title: The quantitative potential for breast tomosynthesis imaging.
abstract: OBJECTIVE
  Due to its limited angular scan range, breast tomosynthesis has lower resolution in the depth direction, which may limit its accuracy in quantifying tissue density. This study assesses the quantitative potential of breast tomosynthesis using relatively simple reconstruction and image processing algorithms. This quantitation could allow improved characterization of lesions as well as image processing to present tomosynthesis images with the familiar appearance of mammography by preserving more low-frequency information.
  
  
  METHODS
  All studies were based on a Siemens prototype MAMMOMAT Novation TOMO breast tomo system with a 45 degrees total angular span. This investigation was performed using both simulations and empirical measurements. Monte Carlo simulations were conducted using the breast tomosynthesis geometry and tissue-equivalent, uniform, voxelized phantoms with cuboid lesions of varying density embedded within. Empirical studies were then performed using tissue-equivalent plastic phantoms which were imaged on the actual prototype system. The material surrounding the lesions was set to either fat-equivalent or glandular-equivalent plastic. From the simulation experiments, the effects of scatter, lesion depth, and background material density were studied. The empirical experiments studied the effects of lesion depth, background material density, x-ray tube energy, and exposure level. Additionally, the proposed analysis methods were independently evaluated using a commercially available QA breast phantom (CIRS Model 11A). All image reconstruction was performed with a filtered backprojection algorithm. Reconstructed voxel values within each slice were corrected to reduce background nonuniformities.
  
  
  RESULTS
  The resulting lesion voxel values varied linearly with known glandular fraction (correlation coefficient R2 > 0.90) under all simulated and empirical conditions, including for the independent tests with the QA phantom. Analysis of variance performed on the fit line parameters revealed statistically significant differences between the two different background materials and between 28 kVp and the remaining energies (26, 30, and 32 kVp) for the dense experimental phantom. How ever, no significant differences arose between different energies for the fatty phantom, nor for any of the many other combinations of parameters.
  
  
  CONCLUSIONS
  These strong linear relationships suggest that breast tomosynthesis image voxel values, after being corrected by our outlined methods, are highly positively correlated with true tissue density. This consistent linearity implies that breast tomosynthesis imaging indeed has potential to be quantitative.
authors.affiliation: Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina 27705, USA. christina.shafer@duke.edu
authors.forename: Christina M
authors.initials: CM
authors.lastname: Shafer
authors.forename: Ehsan
authors.initials: E
authors.lastname: Samei
authors.forename: Joseph Y
authors.initials: JY
authors.lastname: Lo
mesh_terms: D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003198:Computer Simulation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008327:Mammography / Q000295:instrumentation / Q000379:methods*; D008954:Models, Biological; D019047:Phantoms, Imaging; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*
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