Purpose: Physical phantoms are central to the evaluation of 2D and 3D breast-imaging systems. Currently, available physical phantoms have limitations including unrealistic uniform background structure, large expense, or excessive fabrication time. The purpose of this work is to outline a method for rapidly creating realistic, inexpensive physical anthropomorphic phantoms for use in fullfield digital mammography (FFDM) and digital breast tomosynthesis (DBT). Methods: The phantom was first modeled using analytical expressions and then discretized into voxels of a specified size. The interior of the breast was divided into glandular and adipose tissue classes using Voronoi segmentation, and additional structures like blood vessels, chest muscle, and ligaments were added. The physical phantom was then fabricated from the virtual model in a slice by slice fashion through inkjet printing, using parchment paper and a radiopaque ink containing 33% (I 33% ) or 25% (I 25% ) iohexol by volume. Three types of parchment paper (P1, P2, and P3) were examined. The phantom materials were characterized in terms of their effective linear attenuation coefficients (l eff ) using full-field digital mammography (FFDM) and their energy-dependent linear attenuation coefficients (l(E)) using a spectroscopic energy discriminating detector system. The printing method was further validated on the basis of accuracy, print consistency, and the reproducibility of ink batches. Results: The l eff of two types of parchment paper were close to that of adipose tissue, with l eff = 0.61 AE 0.05 cm À1 for P1, 0.61 AE 0.04 cm À1 for P2, and 0.57 AE 0.03 cm À1 for adipose tissue. The addition of the iodinated ink increased the effective attenuation to that of glandular tissue, with l eff = 0.89 AE 0.06 cm À1 for P1 + I 25% and 0.94 AE 0.06 cm À1 for P1 + I 33% compared to 0.90 AE 0.03 cm À1 for glandular tissue. Spectroscopic measurements showed a good match between the parchment paper and reference values for adipose and glandular tissues across photon energies. Good accuracy was found between the model and the printed phantom by comparing a FFDM of the virtual model simulated through Monte Carlo with a real FFDM of the fully printed phantom. High consistency was found over multiple prints, with 3% variability in mean ink signal across various samples. Reproducibility of ink consistency was very high with <1% variation signal from multiple batches of ink. Imaging of the phantom using FFDM and DBT systems showed promising utility for 2D and 3D imaging. Conclusions: A novel, realistic breast phantom can be created using an analytically defined breast model and readily available materials. The work provides a method to fabricate any virtual phantom in a manner that is accurate, inexpensive, easily accessible, and can be made with different materials or breast models.

Purpose Digital breast tomosynthesis (DBT) is a limited‐angle tomographic breast imaging modality that can be used for breast cancer screening in conjunction with full‐field digital mammography (FFDM) or synthetic mammography (SM). Currently, there are five commercial DBT systems that have been approved by the U.S. FDA for breast cancer screening, all varying greatly in design and imaging protocol. Because the systems are different in technical specifications, there is a need for a quantitative approach for assessing them. In this study, the DBT systems are assessed using a novel methodology with an inkjet‐printed anthropomorphic phantom and four alternative forced choice (4AFC) study scheme. Method A breast phantom was fabricated using inkjet printing and parchment paper. The phantom contained 5‐mm spiculated masses fabricated with potassium iodide (KI)‐doped ink and microcalcifications (MCs) made with calcium hydroxyapatite. Images of the phantom were acquired on all five systems with DBT, FFDM, and SM modalities where available using beam settings under automatic exposure control. A 4AFC study was conducted to assess reader performance with each signal under each modality. Statistical analysis was performed on the data to determine proportion correct (PC), standard deviations, and levels of significance. Results For masses, overall detection was highest with DBT. The difference in PC was statistically significant between DBT and SM for most systems. A relationship was observed between increasing PC and greater gantry span. For MCs, performance was highest with DBT and FFDM compared to SM. The difference between PC of DBT and PC of SM was statistically significant for all manufacturers. Conclusions This methodology represents a novel approach for evaluating systems. This study is the first of its kind to use an inkjet‐printed anthropomorphic phantom with realistic signals to assess performance of clinical DBT imaging systems.

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