Evaluating attenuation correction strategies in a dedicated, single-gantry breast PET-tomosynthesis scanner

We are developing a dedicated, combined breast positron emission tomography (PET)-tomosynthesis scanner. Both the PET and digital breast tomosynthesis (DBT) scanners are integrated in a single gantry to provide spatially co-registered 3D PET-tomosynthesis images. The DBT image will be used to identify the breast boundary and breast density to improve the quantitative accuracy of the PET image. This paper explores PET attenuation correction (AC) strategies that can be performed with the combined breast PET-DBT scanner to obtain more accurate, quantitative high-resolution 3D PET images. The PET detector is comprised of a 32 × 32 array of 1.5 × 1.5 × 15 mm³ LYSO crystals. The PET scanner utilizes two detector heads separated by either 9 or 11 cm, with each detector head having a 4 × 2 arrangement of PET detectors. GEANT4 Application for Tomographic Emission simulations were performed using an anthropomorphic breast phantom with heterogeneous attenuation under clinical DBT-compression. FDG-avid lesions, each 5 mm in diameter with 8:1 uptake, were simulated at four locations within the breast. Simulations were performed with a scan time of 2 min. PET AC was performed using the actual breast simulation model as well as DBT reconstructed volumetric images to derive the breast outline. In addition to using the known breast density as defined by the breast model, we also modeled it as uniform patient-independent soft-tissue, and as a uniform patient-specific material derived from breast tissue composition. Measured absolute lesion uptake was used to evaluate the quantitative accuracy of performing AC using the various strategies. This study demonstrates that AC is necessary to obtain a closer estimate of the true lesion uptake and background activity in the breast. The DBT image dataset assists in measuring lesion uptake with low bias by facilitating accurate breast delineation as well as providing accurate information related to the breast tissue composition. While both the uniform soft-tissue and patient-specific material approaches provides a close estimate to the ground truth, <5% bias can be achieved by using a uniform patient-specific material to define the attenuation map.