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1.	Dustler, Magnus, et al. (författare) The characteristics of malignant breast tumors imaged using a prototype mechanical imaging system as an adjunct to mammography 2016 Ingår i: Breast Imaging : 13th International Workshop, IWDM 2016, Malmö, Sweden, June 19-22, 2016, Proceedings - 13th International Workshop, IWDM 2016, Malmö, Sweden, June 19-22, 2016, Proceedings. - Cham : Springer International Publishing. - 1611-3349 .- 0302-9743. - 9783319415451 - 9783319415468 ; 9699, s. 282-288 Konferensbidrag (refereegranskat)abstract Breast cancer is diagnosed by a combination of modalities. Measuring the elasto-mechanical properties of suspicious lesions, by e.g. ultrasound elastography, can help differentiate malignant from benign findings. Using a prototype Mechanical Imaging (MI) system as an adjunct to mammography, the aim of this study was to characterize tumors using MI and compare the readings to those from the contralateral breast. Thirteen bilateral MI sets from women with malignant breast lesions were included in this study, drawn from a larger set of 155 women recalled from screening. The results showed that mean lesion pressure was significantly greater than the mean pressure of the corresponding breast, 7.5 ± 7.0 kPa compared to 2.5 ± 1.6 kPa (P = 0.01). There was no evidence for a difference in mean pressure or standard deviation of the MI image between symptomatic and contralateral asymptomatic breasts (P = 0.24 and 0.68). The results support that it is possible to use MI to distinguish malignant cancers from normal breast tissue. Still, further investigations of the characteristics of benign lesions are necessary to ascertain the usefulness of the system.
2.	Tingberg, Anders, et al. (författare) Preface 2016 Ingår i: Breast Imaging : 13th International Workshop, IWDM 2016 Malmö, Sweden, June 19 – 22, 2016 - 13th International Workshop, IWDM 2016 Malmö, Sweden, June 19 – 22, 2016. - Cham : Springer International Publishing. - 0302-9743. - 9783319415451 - 9783319415468 ; 9699 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
3.	Andersson, Christian, et al. (författare) Utredning om funktions- och leveranskontroller av radiologisk utrustning : För röntgendiagnostik och interventioner 2016 Rapport (övrigt vetenskapligt/konstnärligt)
4.	Andersson, Ingvar, et al. (författare) Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings. 2008 Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 18, s. 2817-2825 Tidskriftsartikel (refereegranskat)abstract The main purpose was to compare breast cancer visibility in one-view breast tomosynthesis (BT) to cancer visibility in one- or two-view digital mammography (DM). Thirty-six patients were selected on the basis of subtle signs of breast cancer on DM. One-view BT was performed with the same compression angle as the DM image in which the finding was least/not visible. On BT, 25 projections images were acquired over an angular range of 50 degrees, with double the dose of one-view DM. Two expert breast imagers classified one- and two-view DM, and BT findings for cancer visibility and BIRADS cancer probability in a non-blinded consensus study. Forty breast cancers were found in 37 breasts. The cancers were rated more visible on BT compared to one-view and two-view DM in 22 and 11 cases, respectively, (p < 0.01 for both comparisons). Comparing one-view DM to one-view BT, 21 patients were upgraded on BIRADS classification (p < 0.01). Comparing two-view DM to one-view BT, 12 patients were upgraded on BIRADS classification (p < 0.01). The results indicate that the cancer visibility on BT is superior to DM, which suggests that BT may have a higher sensitivity for breast cancer detection.
5.	Andersson, Karin, 1989- (författare) Metal artifacts in computed tomography : impact of reduction methods on image quality and radiotherapy treatment planning 2018 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Degradation of image quality by metal artifacts is a common problem in computed tomography (CT) imaging, which can limit the diagnostic value of a CT examination and also introduce inaccuracies in radiotherapy (RT) treatment planning. In recent years, commercial metal artifact reduction (MAR) methods have been launched by several CT vendors. The overall aim of this thesis was to evaluate MAR methods in diagnostic imaging and RT treatment planning.Evaluations of hip prosthesis phantom CT images showed that MAR algorithms in general improved image quality, based on both visual grading analysis and quantitative measures, while the application of virtual monoenergetic reconstructions insufficiently reduced metal artifacts. In some cases additional artifacts were introduced by the MAR algorithms. MAR algorithms were also evaluated in hip prosthesis phantom CT imaging used for proton therapy treatment planning, where improvements in dose calculation accuracy were observed.Studies of Head & Neck (H&N) implant CT images in RT treatment planning were also performed. By visual grading of anatomy visualization with respect to target delineation in dental implant patient images, MAR algorithms were shown to significantly improve image quality. However, only minor effects of H&N implant artifacts on proton dose distributions were seen. The impact might be greater for more severe artifacts than those studied here, and thus further investigations of such cases are needed.In conclusion, MAR algorithms have been shown to enhance image quality for diagnostic applications and to improve anatomy visualization in RT treatment planning. The MAR algorithms led to increased proton dose calculation accuracy in some cases, while in other situations only minor changes were seen.
6.	Aurumskjöld, Marie-Louise, et al. (författare) A PHANTOM STUDY SHOWING THE IMPORTANCE OF COMPRESSION IN CONVENTIONAL DIAGNOSTIC X-RAY EXAMINATIONS. 2010 Ingår i: Radiation Protection Dosimetry. - : Oxford University Press (OUP). - 1742-3406 .- 0144-8420. ; Apr 7, s. 78-80 Tidskriftsartikel (refereegranskat)abstract Compression was earlier an important and well-managed part of the clinical routine, but during the past 15-20 y the use has diminished, except for mammography, where it is a prerequisite for having images of high quality and low radiation dose. According to national and European regulations and recommendations, it is important to apply the compression technique to obtain the optimal image quality and radiation dose in common conventional diagnostic examinations. Current experience of compression technique is, however, based on studies carried out a long time ago and with analogue imaging techniques. An anthropomorphic phantom was used to show the importance of compression in conventional X-ray examinations. The patient thicknesses on volunteers with and without compression was measured. This measurement was done to investigate compression potential on patients and to select suitable phantom thicknesses. The X-ray examinations that were included in the study were abdomen overview, lumbar spine and the pelvis. The results from the phantom study showed a large dependency of the kerma-area product value on the phantom thickness. The phantom study suggests that there is a potential for significant reduction of radiation dose to the patient by using compression also with modern X-ray techniques. A dose reduction of up to 50 % or even more may be obtained.
7.	Aurumskjöld, Marie-Louise, et al. (författare) Evaluation of an iterative model-based reconstruction of pediatric abdominal CT with regard to image quality and radiation dose 2018 Ingår i: Acta Radiologica. - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 59:6, s. 740-747 Tidskriftsartikel (refereegranskat)abstract BackgroundIn pediatric patients, computed tomography (CT) is important in the medical chain of diagnosing and monitoring various diseases. Because children are more radiosensitive than adults, they require minimal radiation exposure. One way to achieve this goal is to implement new technical solutions, like iterative reconstruction.PurposeTo evaluate the potential of a new, iterative, model-based method for reconstructing (IMR) pediatric abdominal CT at a low radiation dose and determine whether it maintains or improves image quality, compared to the current reconstruction method.Material and MethodsForty pediatric patients underwent abdominal CT. Twenty patients were examined with the standard dose settings and 20 patients were examined with a 32% lower radiation dose. Images from the standard examination were reconstructed with a hybrid iterative reconstruction method (iDose4), and images from the low-dose examinations were reconstructed with both iDose4 and IMR. Image quality was evaluated subjectively by three observers, according to modified EU image quality criteria, and evaluated objectively based on the noise observed in liver images.ResultsVisual grading characteristics analyses showed no difference in image quality between the standard dose examination reconstructed with iDose4 and the low dose examination reconstructed with IMR. IMR showed lower image noise in the liver compared to iDose4 images. Inter- and intra-observer variance was low: the intraclass coefficient was 0.66 (95% confidence interval = 0.60–0.71) for the three observers.ConclusionIMR provided image quality equivalent or superior to the standard iDose4 method for evaluating pediatric abdominal CT, even with a 32% dose reduction.
8.	Aurumskjöld, Marie-Louise, et al. (författare) Improvements to image quality using hybrid and model-based iterative reconstructions: a phantom study. 2017 Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 58:1, s. 53-61 Tidskriftsartikel (refereegranskat)abstract The number of computed tomography (CT) examinations is increasing and leading to an increase in total patient exposure. It is therefore important to optimize CT scan imaging conditions in order to reduce the radiation dose. The introduction of iterative reconstruction methods has enabled an improvement in image quality and a reduction in radiation dose.
