2 to 8 cm thick adipose and fibroglandular breasts and without the breast in the x‐ray beam. The recorded x‐ray scatter was analyzed after classification as photons that underwent at least one Compton interaction (incoherent scatter) and as photons that underwent Rayleigh interaction alone (coherent scatter). While G2 is needed in practice, simulations were conducted without G2 to determine its role in scatter reduction. Results: In parallel‐beam geometry, Monte Carlo estimated transmission efficiencies showed good correspondence (r2>0.99) with theory. In cone‐beam geometry, the transmission efficiencies of G0, G1 and G2 gratings were 0.16, 0.7 and 0.25, respectively. Position‐independent estimates of scatter‐to‐primary ratio were 0.08 without the breast, and increased from 0.13 (0.15) to 0.25 (0.31) for 2 to 8 cm thick adipose (fibroglandular) breasts. Coherent scatter was the dominant contributor to total scatter with coherent‐to‐incoherent scatter ratio ranging from 1.65 (1.94) to 1.8 (2.04) for adipose (fibroglandular) breasts. The G2 grating reduced incoherent scatter by ∼5% to 24% for 2 to 8‐cm breasts. Conclusion: The 0.675‐mm thick silicon wafer contributed to ∼30% reduction in transmission efficiency for each grating. The G2 grating reduces the incoherent scatter at the detector plane. Supported in part by the National Institutes of Health (NIH) grants R01 CA128906 and R21 CA134128. The contents are solely the responsibility of the authors and do not represent the official views of the NIH or NCI.

Writing and Reviewing Papers for Medical Physics There is an art to writing a scientific paper so that it communicates accurately, succinctly, and comprehensively. Developing this art comes with experience, and sharing that experience with younger physicists is an obligation of senior scientists, especially those with editorial responsibilities for the journal. In this workshop, the preparation of a scientific manuscript will be dissected so participants can appreciate how each part is developed and then assembled into a complete paper. Then the review process for the paper will be discussed, including how to examine a paper and write an insightful and constructive review. Finally, we will consider the challenge of accommodating the concerns and recommendations of a reviewer in preparing a revision of the paper. A second feature of the workshop will be a discussion of the process of electronic submission of a paper for consideration by Medical Physics. The web‐based PeerX‐Press engine for manuscript submission and management will be examined, with attention to special features such as epaps and line‐referencing. Finally, new features of Medical Physics will be explained, such as Vision 20/20 manuscripts, Physics Letters and the standardized formatting of book reviews. Learning Objectives: 1. Improve the participants' abilities to write a scientific manuscript. 2. Understand the review process for Medical Physics manuscripts and how to participate in and benefit from it. 3. Appreciate the many features of the PeerX‐Press electronic management process for Medical Physics manuscripts. 4. Develop a knowledge of new features of Medical Physics.

Several imaging modalities are being developed to improve early detection and diagnosis and to assist in selecting and monitoring treatments. This symposium will review advances in x‐ray, nuclear, and magnetic resonance breast imaging methods.A primary shortcoming of mammography is that anatomical overlap of dense tissues confounds diagnosis of cancerous lesions. Breast tomosynthesis (BT), now FDA approved, and dedicated breast CT (bCT), not yet FDA approved, each address this shortcoming by providing tomographic imaging. Using similar equipment that also acquires digital mammograms, BT images are reconstructed from several x‐ray projection images acquired from different views (e.g. 15 projections covering 15 degree arc). In this approach the high mammographic resolution is preserved in the x,y direction (axial plane) and tomographic resolution is provided in the z‐plane but with lower resolution. In bCT a flat panel detector is used in rotating cone‐beam CT geometry acquiring 300‐500 images over 360 degrees covering the entire breast in as little as 17 seconds; resolution is again similar to mammography and is isotropic in x,y,z. Both BT and bCT have been developed so that the radiation dose to the breast is similar to two‐view mammography. Both appear to be superior to mammography for visualizing mass lesions, but not yet for visualizing microcalcifications. Improved bCT resolution, and synthetic 2D mammograms derived from BT data promise to improve the performance of each with micro‐calcifications. The added complexity in BT and bCT requires more attention to the details of image acquisition, detector pixel binning, and x‐ray beam pulsing. Technical aspects of BT and bCT and their evolving role in breast imaging will be discussed. Nuclear medicine imaging can show physiological functions of lesions at the molecular level, providing complementary information to the x‐ray techniques. Functional imaging offers the potential to distinguish malignant from benign processes, characterize lesions to assist in selecting therapy, and monitor therapy efficacy. Since imaging is at the molecular pathways level, changes can often be seen well before macroscopic changes to lesion size. Great potential and challenges for nuclear medicine imaging lie in the specificity and availability of radiolabeled molecular probes. Cost and systemic dose are further challenges to nuclear methods, but both single‐photon and positron‐emitting radiotracers show promise for diagnostic and therapeutic applications.With the ability to provide both anatomic and functional imaging, there have been dramatic increases in the range and quality of information available from magnetic resonance imaging (MRI) methods. In particular, dynamic contrast enhanced MRI, diffusion weighted MRI, and proton MR spectroscopy have matured to the point where they can offer relevant and complimentary information on tumor status. Emerging yet promising techniques include magnetization transfer MRI, chemical exchange saturation transfer MRI, magnetic resonance elastography, and hyperpolarized MR. We will provide an overview of each of these techniques in the context of examining therapeutic response in the neoadjuvant setting. We will also briefly discuss the importance of biomarker validation, standardization and reproducibility—critical issues that must be addressed to routinely deploy these methods in the clinical setting. Learning Objectives: 1. Understand the principles and differences between breast tomosynthesis and breast CT, and the technical advantages and limitations of each. 2. Understand potential roles of nuclear medicine/PET in lesion detection, diagnosis, and therapy monitoring. 3. Identify at least three new MR techniques used to image/characterize breast cancer. 4. Appreciate the use of imaging as a biomarker and the importance of standardized image‐based metrics. MacDonald: NIH‐NCI Grant 1R01CA163498