Molecular Breast Imaging System Research Articles

Design of a Low-Dose, Stationary, Tomographic Molecular Breast Imaging System Using 3-D Position Sensitive CZT Detectors

Molecular breast imaging (MBI) has been shown to have high sensitivity for lesion detection, particularly in patients with dense breasts where conventional mammography is limited. However, relatively high radiation dose and long imaging time are limiting factors. Most current MBI systems are based on planar imaging. Improved performance can be achieved using tomographic techniques, which normally involve detector motion. Our goal is to develop a low-dose stationary tomographic MBI system with similar or better performance in terms of lesion detection compared to planar MBI. The proposed system utilizes two opposing cadmium zinc telluride detectors with high intrinsic resolution and depth of interaction (DOI) capability, combined with densely packed multipinhole collimators. This leads to improved efficiency and adequate angular sampling, but also to significant multiplexing (MX), which can result in artefacts. We have developed de-MX algorithms that take advantage of the DOI information. We have performed both analytic and Monte Carlo simulations to demonstrate the feasibility, optimize the design and investigate the expected performance of the proposed system. Lesion detectability was preserved with reduction of acquisition time (or radiation dose) by a factor of 2 compared to planar images at the lowest reported dose. The first prototype is under evaluation at Kromek.

Evaluation of CZT Drift Strip Detectors for Use in 3-D Molecular Breast Imaging

X-ray mammography is a widely used technique for breast cancer screening. However, the technique is imprecise when it comes to radiographically dense breast tissue, and therefore a supplemental screening technique, such as molecular breast imaging (MBI), could increase the cancer detection rate. Emerging technologies within MBI require excellent detector performance, preferably with a submillimeter intrinsic spatial resolution. A collaboration between Kromek and DTU Space aims to advance the DTU Space developed 3-D CdZnTe (CZT) drift strip technology, for application in new emerging MBI systems. This collaboration has resulted in ten compact 3-D MBI test modules with the goal of producing high-performance and high yield detectors. In this article, we present overall excellent detector performance, submillimeter position resolution at both 122 and 661.6 keV, and good energy resolution for the applied electrode deposition and contact optimization. Although the current experimental setup and results suffer from high electronic noise (using discrete NIM standard charge sensitive preamplifiers), we conclude that the measured spatial and spectral performance fulfills the expected requirements for the modules, with room for improvement, especially within limiting electronic noise. The detector test modules indicate a promising future for the 3-D CZT drift strip technology within future emerging MBI systems.

Monte Carlo-derived 99m Tc uptake quantification with commercial planar MBI: Tumor and breast activity concentrations.

Current molecular breast imaging (MBI) images are limited to qualitative evaluation, not absolute measurement, of 99m Tc uptake in benign and malignant breast tissues. This work assesses the accuracy of previously-published and newly-proposed tumor and normal breast tissue 99m Tc uptake MBI measurements using simulations of a commercial dual-headed planar MBI system under typical clinical and acquisition protocols. Quantification techniques were tested in over 4000 simulated acquisitions of spherical and ellipsoid tumors with clinically relevant uptake conditions using a validated Monte Carlo application of the GE Discovery NM750b system. The evaluated techniques consisted of four tumor total activity methodologies (two single-detector-based and two geometric-mean-based), two tumor MBI volume methodologies (diameter-based and ROI-based), and two normal tissue activity concentration methodologies (single-detector-based and geometric-mean-based). The most accurate of these techniques were then used to estimate tumor activity concentrations and tumor to normal tissue relative activity concentrations (RC). Single-detector techniques for tumor total activity quantification achieved mean (standard deviation) relative errors of 0.2% (4.3%) and 1.6% (4.4%) when using the near and far detector images, respectively and were more accurate and precise than the measured 8.1% (5.8%) errors of a previously published geometric-mean technique. Using these activity estimates and the true tumor volumes resulted in tumor activity concentration and RC errors within 10% of simulated values. The precision of tumor activity concentration and RC when using only MBI measurements were largely driven by the errors in estimating tumor MBI volume using planar images (±30% inter-quartile range). Planar MBI images were shown to accurately and reliably be used to estimate tumor total activities and normal tissue activity concentrations in this simulation study. However, volumetric tumor uptake measurements (i.e., absolute and relative concentrations) are limited by inaccuracies in MBI volume estimation using two-dimensional images, highlighting the need for either tomographic MBI acquisitions or anatomical volume estimates for accurate three-dimensional tumor uptake estimates.