9.	Aurumskjöld, Marie-Louise, et al. (författare) MODEL-BASED ITERATIVE RECONSTRUCTION ENABLES THE EVALUATION OF THIN-SLICE COMPUTED TOMOGRAPHY IMAGES WITHOUT DEGRADING IMAGE QUALITY OR INCREASING RADIATION DOSE. 2016 Ingår i: Radiation Protection Dosimetry. - : Oxford University Press (OUP). - 1742-3406 .- 0144-8420. ; 169:1-4, s. 100-106 Tidskriftsartikel (refereegranskat)abstract Computed tomography (CT) is one of the most important modalities in a radiological department. This technique not only produces images that enable radiological reports with high diagnostic confidence, but it may also provide an elevated radiation dose to the patient. The radiation dose can be reduced by using advanced image reconstruction algorithms. This study was performed on a Brilliance iCT, equipped with iDose(4) iterative reconstruction and an iterative model-based reconstruction (IMR) method. The purpose was to investigate the effect of reduced slice thickness combined with an IMR method on image quality compared with standard slice thickness with iDose(4) reconstruction. The results of objective and subjective image quality evaluations showed that a thinner slice combined with IMR can improve the image quality and reduce partial volume artefacts compared with the standard slice thickness with iDose(4). In conclusion, IMR enables reduction of the slice thickness while maintaining or even improving image quality versus iDose(4).
10.	Aurumskjöld, Marie-Louise, et al. (författare) Model based iterative reconstruction IMR gives possibility to evaluate thinner slice thicknesses than conventional iterative reconstruction iDose(4) - a phantom study 2015 Ingår i: Medical Imaging 2015: Physics of Medical Imaging. - : SPIE. - 1996-756X .- 0277-786X. ; 9412, s. 94124-94124 Konferensbidrag (refereegranskat)abstract Computed tomography (CT) is one of the most important modalities in a radiological department, which produces images with high diagnostic confidence, but in some cases contributes to a high radiation dose to the patient. The radiation dose can be reduced by the use of advanced image reconstruction algorithms. This study was done on a Philips Brilliance iCT with iterative reconstruction iDose(4) and model-based iterative reconstruction IMR. The purpose was to investigate the effect on the image quality with thin slice images reconstructed with IMR, compared to standard slice thickness reconstructed with iDose(4). Objective measurements of noise and contrast-to-noise ratio were performed using an image quality phantom, an anthropomorphic phantom and clinical cases. Subjective evaluations of low-contrast resolution were performed by observers using an image quality phantom. IMR gives strong noise reduction and enhanced low-contrast and thereby enable selection of thinner slice thickness. Objective evaluation of image noise shows that thin slices reconstructed with IMR provides lower noise than thicker slice images reconstructed with iDose(4). With IMR the slice thickness is of less importance for the noise. With thinner slices the partial volume artefacts becomes less pronounced. In conclusion, we have shown that IMR enables reduction of the slice thickness and at the same time maintain or even reduce the noise level compared to iDose(4) reconstruction with standard slice thickness. This will subsequently result in an improvement of image quality for images reconstructed with IMR.
11.	Axelsson, Rebecca, et al. (författare) Computer model of mechanical imaging acquisition for virtual clinical trials 2021 Ingår i: Medical Imaging 2021 : Physics of Medical Imaging - Physics of Medical Imaging. - : SPIE. - 1605-7422. - 9781510640191 ; 11595, s. 1-115950 Konferensbidrag (refereegranskat)abstract Malignant breast tumours can be distinguished from benign lesions and normal tissue based on their mechanical properties. Our pilot studies have demonstrated the potential of using Mechanical Imaging (MI) combined with mammography to reduce recalls and false positives in breast cancer screening by more accurately identifying benign lesions. To enable further optimization of MI we propose a computer simulation of the MI acquisition, for use in a Virtual Clinical Trial (VCT) framework. VCTs are computer simulated clinical trials used to efficiently evaluate clinical imaging systems. A linear elastic finite element (FE) model of the breast under dynamic compression was implemented using an open-source FE solver. A spherical tumour (15 mm in diameter) was inserted into the simulated predominantly adipose breast. The location and stiffness of the tumour was varied. The average stress on the compressed breast surface was calculated and compared with the local average stress at the tumour location and the Relative Mean Pressure over lesion Area (RMPA) was calculated. Preliminary results were within a realistic range with an average stress on the breast (tumour) of 5.9-16.6 kPa which is in agreement with published values between 1.0 - 22.5 kPa. This corresponds to RMPA values of 0.96-2.15 depending on stiffness and location of the tumour. This can lead to more detailed validation of various MI acquisition schemes through VCTs before their use in clinical studies.
12.	Axelsson, Rebecca, et al. (författare) Finite element model of mechanical imaging of the breast 2022 Ingår i: Journal of Medical Imaging. - 2329-4302. ; 9:3, s. 1-15 Tidskriftsartikel (refereegranskat)abstract Purpose: Malignant breast lesions can be distinguished from benign lesions by their mechanical properties. This has been utilized for mechanical imaging in which the stress distribution over the breast is measured. Mechanical imaging has shown the ability to identify benign or normal cases and to reduce the number of false positives from mammography screening. Our aim was to develop a model of mechanical imaging acquisition for simulation purposes. To that end, we simulated mammographic compression of a computer model of breast anatomy and lesions. Approach: The breast compression was modeled using the finite element method. Two finite element breast models of different sizes were used and solved using linear elastic material properties in open-source virtual clinical trial (VCT) software. A spherical lesion (15 mm in diameter) was inserted into the breasts, and both the location and stiffness of the lesion were varied extensively. The average stress over the breast and the average stress at the lesion location, as well as the relative mean pressure over lesion area (RMPA), were calculated. Results: The average stress varied 6.2-6.5 kPa over the breast surface and 7.8-11.4 kPa over the lesion, for different lesion locations and stiffnesses. These stresses correspond to an RMPA of 0.80 to 1.46. The average stress was 20% to 50% higher at the lesion location compared with the average stress over the entire breast surface. Conclusions: The average stress over the breast and the lesion location corresponded well to clinical measurements. The proposed model can be used in VCTs for evaluation and optimization of mechanical imaging screening strategies.
13.	Axelsson, Rebecca, et al. (författare) Simultaneous digital breast tomosynthesis and mechanical imaging in women recalled from screening - A preliminary analysis 2022 Ingår i: 16th International Workshop on Breast Imaging, IWBI 2022. - : SPIE. - 0277-786X .- 1996-756X. - 9781510655843 ; 12286 Konferensbidrag (refereegranskat)abstract We have developed a method for simultaneous tomosynthesis and mechanical imaging, called DBTMI. Mechanical imaging measures the stress distribution over the compressed breast surface. Malignant tissue is usually stiffer than benign, which results in higher stress on the compressed breast and enables to distinguish malignant from benign findings. By combining tomosynthesis and mechanical imaging, we could improve cancer detection accuracy by reducing the number of false positive findings. In this study we have analysed clinical DBTMI data, collected from 52 women from an ongoing pilot study at the Skåne University Hospital, Malmö, Sweden. We measured the range of the average stress over the breast surface, the range of average stress over the location of suspected lesions, and the normalized stress over the lesion location. Preliminary results show that the range of stress over the breast surface was 1.23-5.84 kPa, the range over the lesion location 2.10-10.10 kPa, and the normalized stress 1.12-2.44 over the lesion location. Overall, the local stress over malignant lesions was higher than the average stress over the entire breast surface. This is the first step investigating criteria to distinguish between malignant and benign findings based upon clinical DBTMI data.
