The myth of the 50‐50 breast

Yaffe, Martin J.; Boone, John M.; Packard, N.; Alonzo-Proulx, Olivier; Huang, Shih‐Yu; Peressotti, Chris; Al-Mayah, Adil; Brock, Kristy K.

doi:10.1118/1.3250863

Cited by 227 publications

(223 citation statements)

References 41 publications

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“…Importantly, ductal epithelium and fibrous attachments to the skin are present within the subcutaneous fat. 29 Hence, including the subcutaneous fat as part of the breast parenchyma while estimating the glandular fraction, 30 and use of this glandular fraction with the skin layer comprising the epidermis and the dermis would provide a more conservative estimate of radiation risk.…”

Section: Discussionmentioning

confidence: 99%

Technical Note: Skin thickness measurements using high‐resolution flat‐panel cone‐beam dedicated breast CTa)

Shi¹,

Vedantham²,

Karellas³

et al. 2013

Medical Physics

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Purpose: To determine the mean and range of location-averaged breast skin thickness using highresolution dedicated breast CT for use in Monte Carlo-based estimation of normalized glandular dose coefficients. Methods: This study retrospectively analyzed image data from a clinical study investigating dedicated breast CT. An algorithm similar to that described by Huang et al. ["The effect of skin thickness determined using breast CT on mammographic dosimetry," Med. Phys. 35(4), 1199-1206 (2008)] was used to determine the skin thickness in 137 dedicated breast CT volumes from 136 women. The location-averaged mean breast skin thickness for each breast was estimated and the study population mean and range were determined. Pathology results were available for 132 women, and were used to investigate if the distribution of location-averaged mean breast skin thickness varied with pathology. The effect of surface fitting to account for breast curvature was also studied. Results: The study mean (± interbreast SD) for breast skin thickness was 1.44 ± 0.25 mm (range: 0.87-2.34 mm), which was in excellent agreement with Huang et al. Based on pathology, pair-wise statistical analysis (Mann-Whitney test) indicated that at the 0.05 significance level, there were no significant difference in the location-averaged mean breast skin thickness distributions between the groups: benign vs malignant (p = 0.223), benign vs hyperplasia (p = 0.651), hyperplasia vs malignant (p = 0.229), and malignant vs nonmalignant (p = 0.172). Conclusions: Considering this study used a different clinical prototype system, and the study participants were from a different geographical location, the observed agreement between the two studies suggests that the choice of 1.45 mm thick skin layer comprising the epidermis and the dermis for breast dosimetry is appropriate. While some benign and malignant conditions could cause skin thickening, in this study cohort the location-averaged mean breast skin thickness distributions did not differ significantly with pathology. The study also underscored the importance of considering breast curvature in estimating breast skin thickness.

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Section: Discussionmentioning

confidence: 99%

Technical Note: Skin thickness measurements using high‐resolution flat‐panel cone‐beam dedicated breast CTa)

Shi¹,

Vedantham²,

Karellas³

et al. 2013

Medical Physics

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“…23 This is a reasonable assumption as it has been shown that scatter varies minimally with glandular fraction. 21 Since it is known that x-ray scatter varies slowly over the detector, a pixel pitch of 0.7 mm was used in the MC simulations to decrease the simulation time by reducing the noise in the results.…”

Section: B X-ray Scatter Map Librarymentioning

confidence: 99%

X‐ray scatter correction in breast tomosynthesis with a precomputed scatter map library

et al. 2014

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Purpose: To develop and evaluate the impact on lesion conspicuity of a software-based x-ray scatter correction algorithm for digital breast tomosynthesis (DBT) imaging into which a precomputed library of x-ray scatter maps is incorporated. Methods: A previously developed model of compressed breast shapes undergoing mammography based on principal component analysis (PCA) was used to assemble 540 simulated breast volumes, of different shapes and sizes, undergoing DBT. A Monte Carlo (MC) simulation was used to generate the cranio-caudal (CC) view DBT x-ray scatter maps of these volumes, which were then assembled into a library. This library was incorporated into a previously developed software-based x-ray scatter correction, and the performance of this improved algorithm was evaluated with an observer study of 40 patient cases previously classified as BI-RADS R 4 or 5, evenly divided between mass and microcalcification cases. Observers were presented with both the original images and the scatter corrected (SC) images side by side and asked to indicate their preference, on a scale from −5 to +5, in terms of lesion conspicuity and quality of diagnostic features. Scores were normalized such that a negative score indicates a preference for the original images, and a positive score indicates a preference for the SC images. Results: The scatter map library removes the time-intensive MC simulation from the application of the scatter correction algorithm. While only one in four observers preferred the SC DBT images as a whole (combined mean score = 0.169 ± 0.37, p > 0.39), all observers exhibited a preference for the SC images when the lesion examined was a mass (1.06 ± 0.45, p < 0.0001). When the lesion examined consisted of microcalcification clusters, the observers exhibited a preference for the uncorrected images (−0.725 ± 0.51, p < 0.009). Conclusions:The incorporation of the x-ray scatter map library into the scatter correction algorithm improves the efficiency of the algorithm. The observer study presented here is also the first test of the scatter correction algorithm with patient images and human observers, and demonstrates its potential to improve the clinical performance of DBT.

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“…The study also showed (78) that the MGD from FFDM and DBT for a single view increased with increasing breast thickness and was used to construct the plots for 50% and 14.3% fibroglandular breasts in Figure 2a. A 50% fibroglandular breast corresponds to the assumed average breast composition used in United States protocol and a 14.3% fibroglandular breast corresponds to approximately average realistic composition reported in recent studies (79)(80)(81)(82). It is relevant to note that the estimated MGD is with automatic exposure control, and for the desired image quality, the technique factors and consequently the MGD can be chosen.…”

Section: Radiation Dosementioning

confidence: 99%

Digital Breast Tomosynthesis: State of the Art

et al. 2015

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This topical review on digital breast tomosynthesis (DBT) is provided with the intent of describing the state of the art in terms of technology, results from recent clinical studies, advanced applications, and ongoing efforts to develop multimodality imaging systems that include DBT. Particular emphasis is placed on clinical studies. The observations of increase in cancer detection rates, particularly for invasive cancers, and the reduction in false-positive rates with DBT in prospective trials indicate its benefit for breast cancer screening. Retrospective multireader multicase studies show either noninferiority or superiority of DBT compared with mammography. Methods to curtail radiation dose are of importance

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The myth of the 50‐50 breast

Abstract: Based on the results obtained from the four groups of women in our study, the "50-50" breast is not a representative model of the breast composition.

Cited by 227 publications

References 41 publications

Technical Note: Skin thickness measurements using high‐resolution flat‐panel cone‐beam dedicated breast CTa)

Technical Note: Skin thickness measurements using high‐resolution flat‐panel cone‐beam dedicated breast CTa)

X‐ray scatter correction in breast tomosynthesis with a precomputed scatter map library

Digital Breast Tomosynthesis: State of the Art

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