A digital equalisation technique improving visualisation of dense mammary gland and breast periphery in mammography

Introduction: In mammographic imaging, use of high contrast screen-film combinations results in under-exposed and over-exposed film areas corresponding to dense mammary gland and breast periphery (BP), respectively, characterised by degraded image contrast. A digital equalisation technique was designed and developed in order to deal with the problem of poor visualisation of these regions. Methods and material: The technique is based on the film-digitiser characteristic curve and a layer model of the breast region, as depicted on a mammogram. It remaps each layer grey level (GL) values by a correction factor that accounts for thickness variation in BP and the presence of dense fibroglandular tissues at the mammary gland. The major steps of the technique are segmentation, to isolate the breast region from mammogram background, and adaptive layer GL remapping. Results: The performance of the technique was initially evaluated on a sample of 60 mammograms. Comparative evaluation between the initial and processed images was performed on the basis of nine anatomical features situated at dense mammary gland and BP. The mammographic images resulting from application of the proposed technique are GL equalised and the visualisation improvement of all anatomical features was found to be statistically significant (P<0.05) or highly significant (P<0.0001). The proposed technique was also compared with contrast-limited adaptive histogram equalisation (CLAHE) and found to be more effective in the visualisation of all anatomical features examined, for both dense breast (DB) and BP. Discussion and conclusion: Application of the proposed technique results in improved visualisation of both dense mammary gland and BP regions. The proposed technique is independent of breast size, breast symmetry and mammographic view. The technique contributes to breast dose minimisation by eliminating the need for a second acquisition