14.	Bakic, Predrag R., et al. (författare) Artifact reduction in simultaneous tomosynthesis and mechanical imaging of the breast 2019 Ingår i: Medical Imaging 2019 : Physics of Medical Imaging - Physics of Medical Imaging. - : SPIE. - 9781510625433 ; 10948 Konferensbidrag (refereegranskat)abstract Mechanical imaging (MI) uses a pressure sensor array to estimate the stiffness of lesions. Recent clinical studies have suggested that MI combined with digital mammography may reduce false positive findings and negative biopsies by over 30%. Digital breast tomosynthesis (DBT) has been adopted progressively in cancer screening. The tomographic nature of DBT improves lesion visibility by reducing tissue overlap in reconstructed images. For maximum benefit, DBT and MI data should be acquired simultaneously; however, that arrangement produces visible artifacts in DBT images due to the presence of the MI sensor array. We propose a method for reducing artifacts during the DBT image reconstruction. We modified the parameters of a commercial DBT reconstruction engine and investigated the conspicuity of artifacts in the resultant images produced with different sensor orientations. The method was evaluated using a physical anthropomorphic phantom imaged on top of the sensor. Visual assessment showed a reduction of artifacts. In a quantitative test, we calculated the artifact spread function (ASF), and compared the ratio of the mean ASF values between the proposed and conventional reconstruction (termed ASF ratio, RASF). We obtained a mean RASF of 2.74, averaged between two analyzed sensor orientations (45° and 90°). The performance varied with the orientation and the type of sensor structures causing the artifacts. RASF for wide connection lines was larger at 45° than at 90° (5.15 vs. 1.00, respectively), while for metallic contacts RASF was larger at 90° than at 45° (3.31 vs. 2.21, respectively). Future work will include a detailed quantitative assessment, and further method optimization in virtual clinical trials.
15.	Bakic, Predrag R., et al. (författare) Evaluation of a flat fielding method for simultaneous DBT and MI acquisition 2020 Ingår i: 15th International Workshop on Breast Imaging, IWBI 2020. - : SPIE. - 1996-756X .- 0277-786X. - 9781510638310 ; 11513 Konferensbidrag (refereegranskat)abstract We are developing a prototype system for simultaneous digital breast tomosynthesis (DBT) and mechanical imaging (MI). MI maps the local pressure distribution during clinical exams, to distinguish breast abnormalities from the normal tissue. Both DBT alone, and MI when combined with digital mammography, have demonstrated the ability to reduce false positives; however, the benefit of combining DBT with MI has not been investigated. A practical limitation in simultaneous DBT and MI is the presence of the MI sensor in DBT images. Metallic elements of the sensor generate noticeable artifacts, which may interfere with clinical analysis. Previously, we shown that the sensor artifacts can be reduced by flat fielding, which combines projections of the sensor acquired with and without the breast. In this paper we evaluate the flat fielding by assessing artifact reduction and visibility of breast abnormalities. Images of a physical anthropomorphic breast phantom were acquired using a clinical wide-angle DBT system. Visual evaluation was performed by experienced medical physicists. Image quality descriptors were calculated in images with and without flat fielding. To evaluate the visibility of abnormalities we estimated the full width at half maximum (FWHM) for calcifications modeled in the phantom. Our preliminary results suggest a substantial reduction of artifacts by flat fielding (on average 83%). Few noticeable artifacts remain near the breast edge, in the reconstructed image with the sensor in focus. We observed a 17% reduction in the FWHM. Future work would include a detailed assessment, and method optimization using virtual trials as a design aid.
16.	Bakic, Predrag R., et al. (författare) Pre-processing for image quality improvement in simultaneous DBT and mechanical imaging 2020 Ingår i: Medical Imaging 2020 : Physics of Medical Imaging - Physics of Medical Imaging. - : SPIE. - 1605-7422. - 9781510633919 ; 11312 Konferensbidrag (refereegranskat)abstract Simultaneous digital breast tomosynthesis (DBT) and mechanical imaging (MI) offer the potential to combine anatomic information from DBT with functional information from MI. This makes it possible to associate tissue stiffness with specific anatomic structures in the breast, a combination that can reduce false-positive findings by using the MI data to discriminate between ambiguous lesions in DBT. This, in turn, will reduce the frequency of negative biopsies. Simultaneous imaging requires that the MI sensor array be present during DBT acquisition. This introduces artifacts, since the sensor is attenuating. Previously, we demonstrated that the DBT reconstruction could be modified to reduce sensor conspicuity in DBT images. In this paper, we characterize the relative attenuation of the breast and the sensor, to calculate the artifact reduction in DBT reconstruction. We concentrate on pre-processing DBT projections prior to reconstruction. Using commercially available a DBT system, we have confirmed that the sensor array does not completely attenuate the x-rays. This suggests that a pre-processing method based upon flat fielding can be used to reduce artifacts. In a proof-of-concept study, we performed flat fielding by combining DBT projections of the MI sensor with and without an anthropomorphic breast phantom. Visual evaluation confirmed substantially improved image quality. The artifacts were reduced throughout the image for all sensor elements. Few residual artifacts are noticeable where the phantom thickness decreases. The investigation of additional pre-processing, including beam hardening correction is ongoing. Future work includes quantitative validation, noise stabilization, and method optimization in virtual clinical trials and subsequent patient studies.
17.	Barufaldi, Bruno, et al. (författare) Virtual Clinical Trials in Medical Imaging System Evaluation and Optimisation 2021 Ingår i: Radiation Protection Dosimetry. - : Oxford University Press (OUP). - 1742-3406 .- 0144-8420. ; 195:3-4, s. 363-371 Tidskriftsartikel (refereegranskat)abstract Virtual clinical trials (VCTs) can be used to evaluate and optimise medical imaging systems. VCTs are based on computer simulations of human anatomy, imaging modalities and image interpretation. OpenVCT is an open-source framework for conducting VCTs of medical imaging, with a particular focus on breast imaging. The aim of this paper was to evaluate the OpenVCT framework in two tasks involving digital breast tomosynthesis (DBT). First, VCTs were used to perform a detailed comparison of virtual and clinical reading studies for the detection of lesions in digital mammography and DBT. Then, the framework was expanded to include mechanical imaging (MI) and was used to optimise the novel combination of simultaneous DBT and MI. The first experiments showed close agreement between the clinical and the virtual study, confirming that VCTs can predict changes in performance of DBT accurately. Work in simultaneous DBT and MI system has demonstrated that the system can be optimised in terms of the DBT image quality. We are currently working to expand the OpenVCT software to simulate MI acquisition more accurately and to include models of tumour growth. Based on our experience to date, we envision a future in which VCTs have an important role in medical imaging, including support for more imaging modalities, use with rare diseases and a role in training and testing artificial intelligence (AI) systems.
18.	Bejnö, Anna, et al. (författare) Artificial intelligence together with mechanical imaging in mammography 2020 Ingår i: 15th International Workshop on Breast Imaging, IWBI 2020. - : SPIE. - 0277-786X .- 1996-756X. - 9781510638310 ; 11513 Konferensbidrag (refereegranskat)abstract Artificial intelligence (AI) applications are increasingly seeing use in breast imaging, particularly to assist in or automate the reading of mammograms. Another novel technique is mechanical imaging (MI) which estimates the relative stiffness of suspicious breast abnormalities by measuring the distribution of pressure on the compressed breast. This study investigates the feasibility of combining AI and MI information in breast imaging to provide further diagnostic information. Forty-six women recalled from screening were included in the analysis. Mammograms with findings scored on a suspiciousness scale by an AI tool, and corresponding pressure distributions were collected for each woman. The cases were divided into three groups by diagnosis; biopsy-proven cancer, biopsy-proven benign and non-biopsied, very likely benign. For all three groups, the relative increase of pressure at the location of the finding marked most suspicious by the AI software was recorded. A significant correlation between the relative pressure increase at the AI finding and the AI score was established in the group with cancer (p=0.043), but neither group of healthy women showed such a correlation. This study suggests that AI and MI indicate independent markers for breast cancer. The combination of these two methods has the potential to increase the accuracy of mammography screening, but further research is needed.
19.	Bjerkén, Anna, et al. (författare) Dose evaluation of simultaneous breast radiography and mechanical imaging 2023 Ingår i: Medical Imaging 2023 : Physics of Medical Imaging - Physics of Medical Imaging. ; 12463 Konferensbidrag (refereegranskat)abstract This study investigates the impact in terms of radiation dose when performing simultaneous digital breast tomosynthesis(DBT) and mechanical imaging (MI) – DBTMI. DBTMI has demonstrated the potential to increase specificity of cancerdetection, and reduce unnecessary biopsies, as compared to digital mammography (DM) screening. The presence of theMI sensor during simultaneous image acquisition may increase the radiation dose when automatic exposure control is used.In this project, a radiation dose study was conducted on clinically available breast imaging systems with and without theMI sensor. We have investigated three approaches to analyse the dose increase in DBTMI, using (i) the estimates of averageglandular dose (AGD) reported in DICOM headers of radiography images; (ii) AGD measured by a conventionaldosemeter; and (iii) AGD measured by optically stimulated luminescence using NaCl pellets. The relative increase in AGDestimated from DICOM headers when using the MI sensor was on average 10.7% and 12.4%, for DM and DBTmeasurements, respectively. The relative increase in AGD using the conventional dosemeter was 11.2% in DM mode and12.2% in DBT mode. The relative increase in AGD using NaCl pellets was 14.6% in DM mode. Our measurements suggestthat the use of simultaneous breast radiography and MI increases the AGD by 13% on average. The increase in dose is stillbelow the acceptable values in mammography screening recommended by the European Guidelines.
