title: Evaluation of the effect of silicone breast inserts on X-ray mammography and breast tomosynthesis images: A Monte Carlo simulation study.
abstract: OBJECTIVE
  Breast augmentation is one of the most popular cosmetic surgeries worldwide. The aim of this study is to investigate the effect of breast implant insertion on the detectability and visibility of lesions on mammography and breast tomosynthesis (BT) images.
  
  
  METHODS
  Three software phantoms, composed of a homogeneous background with embedded silicone gel structures, and two types of breast abnormalities, microcalcifications (µCs) and masses, were generated. Two X-ray breast imaging modalities were simulated: mammography and BT with six incident monochromatic X-ray beams with energies in the interval between 20 and 30 keV. Projection images were generated using an in-house developed Monte Carlo simulator. The detectability of mammographic findings adjacent to the implant material and the influence of the incident beam energy and implant thickness on the feature detection were studied.
  
  
  RESULTS
  It was found that implants thicker than 26 mm for the case of mammography and 14 mm for the case of BT obscured the visibility of underlying structures. Although BT demonstrated a lack of contrast, this modality was able to visualize µCs under considerable depths of implant. Increasing the incident beam energy led to better visualization of small µCs, while in the case of breast masses, their detectability was limited.
  
  
  CONCLUSIONS
  Silicone gel implants introduce a limitation in the image quality of mammograms resulting in low detectability of features. In addition, silicone gel implants obscure partially or totally parts of the image, depending on the size and the thickness of the implant as well the energy of the X-rays used.
authors.affiliation: Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece. Electronic address: dasnatasa@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Daskalaki
authors.affiliation: Department of Medical Electronics, Technical University of Varna, Varna, Bulgaria.
authors.forename: K
authors.initials: K
authors.lastname: Bliznakova
authors.affiliation: Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Pallikarakis
mesh_terms: D016477:Artifacts; D001940:Breast; D018427:Breast Implants; D008327:Mammography / Q000379:methods*; D009010:Monte Carlo Method; D019047:Phantoms, Imaging; D012828:Silicones
chemical_list: D012828:Silicones
keywords: Breast phantoms; Breast tomosynthesis; Mammography; Silicone gel implants