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The aim of the SYRMA-CT collaboration is to set-up the first clinical trial of phase-contrast breast CT with synchrotron radiation (SR). In order to combine high image quality and low delivered dose a number of innovative elements are merged: a CdTe single photon counting detector, state-of-theart CT reconstruction and phase retrieval algorithms. To facilitate an accurate exam optimization, a Monte Carlo model was developed for dose calculation using GEANT4. In this study, high isotropic spatial resolution (120 mu m)(3) CT scans of objects with dimensions and attenuation similar to a human breast were acquired, delivering mean glandular doses in the range of those delivered in clinical breast CT (5-25 mGy). Due to the spatial coherence of the SR beam and the long distance between sample and detector, the images contain, not only absorption, but also phase information from the samples. The application of a phase-retrieval procedure increases the contrast-to-noise ratio of the tomographic images, while the contrast remains almost constant. After applying the simultaneous algebraic reconstruction technique to low-dose phase-retrieved data sets (about 5 mGy) with a reduced number of projections, the spatial resolution was found to be equal to filtered back projection utilizing a four fold higher dose, while the contrast-to-noise ratio was reduced by 30%. These first results indicate the feasibility of clinical breast CT with SR.

Item does not contain fulltext Breast computed tomography (BCT) is an emerging application of X-ray tomography in radiological practice. A few clinical prototypes are under evaluation in hospitals and new systems are under development aiming at improving spatial and contrast resolution and reducing delivered dose. At the same time, synchrotron-radiation phase-contrast mammography has been demonstrated to offer substantial advantages when compared with conventional mammography. At Elettra, the Italian synchrotron radiation facility, a clinical program of phase-contrast BCT based on the free-space propagation approach is under development. In this paper, full-volume breast samples imaged with a beam energy of 32 keV delivering a mean glandular dose of 5 mGy are presented. The whole acquisition setup mimics a clinical study in order to evaluate its feasibility in terms of acquisition time and image quality. Acquisitions are performed using a high-resolution CdTe photon-counting detector and the projection data are processed via a phase-retrieval algorithm. Tomographic reconstructions are compared with conventional mammographic images acquired prior to surgery and with histologic examinations. Results indicate that BCT with monochromatic beam and free-space propagation phase-contrast imaging provide relevant three-dimensional insights of breast morphology at clinically acceptable doses and scan times.

This work compares estimates of the radiation dose in mammography obtained using three different fibroglandular tissue distributions. Ninety volumetric images of patient breasts were acquired with a dedicated breast CT system and the voxels automatically classified as containing skin, adipose, or glandular tissue. The classified images underwent simulated mechanical compression to mimic the mammographic cranio-caudal acquisition. The voxels containing fibroglandular and adipose tissue were then distributed in the breast phantoms following three different methods: patient-based (i.e., maintaining the original distribution), homogeneous (i.e., each voxel is a homogeneous mixture of adipose and glandular tissue) and newly-proposed continuous (i.e., the glandular tissue is distributed according to a general model, derived from the patient breast CT data). All breast phantoms were used in Monte Carlo simulations to estimate the radiation dose. The results show that the doses estimated using the continuous fibroglandular tissue distribution agree within 3% of the doses estimated using the heterogeneous patient-based distribution, and that it leads to a dose reduction of 27% compared to the homogeneous distribution.

The purpose of this work is to provide an evaluation of the mean glandular dose (MGD) for breast computed tomography (CT) with synchrotron radiation in an axial scanning configuration with a partial or total organ volume irradiation, for the in vivo program of breast CT ongoing at the ELETTRA facility (Trieste, Italy). A Geant4 Monte Carlo code was implemented, simulating the photon irradiation from a synchrotron radiation source in the energetic range from 8 to 50 keV with 1 keV intervals, to evaluate the MGD. The code was validated with literature data, in terms of mammographic normalized glandular dose coefficients (DgN) and with ad hoc experimental data, in terms of computed tomography dose index (CTDI). Simulated cylindrical phantoms of different sizes (diameter at phantom base 8, 10, 12, 14 or 16 cm, axial length 1.5 times the radius) and glandular fraction by weight (0%, 14.3%, 25%, 50%, 75% and 100%) were implemented into the code. The validation of the code shows an excellent agreement both with previously published work and in terms of DgN and CDTI measurements. The implemented simulations show a dependence of the glandular dose estimate on the vertical dimension of the irradiated zone when a partial organ irradiation was implemented. Specific normalized coefficients for calculating the MGD to the whole breast or to the single irradiated slice were reported.

We present the implementation of the CT iterative reconstruction strategy developed within the SYRMA-CT project for in vivo phase contrast CT of the uncompressed breast, ongoing at the ELETTRA synchrotron radiation facility (Trieste, Italy). Propagation-based phase-contrast imaging exploited the high spatial coherence of the monoenergetic laminar X-ray beam (3-mm high along the chest-wall-to-nipple direction), as well as the large object-to-detector distance (∼2 m) and the use of a prototype of Pixirad-8 high-resolution photon counting CdTe detector (60-μm pitch, eight detector units arranged in a row). The signal in projection views depends on the X-ray absorption as well as on the phase shift introduced by the breast tissue in the beam path. A phase retrieval algorithm allows recovering the projected 2D phase map of the irradiated tissue layer, which were input to the CT reconstruction; then, the 3D image of the breast was reconstructed via a simultaneous algebraic reconstruction technique (SART) algorithm. The developed iterative reconstruction — coupled with a filtering process for reducing the noise level and ring artifacts by preserving edges sharpness — showed better image quality than conventional filtered backprojection (FBP) reconstruction. A phantom study showed that the iterative reconstruction produced images with a contrast-to-noise-ratio up to 65% and a spatial resolution up to 12% higher than those obtained with FBP. Finally, the developed algorithm removed ring-like artifacts caused by the detector dead space (0.16 mm) across adjacent detector units and by no perfect equalization after flat-field correction, without worsening the image quality.