20.	Björk, Anna, et al. (författare) Evaluation of a new set of image quality criteria for mammography 2004 Ingår i: Second Malmö Conference on Medical X-ray Imaging: Optimisation Strategies in Medical X-ray Imaging, Malmö, Sweden, 23-25 April 2004. Konferensbidrag (övrigt vetenskapligt/konstnärligt)
21.	Boita, Joana, et al. (författare) Development and content validity evaluation of a candidate instrument to assess image quality in digital mammography : A mixed-method study 2021 Ingår i: European Journal of Radiology. - : Elsevier BV. - 0720-048X. ; 134 Tidskriftsartikel (refereegranskat)abstract Purpose: To develop a candidate instrument to assess image quality in digital mammography, by identifying clinically relevant features in images that are affected by lower image quality. Methods: Interviews with fifteen expert breast radiologists from five countries were conducted and analysed by using adapted directed content analysis. During these interviews, 45 mammographic cases, containing 44 lesions (30 cancers, 14 benign findings), and 5 normal cases, were shown with varying image quality. The interviews were performed to identify the structures from breast tissue and lesions relevant for image interpretation, and to investigate how image quality affected the visibility of those structures. The interview findings were used to develop tentative items, which were evaluated in terms of wording, understandability, and ambiguity with expert breast radiologists. The relevance of the tentative items was evaluated using the content validity index (CVI) and modified kappa index (k). Results: Twelve content areas, representing the content of image quality in digital mammography, emerged from the interviews and were converted into 29 tentative items. Fourteen of these items demonstrated excellent CVI ≥ 0.78 (k > 0.74), one showed good CVI < 0.78 (0.60 ≤ k* ≤ 0.74), while fourteen were of fair or poor CVI < 0.78 (k* ≤ 0.59). In total, nine items were deleted and five were revised or combined resulting in 18 items. Conclusions: By following a mixed-method methodology, a candidate instrument was developed that may be used to characterise the clinically-relevant impact that image quality variations can have on digital mammography.
22.	Boita, Joana, et al. (författare) How does image quality affect radiologists’ perceived ability for image interpretation and lesion detection in digital mammography? 2021 Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 31:7, s. 5335-5343 Tidskriftsartikel (refereegranskat)abstract Objectives: To study how radiologists’ perceived ability to interpret digital mammography (DM) images is affected by decreases in image quality. Methods: One view from 45 DM cases (including 30 cancers) was degraded to six levels each of two acquisition-related issues (lower spatial resolution and increased quantum noise) and three post-processing-related issues (lower and higher contrast and increased correlated noise) seen during clinical evaluation of DM systems. The images were shown to fifteen breast screening radiologists from five countries. Aware of lesion location, the radiologists selected the most-degraded mammogram (indexed from 1 (reference) to 7 (most degraded)) they still felt was acceptable for interpretation. The median selected index, per degradation type, was calculated separately for calcification and soft tissue (including normal) cases. Using the two-sided, non-parametric Mann-Whitney test, the median indices for each case and degradation type were compared. Results: Radiologists were not tolerant to increases (medians: 1.5 (calcifications) and 2 (soft tissue)) or decreases (median: 2, for both types) in contrast, but were more tolerant to correlated noise (median: 3, for both types). Increases in quantum noise were tolerated more for calcifications than for soft tissue cases (medians: 3 vs. 4, p = 0.02). Spatial resolution losses were considered less acceptable for calcification detection than for soft tissue cases (medians: 3.5 vs. 5, p = 0.001). Conclusions: Perceived ability of radiologists for image interpretation in DM was affected not only by image acquisition-related issues but also by image post-processing issues, and some of those issues affected calcification cases more than soft tissue cases. Key Points: • Lower spatial resolution and increased quantum noise affected the radiologists’ perceived ability to interpret calcification cases more than soft tissue lesion or normal cases. • Post-acquisition image processing-related effects, not only image acquisition-related effects, also impact the perceived ability of radiologists to interpret images and detect lesions. • In addition to current practices, post-acquisition image processing-related effects need to also be considered during the testing and evaluation of digital mammography systems.
23.	Boita, Joana, et al. (författare) Validation of a candidate instrument to assess image quality in digital mammography using ROC analysis 2021 Ingår i: European Journal of Radiology. - : Elsevier BV. - 1872-7727 .- 0720-048X. ; 139 Tidskriftsartikel (refereegranskat)abstract PurposeTo validate a candidate instrument, to be used by different professionals to assess image quality in digital mammography (DM), against detection performance results.MethodsA receiver operating characteristics (ROC) study was conducted to assess the detection performance in DM images with four different image quality levels due to different quality issues. Fourteen expert breast radiologists from five countries assessed a set of 80 DM cases, containing 60 lesions (40 cancers, 20 benign findings) and 20 normal cases. A visual grading analysis (VGA) study using a previously-described candidate instrument was conducted to evaluate a subset of 25 of the images used in the ROC study. Eight radiologists that had participated in the ROC study, and seven expert breast-imaging physicists, evaluated this subset. The VGA score (VGAS) and the ROC and visual grading characteristics (VGC) areas under the curve (AUCROC and AUCVGC) were compared.ResultsNo large differences in image quality among the four levels were detected by either ROC or VGA studies. However, the ranking of the four levels was consistent: level 1 (partial AUCROC: 0.070, VGAS: 6.77) performed better than levels 2 (0.066, 6.15), 3 (0.061, 5.82), and 4 (0.062, 5.37). Similarity between radiologists’ and physicists’ assessments was found (average VGAS difference of 10 %).ConclusionsThe results from the candidate instrument were found to correlate with those from ROC analysis, when used by either observer group. Therefore, it may be used by different professionals, such as radiologists, radiographers, and physicists, to assess clinically-relevant image quality variations in DM.
24.	Boll, Måns, et al. (författare) Evaluation of 3D printed contrast detail phantoms for mammography quality assurance 2022 Ingår i: 16th International Workshop on Breast Imaging, IWBI 2022. - : SPIE. - 0277-786X .- 1996-756X. - 9781510655843 ; 12286 Konferensbidrag (refereegranskat)abstract Objects created by 3D printers are increasingly used in various medical applications. Today, affordable 3D printers, using Fused Deposition Modeling are widely available. In this project, a commercially available 3D printer was used to replicate a conventional radiographic contrast detail phantom. Printing materials were selected by comparing their x-ray attenuation properties. Two replicas were printed using polylactic acid, with different filling patterns. The printed phantoms were imaged by a clinical mammography system, using automatic exposure control. Phantom images were visually and quantitively compared to images of the corresponding conventional contrast detail phantom. Visual scoring of the contrast detail elements was performed by a medical physics student. Contrast-to-noise ratio (CNR) was calculated for each phantom element. The diameter and thickness of the smallest visible phantom object were 0.44 mm and 0.09 mm, respectively, for both filling patterns. For the conventional phantom, the diameter and thickness of the smallest visible object were 0.31 mm and 0.09 mm. Visual inspection of printed phantoms revealed some linear artefacts. These artefacts were however not visible on mammographic projections. Quantitively, average CNR of printed phantom objects followed the same trend with an increase of average CNR with increasing disk height. However, there is a limitation of detail objects with disk diameters below 1.25 mm, caused by the available nozzle size. Based upon the encouraging results, future work will explore the use of different materials and smaller nozzle diameters.