Monte Carlo-derived 99m Tc uptake quantification with commercial planar MBI: Absolute tumor activity.

Molecular breast imaging (MBI) of 99m Tc-sestamibi is an emerging adjunct qualitative tool in the detection and diagnosis of breast cancer. This work outlines the development and performance evaluation of a methodology to absolutely quantify tumor 99m Tc activity uptake using a commercially available dual-headed MBI system by implementing corrections for background, scatter, attenuation, and detector characteristics. A validated Monte Carlo application of a commercial MBI system was used to simulate over 7000 unique acquisitions of spherical and ellipsoidal tumors in breast tissue. Tumor absolute activity was calculated following background, scatter, and attenuation corrections of tumor region of interest counts. The methodology was first optimized using a set of high-uptake spherical tumors, and its accuracy and precision was then assessed in a set of spherical tumors with clinical uptake conditions. Finally, the performance of the activity methodology was evaluated under various bias and uncertainty conditions to better characterize the technique under expected clinical measurement conditions. In a test set of images with clinically relevant contrast and noise conditions, the mean ± standard deviation relative error in total tumor activity was 0.5% ± 6.5% (n = 2363) under ideal measurement conditions. Allowing for variability in tumor and background contours and in estimated tumor depths, the expected accuracy of the methodology in clinical practice was 0.5% ± 11.1% (n = 2363), with minimal loss of accuracy for ellipsoidal tumors. Planar MBI photopeak images acquired with standard-of-care protocols can be used to accurately quantify absolute tumor 99m Tc activity with an accuracy and precision of 0.5% ± 11.1%. The reported precision was based on a comprehensive evaluation of random errors and systematic biases.

PPV of the Molecular Breast Imaging Lexicon.

BACKGROUND. Molecular breast imaging (MBI) is used for various breast imaging indications. An MBI lexicon has been developed, although the likelihood of malignancy of the lexicon descriptors has not been assessed to our knowledge. OBJECTIVE. The purpose of this article was to evaluate the PPV for malignancy of the MBI lexicon imaging descriptors. METHODS. This retrospective study included MBI examinations performed from August 1, 2005, through August 31, 2017, that were positive (BI-RADS analogous categories 0, 3, 4, 5, or 6) according to the clinical report and had an available reference standard. Examinations were performed using dual-detector cadmium zinc telluride MBI systems after injection of 99mTc sestamibi. Category 3 lesions had pathologic correlation, at least 2 years of imaging follow-up, or final resolution on follow-up imaging as category 1 or 2; category 4 and 5 lesions had pathologic correlation. MBI examinations were reviewed by one of two radiologists to assess lesions on the basis of the published MBI lexicon for type (mass vs nonmass uptake), distribution (if nonmass uptake), uptake intensity, and number of MBI views on which the lesion was seen. PPV for malignancy was summarized. RESULTS. The analysis included 643 lesions (479 benign, 164 malignant; 83 mass, 560 nonmass uptake) in 509 patients (median age, 56 years). PPV was 73.5% (61/83) for masses and 18.4% (103/560) for nonmass uptake. Among the nonmass uptake lesions, PPV was 36.2% (17/47) for segmental, 20.1% (77/384) for focal, 30.8% (4/13) for diffuse, and 4.3% (5/116) for regional or multiple regional distribution. PPV was 5.3% (5/94) for one view, 15.2% (32/210) for two views, 14.6% (13/89) for three views, and 45.4% (113/249) for four views showing the lesion. PPV was 14.0% (43/307) for mild, 22.4% (51/228) for moderate, and 64.8% (70/108) for marked uptake intensity. CONCLUSION. The MBI lexicon lesion descriptors are associated with likelihood of malignancy. PPV was higher for masses, lesions seen on multiple MBI views, and lesions with marked uptake intensity. Among nonmass uptake lesions, PPV was highest for those with segmental distribution. CLINICAL IMPACT. Insight into the likelihood of malignancy associated with the MBI lexicon descriptors can inform radiologists' interpretations and guide potential future incorporation of the MBI lexicon into the ACR BI-RADS Atlas.

