Potential of phase contrast x-ray imaging for detecting tumors in dense breast: initial phantom studies

The objective of this study is to demonstrate the potential of using the High-energy in-line phase contrast x-ray imaging to detect lesions that are indistinguishable by conventional x-ray mammography but are detectable by supplemental ultrasound screening within dense breasts. For this study, a custom-made prototype x-ray/ultrasound dualmodality phantom that mimics dense breast is created to include embedded carbon fiber disks with multiple diameters and thicknesses. The phase contrast image is acquired using a prototype at 120kVp, 67μA, exposure time of 16.7sec and focal spot size of 18.3μm with average glandular dose (AGD) of 0.3mGy under a geometric magnification of 2.48. The conventional x-ray image is acquired with a bench top system operating at 40kVp, 300μA, exposure time of 50sec and same AGD. The results demonstrate that conventional x-ray imaging is unable to detect any of the carbon fiber disks, while phase contrast imaging and ultrasonography are able to detect most or all of the disks under the applied experimental conditions. These results illustrate phase contrast imaging is capable of detecting targets in a dual-modality phantom which simulates lesions in dense breast tissue, when the simulated lesions are not distinguishable by conventional mammography. Therefore mammographic screening with phase contrast technique could eventually replace both x-ray and ultrasonography for screening detection of small lesions with microcalcification in dense breasts where pathologic lesions are masked due to highly glandular tissue. These results encourage further investigation using high glandular density phantoms to further evaluate the effectiveness of phase contrast imaging as a single modality test, which combines the advantages of both x-ray and ultrasound imaging in cancer screening of patients with dense breasts.