On image quality metrics and the usefulness of grids in digital mammography

Antiscatter grids are used in digital mammography to reduce the scattered radiation from the breast and improve image contrast. They are, however, imperfect and lead to partial absorption of primary radiation, as well as failing to absorb all scattered radiation. Nevertheless, the general consensus has been that antiscatter grids improve image quality for the majority of breast types and sizes. There is, however, inconsistency in the literature, and recent results show that a substantial image quality improvement can be achieved even for thick breasts if the grid is disposed of. The purpose of this study was to investigate if differences in the considered imaging task and experimental setup could explain the different outcomes. We estimated the dose reduction that can be achieved if the grid were to be removed as a function of breast thickness with varying geometries and experimental conditions. Image quality was quantified by the signal-difference-to-noise ratio (SDNR) measured using an aluminum (Al) filter on blocks of poly(methyl methacrylate) (PMMA), and images were acquired with and without grid at a constant exposure. We also used a theoretical model validated with Monte Carlo simulations. Both theoretically and experimentally, the main finding was that when a large [Formula: see text] Al filter was used, the SDNR values for the gridless images were overestimated up to 25% compared to the values for the small [Formula: see text] filter, and gridless imaging was superior for any PMMA thickness. For the small Al filter, gridless imaging was only superior for PMMAs thinner than 4 cm. This discrepancy can be explained by a different sensitivity to and sampling of the angular scatter spread function, depending on the size of the contrast object. The experimental differences were eliminated either by using a smaller region of interest close to the edge of the large filter or by applying a technique of scatter correction by subtracting the estimated scatter image. These results explain the different conclusions reported in the literature and show the importance of the selection of measurement methods. Since the interesting structures in mammography are below the 1-cm scale, we advocate the use of smaller contrast objects for assessment of antiscatter grid performance.