Image quality comparison of synthesized two-dimensional images and digital mammography in breast tomosynthesis: A...

Breast cancer remains a leading cause of cancer-related morbidity and mortality worldwide. Early detection of breast cancer using high-quality mammography is essential for improving prognosis and treatment outcomes. Digital breast tomosynthesis with synthesized two-dimensional mammography (SM) reduces dose and tissue overlap; however, its comprehensive physical evaluations remain limited.

This study quantitatively compared the image quality of conventional digital mammography (DM) and SM acquired using the AMULET Innovality System.

Polymethyl methacrylate, American College of Radiology, and contrast-detail (CD) mammography phantoms were imaged 10 times in both DM and SM modes. Image quality metrics, including signal-to-noise ratio (SNR) maps, noise power spectrum (NPS), contrast-to-noise ratio (CNR), modulation transfer function (MTF), and CD curves, were evaluated.

DM demonstrated higher SNR uniformity and suppressed low- and high-frequency noise, and the CNR values were 1.3-2 times greater than those of SM across all object sizes. MTF analysis showed superior resolution in DM (MTF(f50), 4.0 cycles/mm) compared with that of the SM (2.5 cycles/mm). CD curve analysis confirmed the better detectability of fine structures in DM, with $IQ{F}_{inv}$ values of 134.9 for DM and 56.7 for SM.

Quantitative phantom-based evaluation demonstrated that DM showed superior performance to SM in several physical image quality metrics, including SNR uniformity, noise characteristics, spatial resolution, and contrast-detail detectability. These findings indicate systematic differences in physical image quality between DM and SM; however, further observer and clinical studies are required to clarify how these differences translate to diagnostic performance in clinical practice.