Optimized signal of calcifications in wide-angle digital breast tomosynthesis systems: a virtual clinical study

PURPOSE: To investigate differences in microcalcification detection performance for different acquisition setups in digital breast tomosynthesis (DBT), a convex dose distribution and sparser number of projections compared to the standard set-up was evaluated via a virtual clinical trial (VCT). METHODS AND MATERIALS: Following the Institutional Review Board (IRB) approval and patient consent, mediolateral oblique (MLO) DBT views were acquired at twice the automatic exposure controlled (AEC) dose level; omitting the craniocaudal (CC) view limited the total examination dose. Microcalcification clusters were simulated into the DBT projections and noise was added to simulate lower dose levels. Three set-ups were evaluated: (1) 25 DBT projections acquired with a fixed dose/projection at the clinically used AEC dose level, (2) 25 DBT projections with dose/projection following a convex dose distribution along the scan arc, and (3) 13 DBT projections at higher dose with the total scan dose equal to the AEC dose level and preserving the angular range of 50° (sparse). For the convex set-up, dose/projection started at 0.035 mGy at the extremes and increased to 0.163 mGy for the central projection. A Siemens prototype algorithm was used for reconstruction. An alternative free-response receiver operating characteristic (AFROC) study was conducted with 6 readers to compare the microcalcification detection between the acquisition set-ups. Sixty cropped VOIs of 50x50x(breast thickness) mm3 per set-up were included, of which 50% contained a microcalcification cluster. In addition to localization of the cluster, the readers were asked to count the individual calcifications. The area under the AFROC curve was used to compare the different acquisition set-ups and a paired t-test was used to test significance. RESULTS: The AUCs for the standard, convex and sparse set-up were 0.97±0.01, 0.95±0.02 and 0.89±0.03, respectively, indicating no significant difference between standard and convex set-up (p=0.309), but a significant decrease in detectability was found for the sparse set-up (p=0.001). The number of detected calcifications per cluster was not significantly different between standard and convex set-ups (p=0.049), with 42%±9% and 40%±8%, respectively. The sparse set-up scored lower with a relative number of detected microcalcifications of 34%±11%, but this decrease was not significant (p=0.031). CONCLUSION: A convex dose distribution that increased dose along the scan arc towards the central projections did not increase detectability of microcalcifications in the DBT planes compared to the current AEC set-up. Conversely, a sparse set of projections acquired over the total scan arc decreased microcalcification detectability compared to the variable dose and current clinical set-up.