The SYRMA-CT project aims to set-up the first clinical trial of phase-contrast breast Computed Tomography with synchrotron radiation at the SYRMEP beamline of Elettra, the Italian synchrotron light source. The challenge in a dedicated breast CT is to match a high spatial resolution with a low dose level. In order to fulfil these requirements, the SYRMA-CT project uses a large area CdTe single photon counting detector (Pixirad-8), simultaneous algebraic reconstruction technique (SART) and phase retrieval pre-processing. This work investigates the imaging performances of the system in a continuous acquisition mode and with a low dose level towards the clinical application. A custom test object and a large surgical sample have been studied.

Introduction The first clinical trial of phase-contrast mammography with monochromatic beam was performed at Elettra, the Italian Synchrotron Radiation facility. A lower Mean Glandular Dose (MGD) and a higher specificity were achieved compared to the digital mammography for the patient cohort (more than 70). Purpose The SYRMA-CT project (SYnchrotron Radiation for MAmmography – Computed Tomography) aims to perform the first clinical trial of phase-sensitive breast CT with monochromatic beam. High image quality and low dose are expected according to the results of the first mammography trial. Materials and methods A large area CdTe single photon counting detector (PIXIRAD-8) is used. Phase-retrieval algorithm are applied, thus exploiting propagation based phase-contrast imaging (PPCI). The dose system of the beamline has been calibrated to match the energy requirement up to 40 keV. Due to the peculiar irradiation modality, ad hoc Monte Carlo simulations and experimental measurements were performed for dose evaluation. Results Images of surgical samples included in large test objects (up to 12 cm diameter) were acquired at 38 keV in clinical compatible dose conditions (MGD ∼5 mGy). Phase-retrieval pre-processing was applied improving the CNR of the high-resolution images with (120 μm) 3 voxel size. Conclusion The upgrade of the mammographic facility of the Elettra laboratory towards a new clinical trial is going on. Image quality and dose assessment indicate its feasibility with monochromatic beam. This clinical trial will allow the evaluation of PPCI breast CT in optimal conditions and will give indication for the translation to the hospital of phase-sensitive techniques. Disclosure Nothing to declare.

Purpose Within the SYRMA-CT collaboration based at the ELETTRA synchrotron radiation (SR) facility the authors investigated the imaging performance of the phase-contrast computed tomography (CT) system dedicated to monochromatic in vivo 3D imaging of the female breast, for breast cancer diagnosis. Methods Test objects were imaged at 38 keV using monochromatic SR and a high-resolution CdTe photon-counting detector. Signal and noise performance were evaluated using modulation transfer function (MTF) and noise power spectrum. The analysis was performed on the images obtained with the application of a phase retrieval algorithm as well as on those obtained without phase retrieval. The contrast to noise ratio (CNR) and the capability of detecting test microcalcification clusters and soft masses were investigated. Results For a voxel size of (60 μm)3, images without phase retrieval showed higher spatial resolution (6.7 mm−1 at 10% MTF) than corresponding images with phase retrieval (2.5 mm−1). Phase retrieval produced a reduction of the noise level and an increase of the CNR by more than one order of magnitude, compared to raw phase-contrast images. Microcalcifications with a diameter down to 130 μm could be detected in both types of images. Conclusions The investigation on test objects indicates that breast CT with a monochromatic SR source is technically feasible in terms of spatial resolution, image noise and contrast, for in vivo 3D imaging with a dose comparable to that of two-view mammography. Images obtained with the phase retrieval algorithm showed the best performance in the trade-off between spatial resolution and image noise.

This work investigates the use of XR-QA2 radiochromic films for quantitative imaging of a synchrotron radiation (SR) beam. Pieces (200 × 30 mm2) of XR-QA2 film were irradiated in a plane transverse to the beam axis, at the SYRMEP beamline at ELETTRA (Trieste), with a monochromatic beam of size 170 × 3.94 mm2 (H × V) and energy of 28, 35, 38 or 40 keV. The response was calibrated in terms of average air kerma (120 mGy), measured with a calibrated ionization chamber. Films were digitized in reflectance mode using a flatbed scanner. The 16-bit red channel was used. The netreflectance was then converted to photon fluence per unit air kerma (mm-2 mGy-1). The SR beam profile was acquired also with a scintillator (GOS) based, fiberoptic coupled CCD camera as well as with a scintillator based flat panel detector. Horizontal profiles obtained with the two modalities were compared, evaluated in a ROI of 17.71 × 0.59 mm2, across the beam centre. Once corrected for flat field, the CCD profile was scaled in order to have the same average value as the normalized profile acquired with the gafchromic film. The same procedure was followed for the beam images acquired with the flat panel detector. Horizontal and vertical line profiles acquired with the radiochromic film show an uneven 2D distribution of the beam intensity, with variations in the order of 1520% in the horizontal direction, while the statistical uncertainties evaluated for the radiochromic dose measurements were 6% at 28 keV. Larger variations up to 64% were observed in the vertical direction. The response of the radiochromic film is comparable to that of the other imaging detectors, within less than 5% variation.