Background Automatic exposure control (AEC) plays a crucial role in mammography by determining th... more Background Automatic exposure control (AEC) plays a crucial role in mammography by determining the exposure conditions needed to achieve specific image quality based on the absorption characteristics of compressed breasts. This study aimed to characterize the behavior of AEC for digital mammography (DM), digital breast tomosynthesis (DBT), and low-energy (LE) and high-energy (HE) acquisitions used in contrast-enhanced mammography (CEM) for three mammography systems from two manufacturers. Methods Using phantoms simulating various breast thicknesses, 363 studies were acquired using all available AEC modes 165 DM, 132 DBT, and 66 LE-CEM and HE-CEM. AEC behaviors were compared across systems and modalities to assess the impact of different technical components and manufacturers' strategies on the resulting mean glandular doses (MGDs) and image quality metrics such as contrast-to-noise ratio (CNR). For all systems and modalities, AEC increased MGD for increasing phantom thicknesses and decreased CNR. The median MGD values (interquartile ranges) were 1.135 mGy (0.772-1.668) for DM, 1.257 mGy (0.971-1.863) for DBT, 1.280 mGy (0.937-1.878) for LE-CEM, and 0.630 mGy (0.397-0.713) for HE-CEM. Medians CNRs were 14.2 (7.8-20.2) for DM,) for a single projection in DBT, 11.9 (8.0-18.2) for LE-CEM, and 5.2 (3.6-9.2) for HE-CEM. AECs showed high repeatability, with variations lower than 5% for all modes in DM, DBT, and CEM. The study revealed substantial differences in AEC behavior between systems, modalities, and AEC modes, influenced by technical components and manufacturers' strategies, with potential implications in radiation dose and image quality in clinical settings. The study emphasized the central role of automatic exposure control in DM, DBT, and CEM acquisitions and the great variability in dose and image quality among manufacturers and between modalities. Caution is needed when generalizing conclusions about differences across mammography modalities. • AEC plays a crucial role in DM, DBT, and CEM. • AEC determines the "optimal" exposure conditions needed to achieve specific image quality.
Poster: "ECR 2015 / B-0238 / Should volumetric breast density be included in breast cancer p... more Poster: "ECR 2015 / B-0238 / Should volumetric breast density be included in breast cancer prediction models? Proposal of an integrated quantitative and reproducible approach" by: "S. Ciatti1, G. Gennaro2, V. Mungai1, G. Nannini1; 1Prato/IT, 2Padova/IT"
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
The radiation dose associated with contrast-enhanced mammography (CEM) has been investigated only... more The radiation dose associated with contrast-enhanced mammography (CEM) has been investigated only by single-center studies. In this retrospective study, we aimed to compare the radiation dose between two centers performing CEM within two prospective studies, using the same type of equipment. The CEM mean glandular dose (MGD) was computed for low energy (LE) and high energy (HE) images and their sum was calculated for each view. MGD and related parameters (entrance dose, breast thickness, compression, and density) were compared between the two centers using the Mann–Whitney test. Finally, per-patient MGD was calculated by pooling the two datasets and determining the contribution of LE and HE images. A total of 348 CEM examinations were analyzed (228 from Center 1 and 120 from Center 2). The median total MGD per view was 2.33 mGy (interquartile range 2.19–2.51 mGy) at Center 1 and 2.46 mGy (interquartile range 2.32–2.70 mGy) at Center 2, with a 0.15 mGy median difference (p < 0.001...
Poster: "ECR 2013 / C-1033 / This is what volumetric breast density is" by: "G. Ge... more Poster: "ECR 2013 / C-1033 / This is what volumetric breast density is" by: "G. Gennaro1, R. Highnam2; 1Padova/IT, 2Wellington/NZ"
JNCI: Journal of the National Cancer Institute, 2018
Background Artificial intelligence (AI) systems performing at radiologist-like levels in the eval... more Background Artificial intelligence (AI) systems performing at radiologist-like levels in the evaluation of digital mammography (DM) would improve breast cancer screening accuracy and efficiency. We aimed to compare the stand-alone performance of an AI system to that of radiologists in detecting breast cancer in DM. Methods Nine multi-reader, multi-case study datasets previously used for different research purposes in seven countries were collected. Each dataset consisted of DM exams acquired with systems from four different vendors, multiple radiologists’ assessments per exam, and ground truth verified by histopathological analysis or follow-up, yielding a total of 2652 exams (653 malignant) and interpretations by 101 radiologists (28 296 independent interpretations). An AI system analyzed these exams yielding a level of suspicion of cancer present between 1 and 10. The detection performance between the radiologists and the AI system was compared using a noninferiority null hypothes...
