It is commonly understood that scattered radiation in x-ray computed tomography (CT) degrades the reconstructed image. As a precursor to developing scatter compensation methods, it is important to characterize this scatter using both empirical measurements and Monte Carlo simulations. Previous studies characterizing scatter using both experimental measurements and Monte Carlo simulations have been reported in diagnostic radiology and conventional mammography. The emerging technology of cone-beam CT breast imaging (CTBI) differs significantly from conventional mammography in the breast shape and imaging geometry, aspects that are important factors impacting the measured scatter. This study used a bench-top cone-beam CTBI system with an indirect flat-panel detector. A cylindrical phantom with equivalent composition of 50% fibroglandular and 50% adipose tissues was used, and scatter distributions were measured by beam stop and aperture methods. The GEANT4-based simulation package GATE was used to model x-ray photon interactions in the phantom and detector. Scatter to primary ratio (SPR) measurements using both the beam stop and aperture methods were consistent within 5% after subtraction of nonbreast scatter contributions and agree with the low energy electromagnetic model simulation in GATE. The validated simulation model was used to characterize the SPR in different CTBI conditions. In addition, a realistic, digital breast phantom was simulated to determine the characteristics of various scatter components that cannot be separated in measurements. The simulation showed that the scatter distribution from multiple Compton and Rayleigh scatterings, as well as from the single Compton scattering, has predominantly low-frequency characteristics. The single Rayleigh scatter was observed to be the primary contribution to the spatially variant scatter component.

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