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Journal Article Vedantham, S. However, the breast imaging community recognizes that mammography is not ideal, and in particular is inferior for women with dense breasts. Also, the 2-D projection of a 3-D organ results in tissue superposition contributing to false-positives. The sensitivity of mammography is breast-density dependent. We ideally need 3-D imaging for imaging the 3-D breast.
Also, and importantly, we need to be able to administer intravenous contrast agents for optimal imaging, similar to other organ systems in the body. Dedicated breast CT allows for 3-D imaging of the uncompressed breast.
Almost on the heels of the invention of CT itself, work began on the development of dedicated breast CT. These early breast CT systems were used in clinical trials and the results from comparative performance evaluation of breast CT and mammography for subjects were reported in [Chang et al.
However, the technological limitations at that time stymied clinical translation for decades. Subsequent to the landmark article in [Boone et al. The development of large-area flat-panel detectors with field-of-view sufficient to image the entire breast in each projection enabled development of flat-panel cone-beam breast CT. More recently, the availability of complimentary metal-oxide semiconductor CMOS detectors with lower system noise and finer pixel pitch, combined with the development of x-ray tubes with focal spot dimensions similar to mammography systems, has shown improved spatial resolution and could improve visualization of microcalcifications.
These technological developments promise clinical translation of low-dose cone-beam breast CT. The CdTe-based direct conversion detector technology was previously evaluated and confirmed by simulations and basic experiments on laboratory setups [Kalender et al.
Measurements of dose, technical image quality parameters, and surgical specimens on a pcBCT scanner have been completed. Comparative evaluation of surgical specimens showed that pcBCT outperformed mammography and digital breast tomosynthesis with respect to 3D spatial resolution, detectability of calcifications, and soft tissue delineation. Major barriers to widespread clinical use of BCT relate to radiation dose, imaging of microcalcifications, and adequate coverage of breast tissue near the chest wall.
Adequate chest wall coverage is also technically challenging but recent progress in x-ray tube, detector and table design now enables full breast coverage in the majority of patients.
At this time, BCT has been deemed to be suitable for diagnostic imaging but not yet for screening. Moreover, in diagnostic imaging of the breast the location of the lesion is known and therefore characterization and not detection is by far the primary consideration.
The role of bCT is particularly compelling for diagnostic imaging of the breast because it may replace in part the multiple mammographic views of the breast under vigorous compression.
Other non-screening potential applications of bCT include the assessment of response to neoadjuvant therapy [Vedantham et al. Learning Objectives: To understand the metrics used to evaluate screening and diagnostic imaging To understand the benefits and limitations of current clinical modalities To understand how breast CT can improve over current clinical modalities To note the early attempts to translate breast CT to the clinic in ss To understand the recent developments in low-dose cone-beam breast CT To understand the recent developments in photon-counting breast CT To understand the radiation dose, clinical translation, and recent developments in diagnostic imaging with breast CT Supported in part by NIH grants R21 CA, R01 CA and R01 CA The contents are solely the responsibility of the authors and do not reflect the official views of the NIH or the NCI.
Conflicts of Interest: J.
Reeder and Felson’s Gamuts in Radiology