Objectives This study aims to illustrate a multiparametric automatic method for monitoring long-t... more Objectives This study aims to illustrate a multiparametric automatic method for monitoring long-term reproducibility of digital mammography systems, and its application on a large scale. Methods Twenty-five digital mammography systems employed within a regional screening programme were controlled weekly using the same type of phantom, whose images were analysed by an automatic software tool. To assess system reproducibility levels, 15 image quality indices (IQIs) were extracted and compared with the corresponding indices previously determined by a baseline procedure. The coefficients of variation (COVs) of the IQIs were used to assess the overall variability. Results A total of 2553 phantom images were collected from the 25 digital mammography systems from March 2013 to December 2014. Most of the systems showed excellent image quality reproducibility over the surveillance interval, with mean variability below 5%. Variability of each IQI was 5%, with the exception of one index associated with the smallest phantom objects (0.25 mm), which was below 10%. Conclusions The method applied for reproducibility testsmulti-detail phantoms, cloud automatic software tool to measure multiple image quality indices and statistical process control-was proven to be effective and applicable on a large scale and to any type of digital mammography system. Key Points • Reproducibility of mammography image quality should be monitored by appropriate quality controls. • Use of automatic software tools allows image quality evaluation by multiple indices. • System reproducibility can be assessed comparing current index value with baseline data. • Overall system reproducibility of modern digital mammography systems is excellent. • The method proposed and applied is cost-effective and easily scalable.
A simple phantom for periodic quality control measurement on full field digital mammography syste... more A simple phantom for periodic quality control measurement on full field digital mammography systems has been developed. It was employed with three different digital mammography units, by collecting data on detector linearity and uniformity, image contrast and spatial resolution, reproducibility of detector and automatic exposure control device. Results show the phantom is able to give information about some detector characteristics and can detect problems related to the stability of the automatic exposure control system. It is also fast and easy to use, as required in a quality assurance program.
Poster: "ECR 2015 / C-1576 / Impact of objective volumetric breast density estimates on mean... more Poster: "ECR 2015 / C-1576 / Impact of objective volumetric breast density estimates on mean glandular dose calculations in digital mammography" by: "G. Gennaro1, I. Sechopoulos2, L. Gallo3, V. Rossetti4, R. Highnam5; 1Padova/IT, 2Atlanta, GA/US, 3Castelfranco Veneto/IT, 4Torino/IT, 5Wellington/NZ"
Supplement to: Fisica in medicina, 2004, 2. - Printed from http://www.aifm.it target=NewWindow>... more Supplement to: Fisica in medicina, 2004, 2. - Printed from http://www.aifm.it target=NewWindow>www.aifm.it (February 2005)Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 , Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal
e20574 Background: Recent evidences have suggested potential applications of radiomics in early d... more e20574 Background: Recent evidences have suggested potential applications of radiomics in early diagnosis, prognostic stratification and treatment outcome prediction of Non-Small Cell Lung Cancer (NSCLC) patients. The purpose of this study is to evaluate the ability of radiomic analysis to discriminate between different clinical-pathological conditions in patients with stage III NSCLC. Methods: Baseline CT studies from 59 patients with stage III NSCLC referred to our Institution from 2010 and 2020 were retrospectively reviewed, and the segmentation of the main lung lesion and the extraction of 517 radiomic features performed using a commercial software. The number of features was reduced to 46 by means of principal component analysis applied using the R package “RadAR” (Radiomics Analysis with R). The Kruskal-Wallis test was applied to all the radiomic features in order to evaluate which of them can discriminate between 7 clinical dichotomous characteristics: tumor stage, type, pres...