Monte Carlo simulation of pixelated CZT detector with Geant4: validation of clinical molecular breast imaging system

Purpose. Molecular breast imaging (MBI) of 99mTc-sestamibi with dual-headed, pixelated, cadmium–zinc–telluride (CZT) detectors is increasingly used in breast cancer care for screening/detecting lesions, monitoring response to therapy, and predicting risk of cancer. MBI as a truly quantitative tool in these applications, however, is limited due the lack of absolute 99mTc-sestamibi uptake quantification. To help advance the field of quantitative MBI, we have developed a Monte Carlo simulation application of the GE Discovery NM 750b system. Methods. Our simulation consists of a two-step process using the Geant4 toolkit to model the detector and source geometry and to track photon interactions and a MATLAB script to model the charge transport within the pixelated CZT detector. Simulated detector and detector response model parameters were selected to match measured and simulated standard performance characteristics using various 99mTc point-, line-, and film-sources in air. The final model parameters were verified by comparing the count profiles, energy spectra, and region of interest counts between simulated and measured images of a breast phantom with two spherical lesions in 5 cm thick medium of air or water. Results. Final performance characteristics with 99mTc sources in air were: (1) energy resolution: 6.1% measured versus 5.9% simulated photopeak full-width at half-maximum (FWHM), (2) spatial resolution: mean error between measured and simulated FWHM of 0.08 mm across 4.4–14.0 mm FWHM range, and (3) sensitivity: 572 cpm/μCi measured versus 567 cpm/μCi simulated (<1% error). Good agreement was observed in the breast phantom line profiles through the spherical lesions and overall energy spectra, with <5% difference in sphere counts between simulated and measured data. Conclusion. A pixelated CZT charge transport and induction model was successfully implemented and validated to simulate imaging with the GE Discovery NM 750b system. This work will enable investigations improving MBI image quality and developing algorithms for uptake quantification.

Limited Angle Tomography reconstruction for non-standard MBI system by means of parallel-hole and pinhole optics

The purpose of the present work is the study of reconstruction properties of a new Molecular Breast Imaging (MBI) device for the early diagnosis of breast cancer, in Limited Angle Tomography (LAT), by using two asymmetric detector heads with different collimators. The detectors face each other in anti-parallel viewing direction and, mild-compressing the breast phantom, they are able to reconstruct the inner tumour of the phantoms with only a limited number of projections using a dedicated maximum-likelihood expectation maximization algorithm. The phantoms, the MBI system, as well as the Monte Carlo simulator, are briefly described. The MBI system's model has been implemented in IDL, in order to evaluate the best LAT configuration of the system and its reconstruction ability by varying tumour's size, depth and uptake. The LAT setup in real and simulated configurations, as well as the maximum-likelihood method and the preliminary reconstruction results, are discussed.

Characterization of a Molecular Breast Imaging system in Limited Angle Tomography using a dedicated breast phantom

This work reports on the Limited Angle Tomography (LAT) studies of a novel Molecular Breast Imaging (MBI) system with radionuclides, made by two asymmetric SPECT-like detector heads with two different optics. MBI has a central role to play in detecting the small breast tumours, especially for dense breasts, due to its specificity in detecting tumours even in dense breasts. For this purpose, an innovative device has been developed at ISS in Rome, composed of a dual detector setup which combines images from two complementary detectors at the opposite sides of the compressed breast, and that allows spot compression and LAT for a tumour 3-D reconstruction. Our study tries to demonstrate the feasibility of using this novel system in LAT , where a small detector head with pinhole collimator is able to rotate around the breast phantom, to diagnose the small tumours and to improve the sensitivity and efficiency. Detector heads and phantom, LAT setup and first preliminary results, are presented.

