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Artifacts Caused by Breast Tissue Markers in a Dedicated Cone-beam Breast CT in Comparison to Full-field Digital Mammography

Posted Jun 30, 2017 Updated Apr 10, 2023
By Susanne Wienbeck MD , Carsten Nowak PhD , Antonia Zapf PhD , Georg Stamm PhD , Christina Unterberg-Buchwald MD , Joachim Lotz MD , Uwe Fischer MD
9 min read

Rationale and Objectives

The purpose of this ex vivo study was to investigate artifacts in a cone-beam breast computed tomography (CBBCT) caused by breast tissue markers.

Materials and Methods

Breast phantoms with self-made tissue pork mincemeat were created. Twenty-nine different, commercially available markers with varying marker size, composition, and shape were evaluated. A dedicated CBBCT evaluation of all phantoms was performed with 49 kVp, 50 and 100 mA, and marker orientation parallel and orthogonal to the scan direction. The resultant images were evaluated in sagittal, axial, and coronal view with a slice thickness of 0.5 mm. Additionally, measurements of all markers in the same directions were done with full-field digital mammography.

Results

All markers were visible in full-field digital mammography without any artifacts. However, all markers caused artifacts on a CBBCT. Artifacts were measured as the length of the resulting streakings. Median length of artifacts was 7.2 mm with a wide range from 0 to 48.3 mm (interquartile range 4.3–11.4 mm) dependent on composition, size, shape, weight, and orientation of the markers. The largest artifacts occurred in axial view with a median size of 12.6 mm, with a range from 0 to 48.3 mm, resulting in a relative artifact length (quotient artifact in mm/real physical length of the marker itself) of 4.1 (interquartile range 2.3–6.1, range 0–8.7).

Conclusions

Artifacts caused by markers can significantly influence image quality in a CBBCT, thus limiting primary diagnostics and follow-up in breast cancer. The size of the artifacts depends on the marker characteristics, orientation, and the image plane of reconstruction.

Introduction

The dedicated cone-beam breast computed tomography (CBBCT) designed by Koning Corporation (West Henrietta, NY) is the first commercially available breast CT scanner. First studies reported that CBBCT can significantly improve the detection of breast masses and microcalcifications . This is owing to its high spatial and contrast resolution, and the potential of reconstruction of three-dimensional (3D) information from a series of two-dimensional images .

The CBBCT system is a new and promising diagnostic technique for breast imaging and CT-guided interventions. The CT-guided system is an add-on device for the diagnostic CBBCT. All lesions requiring an image-guided biopsy not visible on magnetic resonance imaging (MRI) or ultrasonography can be biopsied under CT guidance instead of stereotactic biopsy.

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Materials and Methods

Breast Tissue Markers and Breast Phantom

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Figure 1, Photographic, mammographic, and cone-beam breast computed tomography (CBBCT) in axial view of the different breast tissue markers. Mammographic and CBBCT illustrations with scale.

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Assessment of Samples

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Figure 2, (a) Side view: Computed tomography (CT) gantry of a cone-beam breast CT with a flat panel detector on the left side ( arrow ) and an X-ray tube on the right side. The transparent safety cover with the breast tissue phantom is in the middle. The different markers were positioned separately within the central third of tissue depth into the breast tissue phantom. The imaging plane in coronal view (a) was marked with a black line, orthogonal to the detector plane. (b) Top view: a transparent safety cover is around the breast tissue phantom in the middle. The imaging plane in axial (b) and sagittal views (c) were marked with black lines. The different markers were positioned separately within the central third of tissue depth into the breast tissue phantom.

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Figure 3, Comparison of streak artifacts surrounding the breast tissue marker inserted in a breast tissue phantom on full-field digital mammography (FFDM) and cone-beam breast computed tomography (CBBCT). Photographic illustration of the marker, Somatex Tumark Professional (a) and after using energy-dispersive X-ray spectroscopy (EDX) (b) . Mammographic illustration of the marker in a parallel marker orientation (c) . With the same marker orientation (parallel) and a tube current of 100 mA in a CBBCT, its artifacts are shown in axial (d) , coronal (e) , and sagittal views (f) . The maximal size of artifacts was 48.3 mm in axial, 20.3 mm in coronal, and 15.3 mm in sagittal view.

