Phantom-based comparative analysis of contrast-enhanced mammography systems: Image quality and performance evaluation

Contrast-enhanced mammography (CEM) is a technique that exploits the combination of two projections at different energies to produce an energy-subtracted (ES) image to highlight the uptake of iodinated contrast medium in breast lesions. The aim of this study is to analyze and compare the performance of different CEM systems.

Four mammography systems of different vendors (Fujifilm Amulet Innovality, Hologic 3Dimensions, IMS Giotto Class, GE Senographe Pristina) were compared employing a commercial dedicated phantom, equipped with a breast-equivalent target slab with four different iodine concentrations (IC) inserts. Acquisition parameters and average glandular dose (AGD) were collected at different phantom thicknesses (30-80 mm). Contrast-to-noise ratio (CNR) and linearity of IC response with phantom thickness were evaluated.

AGDs (mGy) were in ranges 0.82-3.10, 0.90-6.25, 1.08-3.30, and 0.74-3.63 for Fujifilm, Hologic, GE, and IMS, respectively. High-energy AGD accounted for up to 41.5%, 25.6%, 40.5%, and 23.8% of the total dose for Fujifilm, Hologic, IMS, and GE, respectively. CNR increased with IC and generally decreased with increasing phantom thickness. In recombined images, Hologic, Fujifilm, and GE showed good linearity of IC response with phantom thickness and overlapping trends (maximum error = 1%) for all thicknesses.

Similarities and differences in image quality and dose were found depending on the different technical and image processing characteristics of the different vendors. Linearity of IC at various thicknesses might be further exploited in clinical scenarios to differentiate between suspicious breast lesions.