Monte Carlo simulations of an innovative molecular breast imaging system for the small breast cancer diagnosis using GATE

ABSTRACTThis paper draws attention to the study of performance of a new Molecular Breast Imaging (MBI) device, whose purpose is the early diagnosis of breast cancer, using Monte Carlo simulations. MBI provides functional and specific information that are more appropriated to dense breasts. Two asymmetric heads with different types of collimators, facing each other in anti-parallel viewing direction, characterize the system. Detectors and phantoms, together with the data taking procedure, are shortly reported. Monte Carlo simulations using the GATE (GEANT4 Application for Tomographic Emission) simulation toolkit have been implemented to evaluate the optimal detector configuration, in terms of sensitivity and spatial resolution, and also to reproduce the real experimental data. The device can be used both in spot compression and in Limited Angle Tomography (LAT); in the latter configuration one detector head with pinhole collimator is able to rotate around the breast in order to diagnose and localized the small tumors.

Guidelines for Quality Control Testing of Molecular Breast Imaging Systems.

Molecular breast imaging (MBI) is a nuclear medicine test that uses dedicated γ-cameras designed for imaging of the breast. Despite growing adoption of MBI, there is currently a lack of guidance on appropriate quality control procedures for MBI systems. Tests designed for conventional γ-cameras either do not apply or must be modified for dedicated detectors. Our objective was to provide practical guidance for physics testing of MBI systems by adapting existing quality control procedures for conventional systems. Methods: Quality control tests designed for conventional γ-cameras were attempted on a dedicated MBI system and then modified as necessary to accommodate the pixelated detector, limited space between dual-detector heads, and inability to fully rotate the detector gantry. Results: MBI systems were found to warrant quality control testing of uniformity, spatial resolution, count sensitivity, energy resolution, and lesion contrast. The modified procedures and special considerations needed for these tests were investigated and described. Physics tests of intrinsic uniformity, count rate parameters, and overall system performance for SPECT did not apply to dedicated MBI systems. Conclusion: Routine physics testing of dedicated MBI equipment is important for verifying system specifications and monitoring changes in performance. As adoption of MBI grows, routine testing may be required for obtaining and maintaining accreditation from regulatory bodies.

Performance characteristics of dedicated molecular breast imaging systems at low doses.

The purpose of this study was to compare the system performance characteristics and lesion detection capability of two molecular breast imaging (MBI) systems: a multicrystal sodium iodide (NaI)-based single-head system and a cadmium zinc telluride (CZT)-based dual-head system at low administered doses (150-300 MBq) of Tc-99m sestamibi. System performance characteristics including count sensitivity, uniformity, energy resolution, and spatial resolution were measured using standard NEMA methods, or a modified version thereof in cases where the standard NEMA protocol could not be applied. A contrast-detail phantom with 48 lesions at varying depths from the collimator surface was used to assess lesion contrast-to-noise-ratio (CNR) using background count densities comparable to those observed in patient studies performed with administered doses of 150 MBq Tc-99m sestamibi. Lesions with CNR >3 were deemed to be detectable. Thirty patients undergoing MBI examinations with administered doses of 150-300 MBq were scanned for an additional view on the pixelated NaI system. CNR was calculated for lesions observed on patient images. Background count densities of patient images were measured and compared between the two systems. Over the central field of view, integral and differential uniformity were 6.1% and 4.2%, respectively, for the pixelated NaI system, and 3.8% and 2.7%, respectively, for the CZT system. Count sensitivity was 10.8 kcts/min/MBq for the NaI system and 32.9 kcts/min/MBq for the CZT system. Energy resolution was 13.5% on the pixelated NaI system and 4.5% on the CZT system. Spatial resolution (full-width at half-maximum) for the pixelated NaI detector was 4.2 mm at a distance of 1.2 cm from the collimator and 5.2 mm at 3.1 cm. Spatial resolution of a single CZT detector was 2.9 mm at a distance of 1.2 cm from the collimator and 4.7 mm at 3.1 cm. Effective spatial resolution obtained with dual-head CZT was below 4.7 mm throughout a simulated breast thickness of 6 cm. From contrast-detail phantom images of lesions at distances of 1.5-4.5 cm from the collimator face, the CZT system detected 124 of 144 (86%) of lesions compared to 97 of 144 (67%) with the NaI system. In patient studies, from comparison of the same view with both systems, a total of 7 breast lesions were identified on CZT system in seven patients, and 4 of 7 (57%) were detected on NaI system. Patient image background count densities on the CZT system were on average 3.4 times higher than those on the NaI system. The CZT system demonstrated better uniformity, count sensitivity, spatial resolution, energy resolution, and lesion detection in phantom and patient studies compared to the NaI system. At administered doses of 150-300 MBq Tc-99m sestamibi, patient results obtained with CZT systems may not be directly translatable to NaI systems.

