Objectives: A dual-mode Single Photon Emission Computed Tomography (SPECT)/X-ray CT (XCT) system for full-field mammotomography is proposed for evaluation of breast lesions, where dual-view X-ray mammography has proven to be ineffective or inconclusive, particularly in radiographically dense breasts. Investigated design parameters include combined SPECT/XCT system geometry, X-ray focal spot size, tube loading, kVp, filtration, and detector type to determine operating parameters for a novel quasi-monochromatic X-ray beam for use in X-ray computed mammotomography that would use a dose equal to that from dual view mammography and that could be combined in a dual-mode system with SPECT. Methods: The relatively compact design of the hybrid SPECT/XCT will allow both systems to rotate on the same gantry below a patient. The hybrid system will be composed of a versatile, goniometer-based SPECT gantry, and an XCT system with a fixed position tungsten target, cone-beam geometry and digital flat panel detector frame nearly orthogonal to the SPECT system. The X-ray beam was modeled by xSpect, a semi-empirical simulation code for X-ray production, attenuation, and detection. The idealized operating parameters for the quasi-monochromatic beam were determined by evaluating a beam hardening (minimum) figure of merit (FOM) along with quantitative spectral characteristics, and an exposure efficiency (maximum) FOM. These FOMs were evaluated in 8–16cm thick uncompressed breasts. Filters with atomic numbers (Z) from 51–65 with 10th to 1000th value attenuating layer thicknesses were modeled, while considering tube loading limitations. Results: Using a tungsten target, increased tube potential and filtration can yield minimal beam hardening with improved exposure efficiency and contrast for various thicknesses of uncompressed breasts. Optimal tube operating range between 50–70kVp with filter thickness of between 100th and 500th value layer for Z filters 56–62 result in optimized FOMs while remaining at or below expected dose of two-view X-ray mammography for the entire breast. Mean quasi-monochromatic beam energies were near 40keV, with beam widths of <15% FWHM. Diminishing improvements are seen for filters greater than Z=65 and for thicknesses greater than the 500th value layer. Heavy filtration also demonstrated near-independence of FOM outcomes based on breast size. Conclusion: Simulated data show that a quasi-monochromatic beam with minimal beam hardening can readily be generated. Given the small expected source-image distance, it is geometrically feasible for the XCT system to be mounted on the SPECT gantry so that simultaneous SPECT/XCT images of a pendant, uncompressed breast can be obtained with identical imaging geometries.
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