Radiologist Evaluation of an X-ray Tube-Based Diffraction-Enhanced Imaging Prototype Using Full-Thickness Breast Specimens

Laura Faulconer, Chris A. Parham, Dean M. Connor, Zhong Zhong, Eunhee Kim, Donglin Zeng, Chad A. Livasy, Elodia Cole, Cherie Kuzmiak, Marcia Koomen, Dag Pavic, Etta D. Pisano

Research output: Contribution to journalArticleOtherpeer-review

32 Citations (Scopus)


Rationale and Objectives: Conventional mammographic image contrast is derived from x-ray absorption, resulting in breast structure visualization due to density gradients that attenuate radiation without distinction between transmitted, scattered, or refracted x-rays. Diffraction-enhanced imaging (DEI) allows for increased contrast with decreased radiation dose compared to conventional mammographic imaging because of monochromatic x-rays, its unique refraction-based contrast mechanism, and excellent scatter rejection. However, a lingering drawback to the clinical translation of DEI has been the requirement for synchrotron radiation. Materials and Methods: The authors' laboratory developed a DEI prototype (DEI-PR) using a readily available tungsten x-ray tube source and traditional DEI crystal optics, providing soft tissue images at 60 keV. Images of full-thickness human breast tissue specimens were acquired on synchrotron-based DEI (DEI-SR), DEI-PR, and digital mammographic systems. A panel of expert radiologists evaluated lesion feature visibility and correlation with pathology after receiving training on the interpretation of refraction contrast mammographic images. Results: For mammographic features (mass, calcification), no significant differences were detected between the DEI-SR and DEI-PR systems. Benign lesions were perceived as better seen by radiologists using the DEI-SR system than the DEI-PR system at the [111] reflectivity, with generalizations limited by small sample size. No significant differences between DEI-SR and DEI-PR were detected for any other lesion type (atypical, cancer) at either crystal reflectivity. Conclusions: Thus, except for benign lesion characterizations, the DEI-PR system's performance was roughly equivalent to that of the traditional DEI system, demonstrating a significant step toward clinical translation of this modality for breast cancer applications.

Original languageEnglish
Pages (from-to)1329-1337
Number of pages9
JournalAcademic Radiology
Issue number11
Publication statusPublished - Nov 2009
Externally publishedYes


  • breast cancer
  • Diffraction-enhanced imaging
  • phase contrast
  • reader study
  • synchrotron

Cite this