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In considering a breast CT system, it is important to note that the spectral attenuation profile of a tumor is very similar to that of fibro-glandular tissue. Preliminary evidence based on imaging breast specimens suggest that the CT number of a malignant breast tumor is very similar to that of surrounding fibro-glandular tissue. Therefore, it is expected that radiologists will probably rely more on tumor morphology to distinguish a malignant tumor from fibro-glandular tissue than an increase in contrast per se. Previous studies have shown that iodinated contrast agents can increase the effective attenuation coefficient yielded by a breast tumor thereby providing increased CT tumor contrast. In order to characterize how the intravenous administration of an iodinated contrast agent can affect the performance of CT breast imaging, a computer simulation of such a system was conducted. The two primary goals of this investigation were first to determine how mean glandular dose, choice of x-ray energy spectrum, and iodine contrast agent density affect tumor detection, and second to determine what effect Compton and Rayleigh scattering have on the variability of the attenuation coefficient yielded by CT mammography. The first goal was achieved by making use of a modified version of the Bakic (Med. Phys. 2003) digital breast phantom to model the uncompressed breast, and a 0.5 cm sphere representing a breast tumor was digitally inserted into the ductal region of this phantom. Several projection sets were generated with the tumor containing various densities of iodine contrast agent, different x-ray energy spectra, and different mean glandular dosage (MGD) levels . Slices through the tumor were extracted from the reconstructions of these projections and were used in human observer studies to determine tumor detectability. The second goal was achieved by using the GATE (Geant 4 Application for Tomographic Emission) Monte-Carlo software package to compute the scattering incident on the flat panel detector for an x-ray projection, then using the aforementioned Bakic phantom, a 0.5 cm sphere representing a breast tumor attenuation and a 3.0 mg/ml of Iodinated contrast agent were inserted at various locations with varying attenuation for 100 projection sets with scatter, and 100 projections without scatter. Histograms of the resulting effective attenuation coefficients yielded by Feldkamp filtered backprojection were plotted and compared.
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