Objective To evaluate the effectiveness of a new algorithm developed to reduce artifacts in dual-... more Objective To evaluate the effectiveness of a new algorithm developed to reduce artifacts in dual-energy subtraction (DES) contrast-enhanced mammography (CEM) images while preserving contrast enhancement of possible lesions. Methods A retrospective multi-reader paired study was performed by using 134 CEM studies obtained from the first 134 women enrolled in a prospective clinical study aiming to compare the clinical performance of CEM to those of breast MRI in screening of women at increased risk of breast cancer. Four experienced readers compared independently the standard (STD) DES images with those obtained by reprocessing the raw images by a new algorithm (NEW), expected to reduce the DES artifact intensity. The intensity of three types of artifacts (breast-in-breast, ripple, and skinfold enhancement) and the intensity of possible contrast uptake were assessed visually and rated using a categorical ordinal scale. Proportions of images rated by the majority of readers as “Absent”,...
In this study we used a large previously built database of 2,892 mammograms and 31,650 single mam... more In this study we used a large previously built database of 2,892 mammograms and 31,650 single mammogram radiologists’ assessments to simulate the impact of replacing one radiologist by an AI system in a double reading setting. The double human reading scenario and the double hybrid reading scenario (second reader replaced by an AI system) were simulated via bootstrapping using different combinations of mammograms and radiologists from the database. The main outcomes of each scenario were sensitivity, specificity and workload (number of necessary readings). The results showed that when using AI as a second reader, workload can be reduced by 44%, sensitivity remains similar (difference -0.1%; 95% CI = - 4.1%, 3.9%), and specificity increases by 5.3% (P<0.001). Our results suggest that using AI as a second reader in a double reading setting as in screening programs could be a strategy to reduce workload and false positive recalls without affecting sensitivity.
... BALDAN, ELISA-BETTA BEZZON, COSIMO DI MAGGIO, MANUELA LA GRASSA, ILA-RIA POLICO, ALESSANDRO P... more ... BALDAN, ELISA-BETTA BEZZON, COSIMO DI MAGGIO, MANUELA LA GRASSA, ILA-RIA POLICO, ALESSANDRO PROIETTI, AIDA TOFFOLI hy ... Il rilevamento tomografico consente di fatto di apprez-zare isolatamente le lesioni che più soffrono della so-vrapposizione e ...
Background Automatic exposure control (AEC) plays a crucial role in mammography by determining th... more Background Automatic exposure control (AEC) plays a crucial role in mammography by determining the exposure conditions needed to achieve specific image quality based on the absorption characteristics of compressed breasts. This study aimed to characterize the behavior of AEC for digital mammography (DM), digital breast tomosynthesis (DBT), and low-energy (LE) and high-energy (HE) acquisitions used in contrast-enhanced mammography (CEM) for three mammography systems from two manufacturers. Methods Using phantoms simulating various breast thicknesses, 363 studies were acquired using all available AEC modes 165 DM, 132 DBT, and 66 LE-CEM and HE-CEM. AEC behaviors were compared across systems and modalities to assess the impact of different technical components and manufacturers' strategies on the resulting mean glandular doses (MGDs) and image quality metrics such as contrast-to-noise ratio (CNR). For all systems and modalities, AEC increased MGD for increasing phantom thicknesses and decreased CNR. The median MGD values (interquartile ranges) were 1.135 mGy (0.772-1.668) for DM, 1.257 mGy (0.971-1.863) for DBT, 1.280 mGy (0.937-1.878) for LE-CEM, and 0.630 mGy (0.397-0.713) for HE-CEM. Medians CNRs were 14.2 (7.8-20.2) for DM,) for a single projection in DBT, 11.9 (8.0-18.2) for LE-CEM, and 5.2 (3.6-9.2) for HE-CEM. AECs showed high repeatability, with variations lower than 5% for all modes in DM, DBT, and CEM. The study revealed substantial differences in AEC behavior between systems, modalities, and AEC modes, influenced by technical components and manufacturers' strategies, with potential implications in radiation dose and image quality in clinical settings. The study emphasized the central role of automatic exposure control in DM, DBT, and CEM acquisitions and the great variability in dose and image quality among manufacturers and between modalities. Caution is needed when generalizing conclusions about differences across mammography modalities. • AEC plays a crucial role in DM, DBT, and CEM. • AEC determines the "optimal" exposure conditions needed to achieve specific image quality.
