Task-based strategy for optimized contrast enhanced breast imaging: analysis of six imaging techniques for mammography and tomosynthesis

Digital breast tomosynthesis (DBT) is a novel x-ray imaging technique that provides 3D structural information of the breast. In contrast to 2D mammography, DBT minimizes tissue overlap potentially improving cancer detection and reducing number of unnecessary recalls. The addition of a contrast agent to DBT and mammography for lesion enhancement has the benefit of providing functional information of a lesion, as lesion contrast uptake and washout patterns may help differentiate between benign and malignant tumors. This study used a task-based method to determine the optimal imaging approach by analyzing six imaging paradigms in terms of their ability to resolve iodine at a given dose: contrast enhanced mammography and tomosynthesis, temporal subtraction mammography and tomosynthesis, and dual energy subtraction mammography and tomosynthesis. Imaging performance was characterized using a detectability index d', derived from the system task transfer function (TTF), an imaging task, iodine contrast, and the noise power spectrum (NPS). The task modeled a 5 mm lesion containing iodine concentrations between 2.1 mg/cc and 8.6 mg/cc. TTF was obtained using an edge phantom, and the NPS was measured over several exposure levels, energies, and target-filter combinations. Using a structured CIRS phantom, d' was generated as a function of dose and iodine concentration. In general, higher dose gave higher d', but for the lowest iodine concentration and lowest dose, dual energy subtraction tomosynthesis and temporal subtraction tomosynthesis demonstrated the highest performance.