25.	Breast Imaging. : 13th International Workshop, IWDM 2016 Malmö, Sweden, June 19-22, 2016, Proceedings 2016 Proceedings (redaktörskap) (refereegranskat)
26.	Båth, Magnus, 1974, et al. (författare) Investigation of image components affecting the detection of lung nodules in digital chest radiography 2005 Ingår i: Progress in Biomedical Optics and Imaging - Proceedings of SPIE. - : SPIE. - 1605-7422. ; 5749, s. 231-242 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract The aim of this work was to investigate and quantify the effects of system noise, nodule location, anatomical noise and anatomical background on the detection of lung nodules in different regions of the chest x-ray. Simulated lung nodules of diameter 10 mm but with varying detail contrast were randomly positioned in four different kinds of images: 1) clinical images collected with a 200 speed CR system, 2) images containing only system noise (including quantum noise) at the same level as the clinical images, 3) clinical images with removed anatomical noise, 4) artificial images with similar power spectrum as the clinical images but random phase spectrum. An ROC study was conducted with 5 observers. The detail contrast needed to obtain an Az of 0.80, C0.8, was used as measure of detectability. Five different regions of the chest x-ray were investigated separately. The C0.8 of the system noise images ranged from only 2% (the hilar regions) to 20% (the lateral pulmonary regions) of those of the clinical images. Compared with the original clinical images, the C0.8 was 16% lower for the de-noised clinical images and 71% higher for the random phase images, respectively, averaged over all five regions. In conclusion, regarding the detection of lung nodules with a diameter of 10 mm, the system noise is of minor importance at clinically relevant dose levels. The removal of anatomical noise and other noise sources uncorrelated from image to image leads to somewhat better detection, but the major component disturbing the detection is the overlapping of recognizable structures, which are, however, the main aspect of an x-ray image.
27.	Båth, Magnus, 1974, et al. (författare) Investigation of image components affecting the detection of lung nodules in digital chest radiography 2005 Ingår i: SPIE International Symposium on Medical Imaging 2005, 12-17 February 2005, San Diego, California, USA. Konferensbidrag (övrigt vetenskapligt/konstnärligt)
28.	Båth, Magnus, 1974, et al. (författare) Method of simulating dose reduction for digital radiographic systems. 2005 Ingår i: Radiation protection dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 114:1-3, s. 253-9 Tidskriftsartikel (refereegranskat)abstract The optimisation of image quality vs. radiation dose is an important task in medical imaging. To obtain maximum validity of the optimisation, it must be based on clinical images. Images at different dose levels can then either be obtained by collecting patient images at the different dose levels sought to investigate-including additional exposures and permission from an ethical committee-or by manipulating images to simulate different dose levels. The aim of the present work was to develop a method of simulating dose reduction for digital radiographic systems. The method uses information about the detective quantum efficiency and noise power spectrum at the original and simulated dose levels to create an image containing filtered noise. When added to the original image this results in an image with noise which, in terms of frequency content, agrees with the noise present in an image collected at the simulated dose level. To increase the validity, the method takes local dose variations in the original image into account. The method was tested on a computed radiography system and was shown to produce images with noise behaviour similar to that of images actually collected at the simulated dose levels. The method can, therefore, be used to modify an image collected at one dose level so that it simulates an image of the same object collected at any lower dose level.
29.	Båth, Magnus, 1974, et al. (författare) Method of simulating dose reduction for digital radiographic systems 2004 Ingår i: Second Malmö Conference on Medical X-ray Imaging: Optimisation Strategies in Medical X-ray Imaging, Malmö, Sweden, 23-25 April 2004. Konferensbidrag (övrigt vetenskapligt/konstnärligt)
30.	Båth, Magnus, 1974, et al. (författare) Nodule detection in digital chest radiography: introduction to the RADIUS chest trial. 2005 Ingår i: Radiation protection dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 114:1-3, s. 85-91 Tidskriftsartikel (refereegranskat)abstract Most digital radiographic systems of today have wide latitude and are hence able to provide images with a small constraint on dose level. This opens up for an unprejudiced dose optimisation. However, in order to succeed in the optimisation task, good knowledge of the imaging and detection processes is needed. As a part of the European-wide research project 'unification of physical and clinical requirements for medical X-ray imaging'-governed by the Radiological Imaging Unification Strategies (RADIUS) Group-a major image quality trial was conducted by members of the group. The RADIUS chest trial was focused on the detection of lung nodules in digital chest radiography with the aims of determining to what extent (1) the detection of a nodule is dependent on its location, (2) the system noise disturbs the detection of lung nodules, (3) the anatomical noise disturbs the detection of lung nodules and (4) the image background and anatomical background act as pure noise for the detection of lung nodules. The purpose of the present paper is to give an introduction to the trial and describe the framework and set-up of the investigation.
31.	Börjesson, Sara, et al. (författare) A software tool for increased efficiency in observer performance studies in radiology. 2005 Ingår i: Radiation protection dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 114:1-3, s. 45-52 Tidskriftsartikel (refereegranskat)abstract Observer performance studies are time-consuming tasks, both for the participating observers and for the scientists collecting and analysing the data. A possible way to optimise such studies is to perform them in a completely digital environment. A software tool-ViewDEX (Viewer for Digital Evaluation of X-ray images)-has been developed in Java, enabling it to function on almost any computer. ViewDEX is designed to handle several types of studies, such as visual grading analysis (VGA), image criteria scoring (ICS) and receiver operating characteristics (ROC). The results from each observer are saved in a log file, which can be exported for further analysis in, for example, a special software for analysing ROC results. By using ViewDEX for an ROC experiment, an evaluation rate of approximately 200 images per hour can be achieved, compared to approximately 25 images per hour using hard copy evaluation. The results are obtained within minutes of completion of the viewing. The risk of human errors in the process of data collection and analysis is also minimised. The viewer has been used in a major trial containing approximately 2700 images.
32.	Börjesson, Sara, et al. (författare) A software tool for increased efficiency when performing observer performance studies in a digital environment 2004 Ingår i: Second Malmö Conference on Medical X-ray Imaging: Optimisation Strategies in Medical X-ray Imaging, Malmö, Sweden, 23-25 April 2004. Konferensbidrag (övrigt vetenskapligt/konstnärligt)
33.	Castella, Cyril, et al. (författare) Masses detection in breast tomosynthesis and digital mammography: a model observer study 2009 Ingår i: [Host publication title missing]. - : SPIE. ; 7263 Konferensbidrag (refereegranskat)abstract In this study, we adapt and apply model observers within the framework of realistic detection tasks in breast tomosynthesis (BT). We use images consisting of realistic masses digitally embedded in real patient anatomical backgrounds, and we adapt specific model observers that have been previously applied to digital mammography (DM). We design alternative forced-choice experiments (AFC) studies for DM and BT tasks in the signal known exactly but variable (SKEV) framework. We compare performance of various linear model observers (non-prewhitening matched filter with an eye filter, and several channelized Hotelling observers (CHO) against human. A good agreement in performance between human and model observers can be obtained when an appropriate internal noise level is adopted. Models achieve the same detection performance across BT and DM with about three times less projected signal intensity in BT than in DM (humans: 3.8), due to the anatomical noise reduction in BT. We suggest that, in the future, model observers can potentially be used as an objective tool for automating the optimization of BT acquisition parameters or reconstruction algorithms, or narrowing a wide span of possible parameter combinations, without requiring human observers studies.
34.	Costa, Arthur C., et al. (författare) Assessment of projection interpolation to compensate for the increased radiation dose in DBTMI 2023 Ingår i: Medical Imaging 2023 : Physics of Medical Imaging - Physics of Medical Imaging. - 1605-7422. - 9781510660311 ; 12463 Konferensbidrag (refereegranskat)abstract The combination of digital breast tomosynthesis (DBT) with other imaging modalities has been investigated in order to improve the detection and diagnosis of breast cancer. Mechanical Imaging (MI) measures the stress over the surface of the compressed breast, using a pressure sensor, during radiographic examination and its response has shown a correlation with the presence of malignant lesions. Thus, the combination of DBT and MI (DBTMI) has shown potential to reduce false positive results in breast cancer screening. However, compared to the conventional DBT exam, the presence of the MI sensor during mammographic image acquisition may cause a slight increase in the radiation dose. This work presents a proposal to reduce the radiation dose in DBTMI exams by removing some projections from the original set and replacing them with synthetic projections generated by a video frame interpolation (VFI) neural network. We compared several DBTMI acquisition arrangements, considering the removal of 16% of the original projections, using a deformable physical breast phantom, and evaluated the quality of the reconstructed images based on the Normalized Root Mean Squared Error (NRMSE). The results showed that, for some arrangements, the slices reconstructed with the addition of synthetic DBTMI projections presented better quality than when they were reconstructed with the reduced set of projections. Further studies must be carried out to optimize the interpolation approach.