Half-time Tc-99m sestamibi imaging with a direct conversion molecular breast imaging system.

BackgroundIn an effort to reduce necessary acquisition time to perform molecular breast imaging (MBI), we compared diagnostic performance of MBI performed with standard 10-min-per-view acquisitions and half-time 5-min-per-view acquisitions, with and without wide beam reconstruction (WBR) processing.MethodsEighty-two bilateral, two-view MBI studies were reviewed. Studies were performed with 300 MBq Tc-99 m sestamibi and a direct conversion molecular breast imaging (DC-MBI) system. Acquisitions were 10 min-per-view; the first half of each was extracted to create 5-min-per-view datasets, and WBR processing was applied.The 10-min-, 5-min-, and 5-min-per-view WBR studies were independently interpreted in a randomized, blinded fashion by two radiologists. Assessments of 1 to 5 were assigned; 4 and 5 were considered test positive. Background parenchymal uptake, lesion type, distribution of non-mass lesions, lesion intensity, and image quality were described.ResultsConsidering detection of all malignant and benign lesions, 5 min-per-view MBI had lower sensitivity (mean of 70% vs. 85% (p ≤ 0.04) for two readers) and lower area under curve (AUC) (mean of 92.7 vs. 99.6, p ≤ 0.01) but had similar specificity (p = 1.0). WBR processing did not alter sensitivity, specificity, or AUC obtained at 5 min-per-view.Overall agreement in final assessment between 5-min-per-view and 10-min-per-view acquisition types was near perfect (κ = 0.82 to 0.89); however, fair to moderate agreement was observed for assessment category 3 (probably benign) (κ = 0.24 to 0.48). Of 33 malignant lesions, 6 (18%) were changed from assessment of 4 or 5 with 10-min-per-view MBI to assessment of 3 with 5-min-per-view MBI. Image quality of 5-min-per-view studies was reduced compared to 10-min-per-view studies for both readers (3.24 vs. 3.98, p < 0.0001 and 3.60 vs. 3.91, p < 0.0001). WBR processing improved image quality for one reader (3.85 vs. 3.24, p < 0.0001).ConclusionsAlthough similar radiologic interpretations were obtained with 10-min- and 5-min-per-view DC-MBI, resulting in substantial agreement in final assessment, notable exceptions were found: (1) perceived image quality at 5 min-per-view was lower than that for 10-min-per-view studies and (2) in a number of cases, assessment was downgraded from a recommendation of biopsy to that of short interval follow-up.

99mTc-Sestamibi Using a Direct Conversion Molecular Breast Imaging System to Assess Tumor Response to Neoadjuvant Chemotherapy in Women With Locally Advanced Breast Cancer

The objective of this study was to determine the ability of breast imaging with 99mTc-sestamibi and a direct conversion-molecular breast imaging (MBI) system to predict early response to neoadjuvant chemotherapy (NAC). Patients undergoing NAC for breast cancer were imaged with a direct conversion-MBI system before (baseline), at 3 to 5 weeks after onset, and after completion of NAC. Tumor size and tumor-to-background (T/B) uptake ratio measured from MBI images were compared with extent of residual disease at surgery using the residual cancer burden. Nineteen patients completed imaging and proceeded to surgical resection after NAC. Mean reduction in T/B ratio from baseline to 3 to 5 weeks for patients classified as RCB-0 (no residual disease), RCB-1 and RCB-2 combined, and RCB-3 (extensive residual disease) was 56% (SD, 0.20), 28% (SD, 0.20), and 4% (SD, 0.15), respectively. The reduction in the RCB-0 group was significantly greater than in RCB-1/2 (P = 0.036) and RCB-3 (P = 0.001) groups. The area under the receiver operator characteristic curve for determining the presence or absence of residual disease was 0.88. Using a threshold of 50% reduction in T/B ratio at 3 to 5 weeks, MBI predicted presence of residual disease at surgery with a diagnostic accuracy of 89.5% (95% confidence interval [CI], 0.64%-0.99%), sensitivity of 92.3% (95% CI, 0.74%-0.99%), and specificity of 83.3% (95% CI, 0.44%-0.99%). The reduction in tumor size at 3 to 5 weeks was not statistically different between RCB groups. Changes in T/B ratio on MBI images performed at 3 to 5 weeks following initiation of NAC were accurate at predicting the presence or absence of residual disease at NAC completion.

