Willi A. Kalender PhD, Presenter: Consultant, Siemens AG Consultant, Bayer AG Founder, CT Imaging GmbH Scientific Advisor, CT Imaging GmbH CEO, CT Imaging GmbH

Daniel Kolditz PhD, Abstract Co-Author: Employee, CT Imaging GmbH

Ann-Christin Roessler MSc, Abstract Co-Author: Nothing to Disclose

Christian Steiding MSc, Abstract Co-Author: Employee, CT Imaging GmbH

Evelyn Wenkel MD, Abstract Co-Author: Nothing to Disclose

Ruediger Schultz-Wendtland, Abstract Co-Author: Nothing to Disclose

There is general consensus that computed tomography (CT) can provide good soft-tissue discrimination and dynamic contrast-enhanced studies of the breast, but with insufficient spatial resolution and dose values exceeding the limits set for screening examinations. We re-evaluated if this assumption still holds true for an innovative high-resolution breast CT (bCT) system.

We compared the performance of a bCT prototype (CT Imaging GmbH, Erlangen, Germany) to two clinical systems of two different manufacturers for each digital mammography (DM) and breast tomosynthesis (BT) with respect to detectability of the structures presented by the American College of Radiology (ACR) accreditation phantom. bCT examines one breast at a time with the patient lying prone on the patient bed without exposing the body trunk. The prototype employs a new cadmium telluride detector with 100 µm pixel size, single photon counting electronics and close to 100% detection efficiency [Kalender WA et al. Eur Radiol 2012; 22(1):1-8]. The tests focused on the question if fibers down to 0.75 mm, masses down to 0.50 mm, and specks down to 0.24 mm were clearly distinguished as recommended by the ACR. Tests were also performed to determine image quality and dose. We did not add overlaying structures, which would be potentially confounding the ACR structures for DM and BT.

Acceptance testing for all 5 systems confirmed that they met the requirements for screening mammography; the bCT system provided better than 100 µm spatial resolution at average glandular dose levels below 5 mGy. Measurements of the ACR phantom revealed the following: DM and BT showed fibers, masses and specks as required; bCT went beyond this and revealed even the finest structures presented in the ACR phantom, i.e. fibers of 0.4 mm, masses of 0.25 mm and specks of 0.16 mm.

Fully 3D high-resolution breast CT showed performance superior to DM and BT, even in the benevolent situation with no confounding structures superimposed. Smaller structures may have to be introduced in test phantoms to provide adequate tests for finer details.

High-resolution breast CT appears to offer potential for superposition-free fully 3D imaging of the breast at improved detail resolution and dose levels accepted for screening procedures.

Kalender, W, Kolditz, D, Roessler, A, Steiding, C, Wenkel, E, Schultz-Wendtland, R, Dedicated High-resolution Breast CT Can Outperform Digital Mammography and Breast Tomosynthesis at Equivalent Dose Levels.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13021617.html