35.	Dahlblom, Victor, et al. (författare) Artificial intelligence detection of missed cancers at digital mammography that were detected at digital breast tomosynthesis 2021 Ingår i: Radiology: Artificial Intelligence. - : Radiological Society of North America (RSNA). - 2638-6100. ; 3:6 Tidskriftsartikel (refereegranskat)abstract Purpose: To investigate how an artificial intelligence (AI) system performs at digital mammography (DM) from a screening population with ground truth defined by digital breast tomosynthesis (DBT), and whether AI could detect breast cancers at DM that had originally only been detected at DBT. Materials and Methods: In this secondary analysis of data from a prospective study, DM examinations from 14 768 women (mean age, 57 years), examined with both DM and DBT with independent double reading in the Malmӧ Breast Tomosynthesis Screening Trial (MBTST) (ClinicalTrials.gov: NCT01091545; data collection, 2010–2015), were analyzed with an AI system. Of 136 screening-detected cancers, 95 cancers were detected at DM and 41 cancers were detected only at DBT. The system identifies suspicious areas in the image, scored 1–100, and provides a risk score of 1 to 10 for the whole examination. A cancer was defined as AI detected if the cancer lesion was correctly localized and scored at least 62 (threshold determined by the AI system developers), therefore resulting in the highest examination risk score of 10. Data were analyzed with descriptive statistics, and detection performance was analyzed with receiver operating characteristics. Results: The highest examination risk score was assigned to 10% (1493 of 14 786) of the examinations. With 90.8% specificity, the AI system detected 75% (71 of 95) of the DM-detected cancers and 44% (18 of 41) of cancers at DM that had originally been detected only at DBT. The majority were invasive cancers (17 of 18). Conclusion: Almost half of the additional DBT-only screening-detected cancers in the MBTST were detected at DM with AI. AI did not reach double reading performance; however, if combined with double reading, AI has the potential to achieve a substantial portion of the benefit of DBT screening.
36.	Dahlblom, Victor, et al. (författare) Breast cancer screening with digital breast tomosynthesis : comparison of different reading strategies implementing artificial intelligence 2023 Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 33:5, s. 3754-3765 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: Digital breast tomosynthesis (DBT) can detect more cancers than the current standard breast screening method, digital mammography (DM); however, it can substantially increase the reading workload and thus hinder implementation in screening. Artificial intelligence (AI) might be a solution. The aim of this study was to retrospectively test different ways of using AI in a screening workflow.METHODS: An AI system was used to analyse 14,772 double-read single-view DBT examinations from a screening trial with paired DM double reading. Three scenarios were studied: if AI can identify normal cases that can be excluded from human reading; if AI can replace the second reader; if AI can replace both readers. The number of detected cancers and false positives was compared with DM or DBT double reading.RESULTS: By excluding normal cases and only reading 50.5% (7460/14,772) of all examinations, 95% (121/127) of the DBT double reading detected cancers could be detected. Compared to DM screening, 27% (26/95) more cancers could be detected (p < 0.001) while keeping recall rates at the same level. With AI replacing the second reader, 95% (120/127) of the DBT double reading detected cancers could be detected-26% (25/95) more than DM screening (p < 0.001)-while increasing recall rates by 53%. AI alone with DBT has a sensitivity similar to DM double reading (p = 0.689).CONCLUSION: AI can open up possibilities for implementing DBT screening and detecting more cancers with the total reading workload unchanged. Considering the potential legal and psychological implications, replacing the second reader with AI would probably be most the feasible approach.KEY POINTS: • Breast cancer screening with digital breast tomosynthesis and artificial intelligence can detect more cancers than mammography screening without increasing screen-reading workload. • Artificial intelligence can either exclude low-risk cases from double reading or replace the second reader. • Retrospective study based on paired mammography and digital breast tomosynthesis screening data.
37.	Dahlblom, Victor, et al. (författare) Correspondence between areas causing recall in breast cancer screening and artificial intelligence findings 2022 Ingår i: 16th International Workshop on Breast Imaging, IWBI 2022. - : SPIE. - 0277-786X .- 1996-756X. - 9781510655843 ; 12286 Konferensbidrag (refereegranskat)abstract False positive recall is a major issue in breast cancer screening and the introduction of artificial intelligence (AI) might affect which women who are unnecessarily recalled. We have investigated how an AI system works on false positive recalls at screening and compared with radiologist findings. Two-view digital mammography (DM) examinations from 656 recalled women (136 with screening detected cancer), were analysed with a commercial AI system. The AI findings were matched with the areas on the images causing the recalls. The agreement was studied both at the examination level and for individual findings. Scores were compared between true positive and false positive recalls. ROC analysis was used to study the AI-system's ability to distinguish between true and false positive recalls. It was also studied how the AI system performed on cases where there were discordant readings. AI identified the same areas as radiologists in 80% of the cases recalled on DM. For true positives both the proportion of matching areas and AI scores were higher than for false positive recalls. The AI system also had a relatively large AUC (0.83) for differentiating between false positive recalls and cancers. Further, the AI system identified most of the findings leading to recall in cases where only one of the readers had marked the case for discussion. There is a relatively large agreement between the AI system and radiologists. The AI system scores the false positives lower than true positives. AI complements a single reader in a way similar to a second reader.
38.	Dahlblom, Victor, et al. (författare) Malmö Breast ImaginG database: objectives and development 2023 Ingår i: Journal of Medical Imaging. - 2329-4302. ; 10:6 Tidskriftsartikel (refereegranskat)abstract PurposeWe describe the design and implementation of the Malmö Breast ImaginG (M-BIG) database, which will support research projects investigating various aspects of current and future breast cancer screening programs. Specifically, M-BIG will provide clinical data to: 1. investigate the effect of breast cancer screening on breast cancer prognosis and mortality; 2. develop and validate the use of artificial intelligence and machine learning in breast image interpretation; and 3. develop and validate image-based radiological breast cancer risk profiles.ApproachThe M-BIG database is intended to include a wide range of digital mammography (DM) and digital breast tomosynthesis (DBT) examinations performed on women at the Mammography Clinic in Malmö, Sweden, from the introduction of DM in 2004 through 2020. Subjects may be included multiple times and for diverse reasons. The image data are linked to extensive clinical, diagnostic, and demographic data from several registries.ResultsTo date, the database contains a total of 451,054 examinations from 104,791 women. During the inclusion period, 95,258 unique women were screened. A total of 19,968 examinations were performed using DBT, whereas the rest used DM.ConclusionsWe describe the design and implementation of the M-BIG database as a representative and accessible medical image database linked to various types of medical data. Work is ongoing to add features and curate the existing data.
39.	Dahlblom, Victor, et al. (författare) Personalised breast cancer screening with selective addition of digital breast tomosynthesis through artificial intelligence 2020 Ingår i: 15th International Workshop on Breast Imaging, IWBI 2020. - : SPIE. - 0277-786X .- 1996-756X. - 9781510638310 ; 11513 Konferensbidrag (refereegranskat)abstract Breast cancer screening is predominantly performed using digital mammography (DM), but higher sensitivity has been demonstrated with digital breast tomosynthesis (DBT). A partial DBT screening in selected groups with a clear benefit from DBT might be more feasible than a full implementation, and using artificial intelligence (AI) to select women for DBT might be a possibility. This study used data from Malmö Breast Tomosynthesis Screening Trial, where all women prospectively were examined with separately read DM and DBT. We retrospectively analysed DM examinations (n=14768) with a breast cancer detection software and used the provided risk score (1-10) for risk stratification. We tested how different score thresholds for adding DBT to an initial DM affects the number of detected cancers, additional DBT examinations needed, detection rate, and false positives. If using a threshold of 9.0, 25 (26 %) more cancers would be detected compared to using DM alone. Of the 41 cancers only detected on DBT, 61 % would be detected, with only 1797 (12 %) of the women examined with both DM and DBT. The detection rate for the added DBT would be 14/1000 women, while the false positive recalls would be increased with 58 (21 %). Using DBT only for selected high gain cases could be an alternative to a complete DBT screening. AI could be used for analysing DM to identify high gain cases, where DBT can be added during the same visit. There might be logistical challenges and further studies in a prospective setting are necessary.
