Screening for breast cancer with mammography has been very successful, resulting in part to a reduction of breast cancer mortality by approximately 39% since 1990. However, mammography still has limitations in performance, especially for women with dense breast tissue. Iodinated contrast-enhanced, dedicated breast CT (BCT) has been proposed to improve lesion analysis and the accuracy of diagnostic workup for patients suspected of having breast cancer. A mathematical analysis to explore the use of various x-ray filters for iodinated contrast-enhanced BCT is presented. To assess task-based performance, the ideal linear observer signal-to-noise ratio (SNR) is used as a figure-of-merit under the assumptions of a linear, shift-invariant imaging system. To estimate signal and noise propagation through the BCT detector, a parallel-cascade model was used. The lesion model was embedded into a structured background and included a realistic level of iodine uptake. SNR was computed for 84,000 different exposure settings by varying the kV setting, x-ray filter materials and thickness, breast size, and composition and radiation dose. It is shown that some x-ray filter material/thickness combinations can provide up to 75% improvement in the linear ideal observer SNR over a conventionally used x-ray filter for BCT. This improvement in SNR can be traded off for substantial reductions in mean glandular dose.
Keywords: breast CT; iodine contrast agent; parallel-cascade model.