Breast tomosynthesis with monochromatic beams: a feasibility study using Monte Carlo simulations

The aim of this study is to investigate the impact on image quality of using monochromatic beams for lower dose breast tomosynthesis (BT). For this purpose, modeling and simulation of BT and mammography imaging processes have been performed using two x-ray beams: one at 28 kVp and a monochromatic one at 19 keV at different entrance surface air kerma ranging between 0.16 and 5.5 mGy. Two 4 cm thick computational breast models, in a compressed state, were used: one simple homogeneous and one heterogeneous based on CT breast images, with compositions of 50% glandular-50% adipose and 40% glandular-60% adipose tissues by weight, respectively. Modeled lesions, representing masses and calcifications, were inserted within these breast phantoms. X-ray transport in the breast models was simulated with previously developed and validated Monte Carlo application. Results showed that, for the same incident photon fluence, the use of the monochromatic beam in BT resulted in higher image quality compared to the one using polychromatic acquisition, especially in terms of contrast. For the homogenous phantom, the improvement ranged between 15% and 22% for calcifications and masses, respectively, while for the heterogeneous one this improvement was in the order of 33% for the masses and 17% for the calcifications. For different exposures, comparable image quality in terms of signal-difference-to-noise ratio and higher contrast for all features was obtained when using a monochromatic 19 keV beam at a lower mean glandular dose, compared to the polychromatic one. Monochromatic images also provide better detail and, in combination with BT, can lead to substantial improvement in visualization of features, and particularly better edge detection of low-contrast masses.