Poster: "ECR 2015 / B-0238 / Should volumetric breast density be included in breast cancer p... more Poster: "ECR 2015 / B-0238 / Should volumetric breast density be included in breast cancer prediction models? Proposal of an integrated quantitative and reproducible approach" by: "S. Ciatti1, G. Gennaro2, V. Mungai1, G. Nannini1; 1Prato/IT, 2Padova/IT"
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
The radiation dose associated with contrast-enhanced mammography (CEM) has been investigated only... more The radiation dose associated with contrast-enhanced mammography (CEM) has been investigated only by single-center studies. In this retrospective study, we aimed to compare the radiation dose between two centers performing CEM within two prospective studies, using the same type of equipment. The CEM mean glandular dose (MGD) was computed for low energy (LE) and high energy (HE) images and their sum was calculated for each view. MGD and related parameters (entrance dose, breast thickness, compression, and density) were compared between the two centers using the Mann–Whitney test. Finally, per-patient MGD was calculated by pooling the two datasets and determining the contribution of LE and HE images. A total of 348 CEM examinations were analyzed (228 from Center 1 and 120 from Center 2). The median total MGD per view was 2.33 mGy (interquartile range 2.19–2.51 mGy) at Center 1 and 2.46 mGy (interquartile range 2.32–2.70 mGy) at Center 2, with a 0.15 mGy median difference (p < 0.001...
Poster: "ECR 2013 / C-1033 / This is what volumetric breast density is" by: "G. Ge... more Poster: "ECR 2013 / C-1033 / This is what volumetric breast density is" by: "G. Gennaro1, R. Highnam2; 1Padova/IT, 2Wellington/NZ"
JNCI: Journal of the National Cancer Institute, 2018
Background Artificial intelligence (AI) systems performing at radiologist-like levels in the eval... more Background Artificial intelligence (AI) systems performing at radiologist-like levels in the evaluation of digital mammography (DM) would improve breast cancer screening accuracy and efficiency. We aimed to compare the stand-alone performance of an AI system to that of radiologists in detecting breast cancer in DM. Methods Nine multi-reader, multi-case study datasets previously used for different research purposes in seven countries were collected. Each dataset consisted of DM exams acquired with systems from four different vendors, multiple radiologists’ assessments per exam, and ground truth verified by histopathological analysis or follow-up, yielding a total of 2652 exams (653 malignant) and interpretations by 101 radiologists (28 296 independent interpretations). An AI system analyzed these exams yielding a level of suspicion of cancer present between 1 and 10. The detection performance between the radiologists and the AI system was compared using a noninferiority null hypothes...
Objectives This study aims to illustrate a multiparametric automatic method for monitoring long-t... more Objectives This study aims to illustrate a multiparametric automatic method for monitoring long-term reproducibility of digital mammography systems, and its application on a large scale. Methods Twenty-five digital mammography systems employed within a regional screening programme were controlled weekly using the same type of phantom, whose images were analysed by an automatic software tool. To assess system reproducibility levels, 15 image quality indices (IQIs) were extracted and compared with the corresponding indices previously determined by a baseline procedure. The coefficients of variation (COVs) of the IQIs were used to assess the overall variability. Results A total of 2553 phantom images were collected from the 25 digital mammography systems from March 2013 to December 2014. Most of the systems showed excellent image quality reproducibility over the surveillance interval, with mean variability below 5%. Variability of each IQI was 5%, with the exception of one index associated with the smallest phantom objects (0.25 mm), which was below 10%. Conclusions The method applied for reproducibility testsmulti-detail phantoms, cloud automatic software tool to measure multiple image quality indices and statistical process control-was proven to be effective and applicable on a large scale and to any type of digital mammography system. Key Points • Reproducibility of mammography image quality should be monitored by appropriate quality controls. • Use of automatic software tools allows image quality evaluation by multiple indices. • System reproducibility can be assessed comparing current index value with baseline data. • Overall system reproducibility of modern digital mammography systems is excellent. • The method proposed and applied is cost-effective and easily scalable.
A simple phantom for periodic quality control measurement on full field digital mammography syste... more A simple phantom for periodic quality control measurement on full field digital mammography systems has been developed. It was employed with three different digital mammography units, by collecting data on detector linearity and uniformity, image contrast and spatial resolution, reproducibility of detector and automatic exposure control device. Results show the phantom is able to give information about some detector characteristics and can detect problems related to the stability of the automatic exposure control system. It is also fast and easy to use, as required in a quality assurance program.
