Evaluation of a Dedicated SPECT-CT Mammotomography System for Quantitative Hybrid Breast Imaging

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The overall goal of this dissertation is to optimize and evaluate the performance of the single photon emission computed tomography (SPECT) subsystem of a dedicated three-dimensional (3D) dual-modality breast imaging system for enhanced semi-automated, quantitative clinical imaging. This novel hybrid imaging system combines functional or molecular information obtained with a SPECT subsystem with high-resolution anatomical imaging obtained with a low dose x-ray Computed Tomography (CT) subsystem. In this new breast imaging paradigm, coined "mammotomography," the subject is imaged lying prone while the individual subsystems sweep 3-dimensionally about her uncompressed, pendant breast, providing patient comfort compared to traditional compression-based imaging modalities along with high fidelity and information rich images for the clinician.

System evaluation includes a direct comparison between dedicated 3D SPECT and dedicated 2D scintimammography imaging using the same high performance, semi-conductor gamma camera. Due to the greater positioning flexibility of the SPECT system gantry, under a wide range of measurement conditions, statistically significantly (p<0.05) more lesions and smaller lesion sizes were detected with dedicated breast SPECT than with compressed breast scintimammography. The importance of good energy resolution for uncompressed SPECT breast imaging was also investigated. Results clearly illustrate both visual and quantitative differences between the various energy windows, with energy windows slightly wider than the system resolution having the best image contrast and quality.

An observer-based contrast-detail study was performed in an effort to evaluate the limits of object detectability under various imaging conditions. The smallest object detail was observed using a 45-degree tilted trajectory acquisition. The complex 3D projected sine wave acquisition, however, had the most consistent combined intra and inter-observer results, making it potentially the best imaging approach for consistent clinical imaging.

Automatic ROR contouring is implemented using a dual-layer light curtain design, ensuring that an arbitrarily shaped breast is within ~1 cm of the camera face, but no closer than 0.5 cm at every projection angle of a scan. Autocontouring enables simplified routine scanning using complex 3D trajectories, and yields improved image quality. Absolute quantification capabilities are also integrated into the SPECT system, allowing the calculation of in vivo total lesion activity. Initial feasibility studies in controlled low noise experiments show promising results with total activity agreement within 10% of the dose calibrator values.

The SPECT system is integrated with a CT scanner for added diagnostic power. Initial human subject studies demonstrate the clinical potential of the hybrid SPECT-CT breast imaging system. The reconstructed SPECT-CT images illustrate the power of fusing functional SPECT information to localize lesions not easily seen in the anatomical CT images. Enhanced quantitative 3D SPECT-CT breast imaging, now with the ability to dynamically contour any sized breast, has high potential to improve detection, diagnosis, and characterization of breast cancer in upcoming larger-scale clinical testing.





Cutler, Spencer Johnson (2010). Evaluation of a Dedicated SPECT-CT Mammotomography System for Quantitative Hybrid Breast Imaging. Dissertation, Duke University. Retrieved from https://hdl.handle.net/10161/3096.


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