Results in Physics 7 (2017) 1634–1636

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Results in Physics
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Application of a dual energy X-ray imaging method on breast specimen

V. Koukou a, N. Martini a, G. Fountos b,⇑, C. Michail b, A. Bakas c, G. Oikonomou c, I. Kandarakis b,
G. Nikiforidis a
a
Department of Medical Physics, Faculty of Medicine, University of Patras, 265 00 Patras, Greece
b
Radiation Physics, Materials Technology and Biomedical Imaging Laboratory, Department of Biomedical Engineering, Technological Educational Institute of Athens, Egaleo,
122 10 Athens, Greece
c
Department of Radiology & Radiation Therapy, Faculty of Health and Caring Professions, Technological Educational Institution of Athens, 122 10 Athens, Greece

a r t i c l e i n f o a b s t r a c t

Article history: The purpose of this study was to evaluate a dual energy method, developed by our group, on a breast can-
Received 18 February 2017 cer specimen. A modified radiographic X-ray tube combined with a high resolution complementary
Received in revised form 25 April 2017 metal-oxide semiconductor (CMOS) active pixel sensor (APS) X-ray detector was used. A 40/70 kV spec-
Accepted 27 April 2017
tral combination was filtered with 100 lm cadmium (Cd) and 1000 lm copper (Cu) for the low/high-
Available online 4 May 2017
energy combination. Dual energy images were obtained from a formalin-fixed breast cancer specimen
for various entrance surface doses (ESD). Initial results showed that the DE images were directly compa-
Keywords:
rable with the mammographic image and similar or even increased calcification information was identi-
Dual energy
Calcifications
fied, with mean glandular dose values at acceptable levels.
X-rays Ó 2017 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://
CMOS creativecommons.org/licenses/by/4.0/).

Introduction
Mammography is an important tool for breast carcinoma detec-
tion in early stages. Masses, areas of distortion, and calcifications
that cannot be detected by physical examination can be visible
on mammograms [1]. Calcifications are an exceptionally significant
diagnostic feature as it may be the only marker indicating breast
malignancy [1,2]. Although mammography can detect the afore-
mentioned distortions, their detection may be obscured by over-
lapping tissue structures. Dual energy technique suppresses the
contrast between adipose and glandular tissues revealing patho-
genesis not present in screening mammography [3]. In a previous
experimental dual energy (DE) method of our group, a calcification
thickness of 152 lm was visible, with mean glandular doses (MGD)
ranging from 1.62 to 2.39 mGy [4]. In this work, further evaluation
of our DE method on a breast cancer specimen is presented.
Methods: The Del Medical Eureka radiographic system was
used with tungsten (W) anode and nominal inherent filtration of
3 mm aluminum (Al) [4]. The added filtration was 100 lm Cd (Alfa
Aesar 11371, 99.9975%) at 40 kV and 1000 lm Cu (PTW 99.99%) at
70 kV for the low- and high-energy spectra, respectively [5]. The
used detection system consisted of a Gd2O2S:Tb phosphor screen
(Min-R 2190 with mass thickness of 33.91 mg/cm2) coupled to
an optical readout device including a CMOS Remote RadEye HR
⇑ Corresponding author.
E-mail address: gfoun@teiath.gr (G. Fountos).
[6] photodiode pixel array. The CMOS photodiode array has a for-
mat of 1200  1600 pixels with a pixel pitch of 22.5 lm, corre-
sponding to a total active area of 27 mm  36 mm. The source-
to-detector distance (SDD) was set at 66 cm and no antiscatter grid
was used during image acquisitions. A formalin-fixed human
breast cancer specimen, which was obtained for routine biopsy
processing for histology was irradiated. The total thickness of the
specimen and the formalin compound was approximately 4 cm.
Weighted log-subtraction was used to generate the DE subtraction
images [4]. For each pair of low- and high-energy images, a num-
ber of DE images was generated for all weighting factors in the
range of 0 to 1, at 0.1 intervals. The standard deviation (r) of var-
ious background regions was calculated using a custom-developed
algorithm. The minimum r was achieved by a weighting factor of
0.6. The DE images were compared to the acquired routine digital
mammographic image (Hologic Lorad Selenia: amorphous sele-
nium thin film transistor (a-Se TFT) image receptor with a pixel
pitch of 70 lm, W anode and 60 lm rhodium-Rh filter) of the spec-
imen. Evaluation was performed by an experienced radiologist for
a visual assessment of the proposed dual energy method over real-
istic tissue structures. Calcification information within two
regions-of-interest (ROIs) in both digital radiography and DE
images was examined. The specimen was irradiated with four dif-
ferent total entrance surface doses (ESD): 3.25, 3.06, 2.11 and
1.92 mGy, corresponding to MGD values of 2.39, 2.27, 1.74 and
1.62 mGy respectively [4]. The MGD of the mammographic image
was 0.53 mGy, calculated following a previously described method
of our group, using the ESD [5].

http://dx.doi.org/10.1016/j.rinp.2017.04.034
2211-3797/Ó 2017 The Authors. Published by Elsevier B.V.
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
 V. Koukou et al. / Results in Physics 7 (2017) 1634–1636 1635

Fig. 1. Images of the first ROI of the breast specimen (a) mammographic image and (b–e) the DE images for all MGDs.

Fig. 2. Images of the second ROI of the breast specimen (a) mammographic image and (b–e) the DE images for all MGDs.
1636 V. Koukou et al. / Results in Physics 7 (2017) 1634–1636
Results and conclusions: Two ROIs with sizes of 401  361 and
401  501 pixels were selected and are shown in Figs. 1 and 2,
respectively. Calcifications with sizes ranging from approximately
150–1000 lm were visible in the DE images. Fig. 1 shows a cluster
of calcifications in the mammographic and DE images. The cluster
shown in the mammographic image (Fig. 1(a)) can be observed in
the DE images obtained with MGD of 1.74–2.39 mGy (Fig. 1(b–d)),
except from the image resulted from the lowest MGD of 1.62 mGy
where is barely visible (Fig. 1(e)). As it was expected, the calcifica-
tions are better defined in the DE images obtained by higher ESD
values. In Fig. 2(a) (mammography), the rectangular corresponds
to the area shown in the DE images (Fig. 2(b–e)). The cluster in
the DE images can be observed, as well as, in the mammographic
image. Similarly, when the ESD decreases the calcifications’ mar-
gins are less defined. These initial results showed that the images
were directly comparable and similar or even increased calcifica-
tion information was identified. The MGD ranged from 1.62 to
2.39 mGy, which falls within acceptable levels (below 3 mGy). Fur-
ther work includes an extensive evaluation on a larger number of
breast specimens, in order to increase the accuracy of the proposed
DE method. Moreover, a CMOS APS X-ray detector with larger
dimensions and advanced characteristics will be used [6].
Acknowledgement
This work was supported by Grant Ε.040 from the Research
Committee of the University of Patras (Programme K.
Karatheodori).
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