Poster: "ECR 2015 / C-1576 / Impact of objective volumetric breast density estimates on mean... more Poster: "ECR 2015 / C-1576 / Impact of objective volumetric breast density estimates on mean glandular dose calculations in digital mammography" by: "G. Gennaro1, I. Sechopoulos2, L. Gallo3, V. Rossetti4, R. Highnam5; 1Padova/IT, 2Atlanta, GA/US, 3Castelfranco Veneto/IT, 4Torino/IT, 5Wellington/NZ"
Supplement to: Fisica in medicina, 2004, 2. - Printed from http://www.aifm.it target=NewWindow>... more Supplement to: Fisica in medicina, 2004, 2. - Printed from http://www.aifm.it target=NewWindow>www.aifm.it (February 2005)Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 , Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal
e20574 Background: Recent evidences have suggested potential applications of radiomics in early d... more e20574 Background: Recent evidences have suggested potential applications of radiomics in early diagnosis, prognostic stratification and treatment outcome prediction of Non-Small Cell Lung Cancer (NSCLC) patients. The purpose of this study is to evaluate the ability of radiomic analysis to discriminate between different clinical-pathological conditions in patients with stage III NSCLC. Methods: Baseline CT studies from 59 patients with stage III NSCLC referred to our Institution from 2010 and 2020 were retrospectively reviewed, and the segmentation of the main lung lesion and the extraction of 517 radiomic features performed using a commercial software. The number of features was reduced to 46 by means of principal component analysis applied using the R package “RadAR” (Radiomics Analysis with R). The Kruskal-Wallis test was applied to all the radiomic features in order to evaluate which of them can discriminate between 7 clinical dichotomous characteristics: tumor stage, type, pres...
Objective To evaluate the effectiveness of a new algorithm developed to reduce artifacts in dual-... more Objective To evaluate the effectiveness of a new algorithm developed to reduce artifacts in dual-energy subtraction (DES) contrast-enhanced mammography (CEM) images while preserving contrast enhancement of possible lesions. Methods A retrospective multi-reader paired study was performed by using 134 CEM studies obtained from the first 134 women enrolled in a prospective clinical study aiming to compare the clinical performance of CEM to those of breast MRI in screening of women at increased risk of breast cancer. Four experienced readers compared independently the standard (STD) DES images with those obtained by reprocessing the raw images by a new algorithm (NEW), expected to reduce the DES artifact intensity. The intensity of three types of artifacts (breast-in-breast, ripple, and skinfold enhancement) and the intensity of possible contrast uptake were assessed visually and rated using a categorical ordinal scale. Proportions of images rated by the majority of readers as “Absent”,...
In this study we used a large previously built database of 2,892 mammograms and 31,650 single mam... more In this study we used a large previously built database of 2,892 mammograms and 31,650 single mammogram radiologists’ assessments to simulate the impact of replacing one radiologist by an AI system in a double reading setting. The double human reading scenario and the double hybrid reading scenario (second reader replaced by an AI system) were simulated via bootstrapping using different combinations of mammograms and radiologists from the database. The main outcomes of each scenario were sensitivity, specificity and workload (number of necessary readings). The results showed that when using AI as a second reader, workload can be reduced by 44%, sensitivity remains similar (difference -0.1%; 95% CI = - 4.1%, 3.9%), and specificity increases by 5.3% (P<0.001). Our results suggest that using AI as a second reader in a double reading setting as in screening programs could be a strategy to reduce workload and false positive recalls without affecting sensitivity.
... BALDAN, ELISA-BETTA BEZZON, COSIMO DI MAGGIO, MANUELA LA GRASSA, ILA-RIA POLICO, ALESSANDRO P... more ... BALDAN, ELISA-BETTA BEZZON, COSIMO DI MAGGIO, MANUELA LA GRASSA, ILA-RIA POLICO, ALESSANDRO PROIETTI, AIDA TOFFOLI hy ... Il rilevamento tomografico consente di fatto di apprez-zare isolatamente le lesioni che più soffrono della so-vrapposizione e ...
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