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Gilbert F.J.,University of Cambridge | Tucker L.,University of Cambridge | Young K.C.,National Coordinating Center for the Physics of Mammography | Young K.C.,University of Surrey
Clinical Radiology | Year: 2016

Breast screening with full-field digital mammography (FFDM) fails to detect 15-30% of cancers. This figure is higher for women with dense breasts. A new tomographic technique in mammography has been developed - digital breast tomosynthesis (DBT) - which allows images to be viewed in sections through the breast and has the potential to improve cancer detection rates. Results from retrospective reading studies comparing DBT with FFDM have been largely favourable with improvement in sensitivity and specificity. Increases in diagnostic accuracy have been reported as being independent of breast density; however there are mixed reports regarding the detection of microcalcification. Prospective screening studies using DBT with FFDM have demonstrated increased rates in cancer detection compared with FFDM alone. A reduction in false-positive recall rates has also been shown. Screening with the addition of DBT would approximately double radiation dose; however a simulated FFDM image can be generated from a DBT scan. The combination of simulated FFDM images and DBT is being evaluated within several studies and some positive results have been published. Interval cancer rates for the UK National Health Service Breast Screening Programme (NHSBSP) demonstrate the limited sensitivity of FFDM in cancer detection. DBT has the potential to increase sensitivity and decrease false-positive recall rates. It has approval for screening and diagnostics in several countries; however, there are issues with DBT as a screening tool including additional reading time, IT storage and connectivity, over-diagnosis, and cost effectiveness. Feasibility and cost-effectiveness trials are needed before the implementation of DBT in NHSBSP can be considered. © 2015 The Royal College of Radiologists. Source


Diaz O.,University of Surrey | Dance D.R.,National Coordinating Center for the Physics of Mammography | Dance D.R.,University of Surrey | Young K.C.,National Coordinating Center for the Physics of Mammography | And 4 more authors.
Physics in Medicine and Biology | Year: 2014

Digital breast tomosynthesis (DBT) is a promising technique to overcome the tissue superposition limitations found in planar 2D x-ray mammography. However, as most DBT systems do not employ an anti-scatter grid, the levels of scattered radiation recorded within the image receptor are significantly higher than that observed in planar 2D x-ray mammography. Knowledge of this field is necessary as part of any correction scheme and for computer modelling and optimisation of this examination. Monte Carlo (MC) simulations are often used for this purpose, however they are computationally expensive and a more rapid method of calculation is desirable. This issue is addressed in this work by the development of a fast kernel-based methodology for scatter field estimation using a detailed realistic DBT geometry. Thickness-dependent scatter kernels, which were validated against the literature with a maximum discrepancy of 4% for an idealised geometry, have been calculated and a new physical parameter (air gap distance) was used to estimate more accurately the distribution of scattered radiation for a series of anthropomorphic breast phantom models. The proposed methodology considers, for the first time, the effects of scattered radiation from the compression paddle and breast support plate, which can represent more than 30% of the total scattered radiation recorded within the image receptor. The results show that the scatter field estimator can calculate scattered radiation images in an average of 80 min for projection angles up to 25° with equal to or less than a 10% error across most of the breast area when compared with direct MC simulations. © 2014 Institute of Physics and Engineering in Medicine. Source


Oduko J.,National Coordinating Center for the Physics of Mammography | Young K.,National Coordinating Center for the Physics of Mammography | Young K.,University of Surrey
Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) | Year: 2016

A nation-wide survey of patient dose data was carried out, using data recorded in 2013–2015. Data from 32,000 women were collected. The average dose for oblique views, for DR systems, was 1.65 mGy for all women, and 1.35 mGy for 50–60 mm breasts. There was a wide range of doses for different systems, with the highest more than twice the dose of the lowest (2.03 mGy and 0.91 mGy respectively for the Hologic Dimensions and Philips MicroDose L30 systems, averaged over all breasts). Image quality, as indicated by the threshold gold thickness for 0.25 mm details, was better (0.21 μm) for the Hologic systems; for all the others it was practically the same (0.28 μm), although their doses to the average breast varied over a wide range. © Springer International Publishing Switzerland 2016. Source


Shaheen E.,University Hospitals Leuven | De Keyzer F.,University Hospitals Leuven | Bosmans H.,University Hospitals Leuven | Dance D.R.,National Coordinating Center for the Physics of Mammography | And 4 more authors.
Medical Physics | Year: 2014

