Improved in-plane visibility of tumors using breast tomosynthesis

The purpose of this work was to evaluate and compare the visibility of simulated tumors in 2D digital mammography (DM) and breast tomosynthesis (BT) images of patients. Images of the same women were acquired on both a DM system (Mammomat Novation, Siemens) and a BT prototype system adapted from the same type of DM system. Using the geometrical properties of the two systems, simulated, ellipsoid-shaped tumors (average dimension: 8.4 mm × 6.6 mm × 5 mm) with irregular margins were projected and added to each DM image as well as each BT projection image prior to 3D reconstruction. The same beam quality and approximately the same total absorbed dose were used for each breast image acquisition on both systems. Two simulated tumors were added to each of thirty patient scans, yielding sixty cases. A series of 4-alternative forced choice (4-AFC) human observer experiments were conducted in order to determine what projected signal intensity (contrast) of the tumors in the DM images would be needed to achieve the same detectability as in the reconstructed BT images. Nine observers participated. For the BT 4-AFC experiment, when the signal intensity of the tumor on the central projection was 0.010 (natural logarithmic units) the mean percent of correct responses (PC) was measured to be 81.5%, which converted to a detectability index value (d') of 1.96. For the DM system, the same detectability was achieved at a signal intensity determined to be 0.038. Equivalent levels of tumor detection in BT images were thus achieved at around four times less projected signal intensity than in DM images, indicating that the use of BT may lead to earlier detection of breast cancer.