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Quantification of Al-equivalent thickness of just visible microcalcifications in full field digital mammograms.

Characterization of digital mammography systems is often performed by means of contrast-detail curves using a homogeneous phantom with inserts of different sizes and thicknesses. In this article, a more direct measure of the threshold contrast-detail characteristics of microcalcifications in clinical mammograms is proposed, which also takes into account routine processing and display. The proposed method scores the detectability of simulated microcalcifications with known size and aluminum-equivalent thickness. Thickness estimates, based on x-ray transmission coefficients, were first validated for Al particles. The same approach was then applied to associate Al-equivalent thickness with simulated microcalcifications. Thirty-five mammograms of patients were acquired using a full field digital mammography (FFDM) system operating under standard exposure conditions. Different microcalcifications were simulated using templates of real microcalcifications as described in Med. Phys. 30, 2234-2240 (2003). These templates were first modified such that they simulated a template of the same microcalcification for an ideally sharp detector. They were then adjusted for the imaging characteristics of the FFDM, beam quality, and breast thickness. Microcalcification sizes in the image plane ranged from 200 to 800 microm. Their peak Al-equivalent thickness varied between 70 and 1000 microm. Software phantoms were created. They consisted of 0-10 simulated microcalcifications randomly distributed in 2 cm by 2 cm frames embedded within digital mammograms. Routine processing and printing followed. Three experienced radiologists recorded the locations of the microcalcifications, and confidence ratings were given. Free response receiver operating characteristics (FROC) analysis was performed. Using a binary score, the fractions of detected microcalcifications were plotted as a function of equivalent diameter for the different Al-equivalent thicknesses. Pair-wise agreement of the detected microcalcifications was calculated for the different Al-equivalent thickness groups. The FROC curves of each radiologist indicated similar true positive fractions for a given number of false positives per image. One radiologist applied a more conservative scoring. Detected fractions for the different sizes of the microcalcifications showed the same trend for all observers. In addition, the observer with the least FP also detected less microcalcifications. The pair-wise agreement of the detected microcalcifications was good. The average detected fractions were >0.5 for microcalcifications with equivalent diameter >400 microm and Al-equivalent thickness >400 microm. An average detected fraction >0.5 was also seen for microcalcifications with equivalent diameter <400 microm and equivalent thickness >800 microm. The detected fractions of smaller microcalcifications were <0.5. The results obtained with this method indicate that it may be possible to quantify the performance of a digital mammography detector including processing and viewing for the detection of microcalcifications. We hypothesize that the FROC curves and detected fractions of simulated microcalcifications of different sizes reflect the clinical reality.