Collimator design for a dedicated molecular breast imaging‐guided biopsy system: Proof‐of‐concept

Molecular breast imaging (MBI) is a dedicated nuclear medicine breast imaging modality that employs dual-head cadmium zinc telluride (CZT) gamma cameras to functionally detect breast cancer. MBI has been shown to detect breast cancers otherwise occult on mammography and ultrasound. Currently, a MBI-guided biopsy system does not exist to biopsy such lesions. Our objective was to consider the utility of a novel conical slant-hole (CSH) collimator for rapid (<1 min) and accurate monitoring of lesion position to serve as part of a MBI-guided biopsy system. An initial CSH collimator design was derived from the dimensions of a parallel-hole collimator optimized for MBI performed with dual-head CZT gamma cameras. The parameters of the CSH collimator included the collimator height, cone slant angle, thickness of septa and cones of the collimator, and the annular areas exposed at the base of the cones. These parameters were varied within the geometric constraints of the MBI system to create several potential CSH collimator designs. The CSH collimator designs were evaluated using Monte Carlo simulations. The model included a breast compressed to a thickness of 6 cm with a 1-cm diameter lesion located 3 cm from the collimator face. The number of particles simulated was chosen to represent the count density of a low-dose, screening MBI study acquired with the parallel-hole collimator for 10 min after a ∼150 MBq (4 mCi) injection of Tc-99m sestamibi. The same number of particles was used for the CSH collimator simulations. In the resulting simulated images, the count sensitivity, spatial resolution, and accuracy of the lesion depth determined from the lesion profile width were evaluated. The CSH collimator design with default parameters derived from the optimal parallel-hole collimator provided 1-min images with error in the lesion depth estimation of 1.1 ± 0.7 mm and over 21 times the lesion count sensitivity relative to 1-min images acquired with the current parallel-hole collimator. Sensitivity was increased via more vertical cone slant angles, larger annular areas, thinner cone walls, shorter cone heights, and thinner radiating septa. Full width at half maximum trended in the opposite direction as sensitivity for all parameters. There was less error in the depth estimates for less vertical slant angles, smaller annular areas, thinner cone walls, cone heights near 1 cm, and generally thinner radiating septa. A Monte Carlo model was used to demonstrate the feasibility of a CSH collimator design for rapid biopsy application in molecular breast imaging. Specifically, lesion depth of a 1-cm diameter lesion positioned in the center of a typical breast can be estimated with error of less than 2 mm using circumferential count profiles of images acquired in 1 min.

