TU-CD-207-08: Intrinsic Image Quality Comparison of Synthesized 2-D and FFDM Images

Purpose: With the combined interest of managing patient dose, maintaining or improving image quality, and maintaining or improving the diagnostic utility of mammographic data, this study aims to compare the intrinsic image quality of Hologic's synthesized 2-D (C-View) and 2-D FFDM images in terms of resolution, contrast, and noise. Methods: This study utilized a novel 3-D printed anthropomorphic breast phantom in addition to the American College of Radiology (ACR) mammography accreditation phantom. Analysis of the 3-D anthropomorphic phantom included visual assessment of resolution and analysis of the normalized noise power spectrum. Analysis of the ACR phantom included both visual inspection and objective automated analysis using in-house software. The software incorporates image- and object-specific CNR visibility thresholds which account for image characteristics such as noise texture which affect object visualization. T- test statistical analysis was also performed on ACR phantom scores. Results: The spatial resolution of C-View images is markedly lower (at least 50% worse) than that of FFDM. And while this is generally associated with the benefit of reduced relative noise magnitude, the noise in C-View images tends to have a more mottled (predominantly low-frequency) texture. In general, for high contrast objects, C-View provides superior visualization over FFDM; however this benefit diminishes for low contrast objects and is applicable only to objects that are sufficiently larger than the spatial resolution threshold. Based on both observer and automated ACR phantom analysis, between 50–70% of C-View images failed to meet ACR minimum accreditation requirements – primarily due to insufficient (unbroken) fiber visibility. Conclusion: Compared to FFDM, C-View offers better depiction of objects of certain size and contrast, but provides poorer overall resolution and noise properties. Based on these findings, the utilization of C-View images in the clinical setting requires careful consideration, especially if considering the discontinuation of FFDM imaging