40.	Dahlblom, Victor, et al. (författare) Personalized breast cancer screening with selective addition of digital breast tomosynthesis through artificial intelligence 2023 Ingår i: Journal of Medical Imaging. - 2329-4302. ; 10:Suppl 2 Tidskriftsartikel (refereegranskat)abstract PURPOSE: Breast cancer screening is predominantly performed using digital mammography (DM), but digital breast tomosynthesis (DBT) has higher sensitivity. DBT demands more resources than DM, and it might be more feasible to reserve DBT for women with a clear benefit from the technique. We explore if artificial intelligence (AI) can select women who would benefit from DBT imaging.APPROACH: We used data from Malmö Breast Tomosynthesis Screening Trial, where all women prospectively were examined with separately double read DM and DBT. We retrospectively analyzed DM examinations (n=14768) with a breast cancer detection system and used the provided risk score (1 to 10) for risk stratification. We tested how different score thresholds for adding DBT to an initial DM affects the number of detected cancers, additional DBT examinations needed, detection rate, and false positives.RESULTS: If using a threshold of 9.0, 25 (26%) more cancers would be detected compared to using DM alone. Of the 41 cancers only detected on DBT, 61% would be detected, with only 1797 (12%) of the women examined with both DM and DBT. The detection rate for the added DBT would be 14/1000 women, whereas the false-positive recalls would be increased with 58 (21%).CONCLUSION: Using DBT only for selected high gain cases could be an alternative to complete DBT screening. AI can analyze initial DM images to identify high gain cases where DBT can be added during the same visit. There might be logistical challenges, and further studies in a prospective setting are necessary.
41.	Dustler, Magnus, et al. (författare) A Study of the Feasibility of using slabbing to reduce Tomosynthesis Review Time 2013 Ingår i: Medical Imaging 2013: Image Perception, Observer Performance, And Technology Assessment. - : SPIE. - 0277-786X .- 1996-756X. ; 8673, s. 86731-86731 Konferensbidrag (refereegranskat)abstract This study aimed to investigate whether decreasing the amount of slices in breast tomosynthesis (BT) image volumes reduce reading time. BT slices were combined into so-called slabs, by reconstructing thin slices and merging them into thicker slabs. Sets of slabs where created from 35 clinical BT volumes with malignant or benignant findings and from 50 BT volumes drawn from screening sets (without any prior review). The image sets were reviewed in two separate sessions while the review time was recorded. A total of five experienced radiologists were employed for the image review. Additionally a VGA study was performed to compare slabbed images with the originals in order to ensure that the image quality was not significantly degraded. One set of 27 pathological cases (13 masses and 14 microcalcification clusters) and one of 22 subtle lesions that had been missed on digital mammography but detected on BT were presented to an experienced radiologist and 2 medical physicists who rated the quality of the slabbed versions relative to the originals. The study could find no significant degradation in image quality when using 2 mm slabs instead of 1 mm slices. There was no significant decrease in reading time on clinical cases (P=.133), but on screening images there was a significant decrease of 7.7 +/- 9.6 s from an average level of 32.2 +/- 14.5 s (P<.0001). This suggests that increasing slab thickness can reduce the time radiologists spend studying normal images by 20%.
42.	Dustler, Magnus, et al. (författare) Application of the fractal Perlin noise algorithm for the generation of simulated breast tissue 2015 Ingår i: Medical Imaging 2015: Physics of Medical Imaging. - : SPIE. - 1996-756X .- 0277-786X. ; 9412, s. 94123-94123 Konferensbidrag (refereegranskat)abstract Software breast phantoms are increasingly seeing use in preclinical validation of breast image acquisition systems and image analysis methods. Phantom realism has been proven sufficient for numerous specific validation tasks. A challenge is the generation of suitably realistic small-scale breast structures that could further improve the quality of phantom images. Power law noise follows the noise power characteristics of breast tissue, but may not sufficiently represent certain (e.g., non-Gaussian) properties seen in clinical breast images. The purpose of this work was to investigate the utility of fractal Perlin noise in generating more realistic breast tissue through investigation of its power spectrum and visual characteristics. Perlin noise is an algorithm that creates smoothly varying random structures of an arbitrary frequency. Through the use of a technique known as fractal noise or fractional Brownian motion (fBm), octaves of noise with different frequency are combined to generate coherent noise with a broad frequency range. fBm is controlled by two parameters - lacunarity and persistence - related to the frequency and amplitude of successive octaves, respectively. Average noise power spectra were calculated and beta parameters estimated in sample volumes of fractal Perlin noise with different combinations of lacunarity and persistence. Certain combinations of parameters resulted in noise volumes with beta values between 2 and 3, corresponding to reported measurements in real breast tissue. Different combinations of parameters resulted in different visual appearances. In conclusion, Perlin noise offers a flexible tool for generating breast tissue with realistic properties.
43.	Dustler, Magnus, et al. (författare) Breast compression in mammography: pressure distribution patterns 2012 Ingår i: Acta Radiologica. - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 53:9, s. 973-980 Tidskriftsartikel (refereegranskat)abstract Background: Breast compression is important in mammography in order to improve image quality, better separate tissue components, and reduce absorbed dose to the breast. In this study we use a method to measure and visualize the distribution of pressure over a compressed breast in mammography. Purpose: To measure and describe the pressure distribution over the breast as a result of applied breast compression in mammography. Material and Methods: One hundred and three women aged 40.7-74.3 years (median, 48.9 years) invited for mammographic screening consented to take part in this study. They were subjected to two additional breast compressions of the left breast (standard force and approximately 50% reduction). Pressure images of the compressed breast were obtained using force sensing resistor (FSR) sensors placed underneath the compression plate. Subjects rated their experience of pain on a visual analogue scale (VAS). Results: Four pressure patterns were identified, fitting 81 of the 103 breasts, which were grouped accordingly. The remaining 22 breasts were found to correspond to a combination of any two patterns. Two groups (43 breasts) showed pressure mainly over the juxtathoracic part of the breast, had significantly greater breast thickness (P = 0.003) and had a lower mean pressure over dense tissue (P < 0.0001) than those with more evenly distributed pressure. Reducing compression force increased average breast thickness by 1.8 mm (P < 0.0001). Conclusion: The distribution of pressure differed greatly between breasts. In a large proportion of breasts the compression plate did not provide optimal compression of the breast, the compression force being absorbed in juxtathoracic structures.
44.	Dustler, Magnus, et al. (författare) Can mechanical imaging increase the specificity of mammography screening? 2017 Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 27:8, s. 3217-3225 Tidskriftsartikel (refereegranskat)abstract Objectives: This study aimed to investigate the effects of adding adjunct mechanical imaging to mammography breast screening. We hypothesized that mechanical imaging could detect increased local pressure caused by both malignant and benign breast lesions and that a pressure threshold for malignancy could be established. The impact of this on breast screening was investigated with regard to reductions in recall and biopsy rates. Methods: 155 women recalled from breast screening were included in the study, which was approved by the regional ethical review board (dnr 2013/620). Mechanical imaging readings were acquired of the symptomatic breast. The relative mean pressure on the suspicious area (RMPA) was defined and a threshold for malignancy was established. Results: Biopsy-proven invasive cancers had a median RMPA of 3.0 (interquartile range (IQR) = 3.7), significantly different from biopsy-proven benign at 1.3 (IQR = 1.0) and non-biopsied cases at 1.0 (IQR = 1.3) (P < 0.001). The lowest RMPA for invasive cancer was 1.4, with 23 biopsy-proven benign and 33 non-biopsied cases being below this limit. Had these women not been recalled, recall rates would have been reduced by 36% and biopsy rates by 32%. Conclusions: If implemented in a screening situation, this may substantially lower the number of false positives. Key Points: • Mechanical imaging is used as an adjunct to mammography in breast screening.• A threshold pressure can be established for malignant breast cancer.• Recalls and biopsies can be substantially reduced.
45.	Dustler, Magnus, et al. (författare) The effect of breast density on the performance of deep learning-based breast cancer detection methods for mammography 2020 Ingår i: 15th International Workshop on Breast Imaging, IWBI 2020. - : SPIE. - 1996-756X .- 0277-786X. - 9781510638310 ; 11513 Konferensbidrag (refereegranskat)abstract Mammographic sensitivity in breasts with higher density has been questioned. Higher breast density is also linked to an increased risk for breast cancer. Even though digital breast tomosynthesis (DBT) offers an attractive solution, for varied reasons it has not yet been widely adopted in screening. An alternative could be to boost the performance of standard mammography by using computer-aided detection based on deep learning, but it remains to be proven how such methods are affected by density. A deep-learning based computer-aided detection program was used to score the suspicion of cancer on a scale of 1 to 10. A set of 13838 mammography screening exams were used. All cases had BIRADS density values available. The set included 2304 exams (11 cancers) in BIRADS 1, 5310 (51 cancers) in BIRADS 2, 4844 (73 cancers) in BIRADS 3 and 1223 (22 cancers) in BIRADS 4. A Kruskal-Wallis analysis of variance showed no statistically significant differences between the cancer risk scores of the density categories for cases diagnosed with cancer (P=0.9225). An identical analysis for cases without cancer, showed significant differences between the density categories (P<0.0001). The results suggest that the risk categorization of the deep-learning software is not affected by density, as though some density categories receive higher risk assessments in general, this does not hold for cancer cases, which show uniformly high risk values despite density. This shows the potential for deep-learning to improve screening sensitivity even for women with high density breasts.