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Assessment of Artifacts

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Statistical Analysis

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Results

Study Collective

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Effect of Marker Composition

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TABLE 1

Detail Information of the Manufacturers of the Different Breast Tissue Markers

Marker Group Size Distributing Company Bioresorbable Embedding Material Material Composition Shape Metallic marker TriMark for Eviva/ATEC 9G Hologic — Titanium Cork Tumark Professional 18G Somatex — Nitinol “U” shaped Tumark Q 18G Somatex — Nitinol “Q” shaped O-Twist-Marker 18G BIP — Nitinol Ring UltraClip 17G Bard — Titanium

BioDur 108

(nickel free) Ribbon

Coil Combined (metallic marker with non-metallic coating) SecurMark for Eviva 9G Hologic Glycoprene suture-like netting Titanium Top hat

Mini cork MammoMARK 8G Mammotome Bioresorbable collagen pad Titanium Bowtie 10G 11G 14G HydroMARK 8G Mammotome PEG based hydrogel pellets Stainless steel and titanium Open coil

Butterfly

Barrel 9G 11G 12G 13G 15G SenoMark 11G Bard 3 PGA pads Titanium

316L stainless steel “O” shaped

M-form 14G Gel Mark Ultra 11G Bard 10 PLA/PGA pellets and one radiopaque marker 316L stainless steel Omega StarchMark 10G Bard 6 polysaccharide pellets and 1 PLA/PGA with radiopaque marker 316L stainless steel Omega UltraClip Dual Trigger 17G Bard non-absorbable polyvinyl acetate polymer BioDur 108 (nickel free) Coil Non-metallic marker MammoSTAR 10G Mammotome Beta glucan Carbon-coated zirconium oxide Barbell 11G 14G

PEG, polyethylenglycol; PGA, polyglycolic acid; PLA, polylactic acid.

The markers were divided into metallic markers, combined markers, and non-metallic markers.

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Figure 4, Comparison of the size of the artifacts relative to the maximal length of the marker in the three different marker groups. Group 1—metallic marker; group 2—combined marker (metallic marker with non-metallic coating); group 3—non-metallic marker. By tendency, the artifacts caused by the combined markers were smaller than the artifacts caused by the other groups ( P values: overall = .02, group 1 vs. group 2 = .048, group 1 vs. group 3 = .323, group 2 vs. group 3 = .049).

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Effect of Marker Orientation and Dosage

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Figure 5, (a) Comparison of the size of the artifacts relative to the maximal length of the marker in the two different marker orientations (parallel and orthogonal). All imaging planes were used to determine the artifact size. An increase in the size of artifacts was measured if the marker orientation was parallel to the scan direction ( P < .01). (b) Comparison of the size of the artifacts relative to the maximal length of the marker in the three different imaging planes (axial, coronal, and sagittal). Both marker orientations (parallel and orthogonal) were used to determine the artifact size. The largest artifacts occurred in an image analysis in axial view ( P values of all pairwise comparisons: <.01).

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TABLE 2

Comparative Analysis of the Different Artifact Sizes Relative to the Length of All the Breast Tissue Markers in the Imaging Planes (Axial, Coronal, and Sagittal) and the Marker Orientation (Orthogonal and Parallel)

Imaging Planes Marker Orientation Artifact Size (mm) Median IQR Range_P_ Value Axial Orthogonal 5.1 2.9–8.6 0–8.7 <.01 Parallel 3.4 1.8–4.7 0–6.2 Coronal Orthogonal 4.0 2.6–4.6 0–6.6 .03 Parallel 3.2 2.0–4.0 0–5.8 Sagittal Orthogonal 2.0 0.9–3.1 0–4.4 .01 Parallel 1.6 0–2.2 0–4.5

IQR, interquartile range.

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Effect of Marker Size, Shape, and Weight

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Figure 6, Comparison of the size of artifacts relative to the maximal length of the marker for the different marker shapes. The median artifact size tended to be the smallest with the ring-shaped marker (2.5), was second lowest with the straight open marker tube (3.1), and were the greatest with the straight closed marker tube (3.4) (overall P value 0 = .44, ring vs. straight open P = .95, ring vs. straight closed P = .44, straight open vs. straight closed P = .23).

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Discussion

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Acknowledgment

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Academic Radiology, Volume 24, Issue 7
Journals General Radiology
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