Purpose: This work proposes a new method of building 3D breast mass models with different morphological shapes and describes the validation of the realism of their appearance after simulation into 2D digital mammograms and breast tomosynthesis images. Methods: Twenty-five contrast enhanced MRI breast lesions were collected and each mass was manually segmented in the three orthogonal views: sagittal, coronal, and transversal. The segmented models were combined, resampled to have isotropic voxel sizes, triangularly meshed, and scaled to different sizes. These masses were referred to as nonspiculated masses and were then used as nuclei onto which spicules were grown with an iterative branching algorithm forming a total of 30 spiculated masses. These 55 mass models were projected into 2D projection images to obtain mammograms after image processing and into tomographic sequences of projection images, which were then reconstructed to form 3D tomosynthesis datasets. The realism of the appearance of these mass models was assessed by five radiologists via receiver operating characteristic (ROC) analysis when compared to 54 real masses. All lesions were also given a breast imaging reporting and data system (BIRADS) score. The data sets of 2D mammography and tomosynthesis were read separately. The Kendall's coefficient of concordance was used for the interrater observer agreement assessment for the BIRADS scores per modality. Further paired analysis, using the Wilcoxon signed rank test, of the BIRADS assessment between 2D and tomosynthesis was separately performed for the real masses and for the simulated masses. Results: The area under the ROC curves, averaged over all observers, was 0.54 (95% confidence interval [0.50, 0.66]) for the 2D study, and 0.67 (95% confidence interval [0.55, 0.79]) for the tomosynthesis study. According to the BIRADS scores, the nonspiculated and the spiculated masses varied in their degrees of malignancy from normal (BIRADS 1) to highly suggestive for malignancy (BIRADS 5) indicating the required variety of shapes and margins of these models. The assessment of the BIRADS scores for all observers indicated good agreement based on Kendall's coefficient for both the 2D and the tomosynthesis evaluations. The paired analysis of the BIRADS scores between 2D and tomosynthesis for each observer revealed consistent behavior for the real and simulated masses. Conclusions: A database of 3D mass models, with variety of shapes and margins, was validated for the realism of their appearance for 2D digital mammography and for breast tomosynthesis. This database is suitable for use in future observer performance studies whether in virtual clinical trials or in patient images with simulated lesions. © 2014 American Association of Physicists in Medicine. Source


Shaheen E.,University Hospitals Leuven | Van Ongeval C.,University Hospitals Leuven | Zanca F.,University Hospitals Leuven | Cockmartin L.,University Hospitals Leuven | And 5 more authors.
Medical Physics | Year: 2011

Purpose: This work proposes a new method of building 3D models of microcalcification clusters and describes the validation of their realistic appearance when simulated into 2D digital mammograms and into breast tomosynthesis images. Methods: A micro-CT unit was used to scan 23 breast biopsy specimens of microcalcification clusters with malignant and benign characteristics and their 3D reconstructed datasets were segmented to obtain 3D models of microcalcification clusters. These models were then adjusted for the x-ray spectrum used and for the system resolution and simulated into 2D projection images to obtain mammograms after image processing and into tomographic sequences of projection images, which were then reconstructed to form 3D tomosynthesis datasets. Six radiologists were asked to distinguish between 40 real and 40 simulated clusters of microcalcifications in two separate studies on 2D mammography and tomosynthesis datasets. Receiver operating characteristic (ROC) analysis was used to test the ability of each observer to distinguish between simulated and real microcalcification clusters. The kappa statistic was applied to assess how often the individual simulated and real microcalcification clusters had received similar scores (agreement) on their realistic appearance in both modalities. This analysis was performed for all readers and for the real and the simulated group of microcalcification clusters separately. Poor agreement would reflect radiologists' confusion between simulated and real clusters, i.e., lesions not systematically evaluated in both modalities as either simulated or real, and would therefore be interpreted as a success of the present models. Results: The area under the ROC curve, averaged over the observers, was 0.55 (95 confidence interval 0.44, 0.66) for the 2D study, and 0.46 (95 confidence interval 0.29, 0.64) for the tomosynthesis study, indicating no statistically significant difference between real and simulated lesions (p 0.05). Agreement between allocated lesion scores for 2D mammography and those for the tomosynthesis series was poor. Conclusions: The realistic appearance of the 3D models of microcalcification clusters, whether malignant or benign clusters, was confirmed for 2D digital mammography images and the breast tomosynthesis datasets; this database of clusters is suitable for use in future observer performance studies related to the detectability of microcalcification clusters. Such studies include comparing 2D digital mammography to breast tomosynthesis and comparing different reconstruction algorithms. © 2011 American Association of Physicists in Medicine. Source

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