WE‐A‐213CD‐01: Molecular Imaging of the Breast

Molecular imaging of the breast using either SPECT or PET based radiopharmaceuticals is a relatively new area of focus for nuclear medicine and has grown in importance over the last few years with the development of specialized small field of view gamma cameras and small PET systems designed to provide high resolution functional images of the breast. Molecular Breast Imaging (MBI) / Breast Specific Gamma imaging (BSGI): MBI and BSGI are currently performed with Tc‐99m sestamibi and have shown a high sensitivity for the detection of small breast lesions, with reported sensitivities of ∼90%. Sensitivity is lowest for tumors &lt; 5 mm in size. This talk will review the technology behind both MBI and BSGI and the primary clinical applications. It will also review the potential use of MBI as a screening technique. Recent studies have shown that it may be considerably more sensitive than mammography in women with dense breast tissue. A significant issue with MBI / BSGI is radiation burden and this talk will review efforts to increase the sensitivity of these technologies to allow a reduction in the administered dose of radiopharmaceutical, and thereby achieve a comparable radiation burden to mammography. Positron Emission Mammography (PEM): PEM is currently performed on a dual detector system incorporating 2 scanning arrays of BGO crystals providing limited angle tomographic imaging. Studies using F‐18 FDG have shown PEM to have comparable sensitivity to MRI for the detection of breast cancer. It is a useful tool in the preoperative assessment of disease extent and in evaluating response to neoadjuvant therapy. As with single photon systems, sensitivity is lowest for tumors &lt; 5 mm in size. Current systems employ doses of 10 mCi F‐18 FDG. Recent technical developments have seen the emergence of systems using small ring detectors or rotating planar detectors that provide full tomographic views of the breast. Clinical studies are expected to show improvements in spatial resolution and a reduction in the administered dose of F‐18 required. COI: The author and Mayo Clinic receive royalties from patents licensed to Gamma Medica Ideas, a manufacturer of MBI systems. Learning Objective:1) Understand the different technologies (PEM,MBI, BSGI) and detector configurations now available for molecular imaging of the breast. 2) Understand the potential applications for molecular imaging of the breast in both the diagnostic and screening environments. 3) Compare the strengths and weakness of molecular imaging techniques with other breast imaging modalities. 4) Appreciate the potential future applications of this technology in the understanding of breast disease. 5) Demonstrate understanding of the radiation dose implications of current radiopharmaceuticals and how the dose can be reduced with new technologies and radiopharmaceuticals.

Proof of concept for low‐dose molecular breast imaging with a dual‐head CZT gamma camera. Part I. Evaluation in phantoms

Molecular breast imaging (MBI) is a nuclear medicine technology that uses dual-head cadmium zinc telluride (CZT) gamma cameras to image functional uptake of a radiotracer, Tc-99m sestamibi, in the breast. An important factor in adoption of MBI in the screening setting is reduction of the necessary administered dose of Tc-99m sestamibi from the typically used dose of 740 MBq to approximately 148 MBq, such that MBI's whole-body effective dose is comparable to that of screening mammography. Methods that increase MBI count sensitivity may allow a proportional reduction in the necessary administered dose. Our objective was to evaluate the impact of two count sensitivity improvement methods on image quality by evaluating count sensitivity, spatial resolution, and lesion contrast in phantom simulations. Two dual-head CZT-based MBI systems were studied: LumaGem and Discovery NM 750b. Two count sensitivity improvement methods were implemented: registered collimators optimized for dedicated breast imaging and widened energy acceptance window optimized for use with CZT. System sensitivity, spatial resolution, and tumor contrast-to-noise ratio (CNR) were measured comparing standard collimation and energy window setting [126-154 keV (+10%, -10%)] with optimal collimation and a wide energy window [110-154 keV (+10%, -21%)]. Compared to the standard collimator designs and energy windows for these two systems, use of registered optimized collimation and wide energy window increased system sensitivity by a factor of 2.8-3.6. Spatial resolution decreased slightly for both systems with new collimation. At 3 cm from the collimator face, LumaGem's spatial resolution was 4.8 and 5.6 mm with standard and optimized collimation; Discovery NM 750b's spatial resolution was 4.4 and 4.6 mm with standard and optimized collimation, respectively. For both systems, at tumor depths of 1 and 3 cm, use of optimized collimation and wide energy window significantly improved CNR compared to standard settings for tumors 8.0 and 9.2 mm in diameter. At the closer depth of 1 cm, optimized collimation and wide energy window also significantly improved CNR for 5.9 mm tumors on Discovery NM 750b. Registered optimized collimation and wide energy window yield a substantial gain in count sensitivity and measurable gain in CNR, with some loss in spatial resolution compared to the standard collimator designs and energy windows used on these two systems. At low-count densities calculated to represent doses of 148 MBq, this tradeoff results in adequate count density and lesion contrast for detection of lesions ≥8 mm in the middle of a typical breast (3 cm deep) and lesions ≥6 mm close to the collimator (1 cm deep).

Design of optimal collimation for dedicated molecular breast imaging systems.