46.	Dustler, Magnus, et al. (författare) The Effect of Breast Positioning on Breast Compression in Mammography: a Pressure Distribution Perspective 2012 Ingår i: Medical Imaging 2012: Physics of Medical Imaging. - : SPIE. - 1996-756X .- 0277-786X. ; 8313 Konferensbidrag (refereegranskat)abstract The standard procedure at mammography is to compress the breast in order to improve image quality, better separate tissue components and reduce absorbed dose to the breast. Traditionally, compression guidelines have been based on applied force, rather than actual thickness reduction. Structures such as the pectoral muscle are stiffer than breast tissue and if compressed along with it, as in the MLO-projection, might absorb much of the applied force. This study investigated the difference in compression of breasts before and after they were repositioned to exclude 1 cm of the juxtathoracic part. Twenty-one women were included in the study. The distribution of compression pressure was measured using thin FSR (Force Sensing Resistor) pressure sensors attached to the compression paddle. Breast thickness and compression force were measured by the mammographic device. Compared to standard positioning the repositioned breasts were thinner by 4.4 +/- 2.3 mm (P < 0.001) (from 50.3 mm to 45.9 mm) and had a 12.3 +/- 24.5 cm(2) (P = 0.032) larger area over which pressure was distributed (from 97.6 cm(2) to 109.9 cm(2)), despite less of the breast being included in the projection. This indicates that the inclusion of the pectoral muscle and other juxtathoracic structures in the MLO-projection substantially affects pressure distribution and prevents proper compression of the breast. The results suggest that the exact positioning of the MLO-projection should be carefully evaluated in order to find a balance between breast compression and tissue inclusion.
47.	Fransson, Veronica, et al. (författare) Dose-length-product determination on cone beam computed tomography through experimental measurements and dose-area-product conversion 2021 Ingår i: Medical Imaging 2021 : Physics of Medical Imaging - Physics of Medical Imaging. - : SPIE. - 1605-7422. - 9781510640207 ; 11595 Konferensbidrag (refereegranskat)abstract The dosimetry of cone beam computed tomography (CBCT) is not fully elaborated yet, and some of these systems presents dose-area-product (DAP) values after an examination rather than, as in the case of traditional CT, the doselength- product (DLP). The purpose of this study was to provide a reproducible and straight-forward method for DLP measurements on CBCT, as well as to validate a tool for estimating DLP for a CBCT system in terms of accuracy. A prototype conversion tool for estimating DLP, using the DAP value, was provided by the vendor of a CBCT system which currently display only DAP. The DAP to DLP conversion tool was validated using five protocols for extremity imaging. DLP was measured using a 30 cm ionization chamber and 30 cm long cylindrical PMMA-phantom. DLP, the integrated absorbed dose within the ionization chamber, was measured through central and peripheral measurements in the phantom in order to calculate the weighted DLP, DLPW,CBCT. Comparisons between DLPW,CBCT and estimated DLP, showed that the conversion tool was accurate within 10%, with a mean average error of 6.1% for all measured protocols. The variation between repeated measurements was small, making the method highly reproducible. In conclusion, in this study a simple method for determining DLP on CBCT was presented, and it was validated that the conversion tool can present the delivered dose in terms of DLP with high accuracy. The measured DLP, as well as the DLP estimated by the conversion tool, is suitable for quality control and relative dose comparisons between protocols, but its’ relation to the DLP of CT systems should be investigated further in order to relate to patient dose.
48.	Förnvik, Daniel, et al. (författare) A human observer study for evaluation and optimization of reconstruction methods in breast tomosynthesis using clinical cases 2011 Ingår i: Medical Imaging 2011: Physics of Medical Imaging. - : SPIE. - 0277-786X .- 1996-756X. ; 7961, s. 79615-79615 Konferensbidrag (refereegranskat)abstract In breast tomosynthesis1 (BT) a number of 2D projection images are acquired from different angles along a limited arc. The imaged breast volume is reconstructed from the projection images, providing 3D information. The purpose of the study was to investigate and optimize different reconstruction methods for BT in terms of image quality using human observers viewing clinical cases. Sixty-six cases with suspected masses and calcifications were collected from 55 patients. Four different reconstructions of each image set were evaluated by four observers (two experienced radiologists, two experienced medical physicists): filtered back projection (FBP), iterative adapted FBP (iFBP) and two ML-convex iterative algorithm (MLCI) reconstructions (8 and 10 iterations) that differed in noise level and contrast of clinical details. Representation of masses and microcalcifications was evaluated. The structures were rated according to the overall appearance in a rank-order study. The differently reconstructed images of the same structure were displayed side by side in random order. The observers were forced to rank the order of the different reconstructed images and their proportions at each rank were scored. The results suggest that even though the FBP contains most noise its reconstructions are considered best overall, followed by iFBP, which contains least noise. In both FBP and iFBP methods the sharp borders and mass speculations were better represented than in iterative reconstructions while out-of-plane artifacts were better suppressed in the latter. However, in clinical practice the differences between the reconstructions may be considered negligible.
49.	Förnvik, Daniel, et al. (författare) Breast tomosynthesis: Accuracy of tumor measurement compared with digital mammography and ultrasonography. 2010 Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 51, s. 240-247 Tidskriftsartikel (refereegranskat)abstract Background: Mammographic tumor size measurement can be difficult because breast structures are superimposed onto a two-dimensional (2D) plane, potentially obscuring the tumor outline. Breast tomosynthesis (BT) is a 3D X-ray imaging technique in which low-dose images are acquired over a limited angular range at a total dose comparable to digital mammography (DM). These low-dose images are used to mathematically reconstruct a 3D image volume of the breast, thus reducing the problem of superimposed tissue. Purpose: To investigate whether breast cancer size can be more accurately assessed with breast tomosynthesis than with digital mammography and ultrasonography (US), by reducing the disturbance effect of the projected anatomy. Material and Methods: A prototype BT system was used. The main inclusion criterion for BT examination was subtle but suspicious findings of breast cancer on 2D mammography. Sixty-two women with 73 breast cancers were included. BT, DM, and US sizes were measured independently by experienced radiologists without knowledge of the pathology results, which were used as reference. Results: The tumor outline could be determined in significantly more cases with BT (63) and US (60) than DM (49). BT and US size correlated well with pathology (R=0.86 and R=0.85, respectively), and significantly better than DM size (R=0.71). Accordingly, staging was significantly more accurate with BT than with DM. Conclusion: The study indicates that BT is superior to DM in the assessment of breast tumor size and stage.
50.	Förnvik, Daniel, et al. (författare) No evidence for shedding of circulating tumor cells to the peripheral venous blood as a result of mammographic breast compression. 2013 Ingår i: Breast Cancer Research and Treatment. - : Springer Science and Business Media LLC. - 1573-7217 .- 0167-6806. ; 141:2, s. 187-195 Tidskriftsartikel (refereegranskat)abstract This pilot study aimed to investigate whether mammographic compression procedures might cause shedding of tumor cells into the circulatory system as reflected by circulating tumor cell (CTC) count in peripheral venous blood samples. From March to October 2012, 24 subjects with strong suspicion of breast malignancy were included in the study. Peripheral blood samples were acquired before and after mammography. Enumeration of CTCs in the blood samples was performed using the CellSearch(®) system. The pressure distribution over the tumor-containing breast was measured using thin pressure sensors. The median age was 66.5 years (range, 51-87 years). In 22 of the 24 subjects, breast cancer was subsequently confirmed. The difference between the average mean tumor pressure 6.8 ± 5.3 kPa (range, 1.0-22.5 kPa) and the average mean breast pressure 3.4 ± 1.6 kPa (range, 1.5-7.1 kPa) was statistically significant (p < 0.001), confirming that there was increased pressure over the tumor. The median pathological tumor size was 19 mm (range, 9-30 mm). Four subjects (17 %) were CTC positive before compression and two of these (8 %) were also CTC positive after compression. A total of seven CTCs were isolated with a mean size of 8 × 6 μm(2) (range of the longest diameter, 5-12 μm). The study supports the view that mammography is a safe procedure from the point of view of tumor cell shedding to the peripheral blood.

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