Molecular breast imaging (MBI) is a functional imaging technique that uses specialized small field-of-view gamma cameras to detect the preferential uptake of a radiotracer in breast lesions. MBI has potential to be a useful adjunct method to screening mammography for the detection of occult breast cancer. However, a current limitation of MBI is the high radiation dose (a factor of 7-10 times that of screening mammography) associated with current technology. The purpose of this study was to optimize the gamma camera collimation with the aim of improving sensitivity while retaining adequate resolution for the detection of sub-10-mm lesions. Square-hole collimators with holes matched to the pixilated cadmium zinc telluride detector elements of the MBI system were designed. Data from MBI patient studies and parameters of existing dual-head MBI systems were used to guide the range of desired collimator resolutions, source-to-collimator distances, pixel sizes, and collimator materials that were examined. General equations describing collimator performance for a conventional gamma camera were used in the design process along with several important adjustments to account for the specialized imaging geometry of the MBI system. Both theoretical calculations and a Monte Carlo model were used to measure the geometric efficiency (or sensitivity) and resolution of each designed collimator. Results showed that through optimal collimation, collimator sensitivity could be improved by factors of 1.5-3.2, while maintaining a collimator resolution of either < or =5 or < or = 7.5 mm at a distance of 3 cm from the collimator face. These gains in collimator sensitivity permit an inversely proportional drop in the required dose to perform

Molecular Breast Imaging: Use of a Dual-Head Dedicated Gamma Camera to Detect Small Breast Tumors

Molecular breast imaging with a single-head cadmium zinc telluride (CZT) gamma camera has previously been shown to have good sensitivity for the detection of small lesions. To further improve sensitivity, we developed a dual-head molecular breast imaging system using two CZT detectors to simultaneously acquire opposing breast views and reduce lesion-to-detector distance. We determined the incremental gain in sensitivity of molecular breast imaging with dual detectors. Patients with BI-RADS category 4 or 5 lesions < 2 cm that were identified on mammography or sonography and scheduled for biopsy underwent molecular breast imaging as follows: After injection of 740 MBq of technetium-99m ((99m)Tc) sestamibi, 10-minute craniocaudal and mediolateral oblique views of each breast were acquired. Blinded reviews were performed using images from both detectors 1 and 2 and images from detector 1 only (simulating a single-head system). Lesions were scored on a scale of 1-5; 2 or higher was considered positive. Of the 150 patients in the study, 128 cancers were confirmed in 88 patients. Averaging the results from the three blinded readers, the sensitivity of dual-head molecular breast imaging was 90% (115/128), whereas the sensitivity from review of only single-head molecular breast imaging was 80% (102/128). The sensitivity for the detection of cancers < or = 10 mm in diameter was 82% (50/61) for dual-head molecular breast imaging and 68% (41/61) for single-head molecular breast imaging. On average, 13 additional cancers were seen on dual-head images and the tumor uptake score increased by 1 or more in 60% of the identified tumors. Gains in sensitivity with the dual-head system molecular breast imaging are partially due to increased confidence in lesion detection. Molecular breast imaging can reliably detect breast lesions < 2 cm and dual-head molecular breast imaging can significantly increase sensitivity for subcentimeter lesions.

Quantification of lesion size, depth, and uptake using a dual‐head molecular breast imaging system

A method to perform quantitative lesion analysis in molecular breast imaging (MBI) was developed using the opposing views from a novel dual-head dedicated gamma camera. Monte Carlo simulations and phantom models were used to simulate MBI images with known lesion parameters. A relationship between the full widths at 25%, 35%, and 50% of the maximum of intensity profiles through lesions and the true lesion diameter as a function of compressed breast thickness was developed in order to measure lesion diameter. Using knowledge of compressed breast thickness and the attenuation of gamma rays in soft tissue, a method was developed to measure the depth of the lesion to the collimator face. Using the measured lesion diameter and measurements of counts in the lesion and background breast region, relative radiotracer uptake or tumor to background ratio (T/B ratio) was calculated. Validation of the methods showed that the size, depth, and T/B ratio can be accurately measured for a range of small breast lesions with T/B ratios between 10:1 and 40:1 in breasts with compressed thicknesses between 4 and 10 cm. Future applications of this work include providing information about lesion location in patients for performing a biopsy of site and the development of a threshold for the T/B ratio that can distinguish benign from malignant disease.