Combined Digital X-Ray, Optical, and Ultrasound Breast Imaging

描述（由申请人提供）：在未来十年，乳腺癌筛查可能是x射线、超声（US）和/或光学成像的某种组合，如果这种组合能够有效地进行的话。为了实现这一目标，提出了一种概念验证的多模态系统，其中x射线，US和光学乳房图像都是在相同的乳房x线摄影几何中获得的，从而可以直接将US和光学图像的复杂模式与3D版乳房x线摄影，数字断层合成乳房x线摄影（DTM）中的模式进行比较，从其与乳房x线摄影的相似性来看，这是一个非常丰富的经验。据推测，有了这个系统，不仅可以获得乳房x线摄影/超声/光学共定位的直接好处，而且还可以从这些模式的组合中获得卓越的图像质量和诊断信息。光谱光声层析成像（S-PAT）是一种很有前途的成像方法，具有红光和近红外光吸收提供的对比度，以及来自US换能器的热声信号检测提供的高分辨率和灵敏度。这些换能器将是专门的，宽带阵列允许合成孔径形成。进一步增强灵敏度的是乳房两侧压缩后的短光路长度。内源性造影剂、氧和脱氧血红蛋白的高分辨率成像的潜力，以及未来靶向外源性光学造影剂的潜力，值得我们进行大量的开发和研究。该系统将S-PAT的内源性对比成像带入实际测试，与最先进的竞争和互补成像模式相一致，包括与S-PAT比较的美国彩色血流多普勒成像。目前BRP中的x射线DTM系统提供的功能远远超过其他研究和临床原型。这个组合系统中的超声波达到了产生与x射线基本相同的良好图像的目标，并且具有良好的患者接受度。自首次提交此更新提案以来，已对压缩乳房自动超声扫描的实际临床性能进行了研究。随着所提出的倾斜网格压缩桨和有效的声学耦合凝胶分配系统的发展，这些问题应该得到很好的解决。随着这些进一步的发展，该系统将准备好解决一个非常严肃的问题，即使用该系统的前两种模式，DTM和自动US （AUS）进行乳腺癌筛查的可行性。建议在第二年开始进行一项大型初步试验，以证明联合系统频繁研究的可行性，并在一项回调丰富的筛查研究中评估以下问题：1)联合DTM/AUS是否会比传统乳房x线摄影筛查导致更少的回调；2)联合系统的灵敏度是否会从典型现代乳房x光检查的72%的历史比率显著提高。

DESCRIPTION (provided by applicant): In the next decade, breast cancer screening will likely be some combination of x-ray, ultrasound (US) and/or optical imaging, if this combination can be performed efficiently. Towards this goal, a proof-of-concept multimodality system is proposed in which, x-ray, US and optical breast images are all acquired in the same mammographic geometry, making it possible to directly compare the complex patterns of the US and optical images with those patterns in a 3D version of mammography, digital tomosynthesis mammography (DTM), where there is, from its similarity with mammography, a great wealth of experience. It is hypothesized that with this system, not only will it be possible to reap the direct benefits of mammographic/US/optical co-localization but also to achieve superior image quality and diagnostic information from the combination of these modes. Spectroscopic photoacoustic tomography (S-PAT) is a promising imaging approach, with contrast provided by red and near infrared light absorption and with high resolution and sensitivity provided by the thermoacoustic signal detection from US transducers. These transducers will be specialized, broadband arrays allowing for synthetic aperture formation. Further enhancing sensitivity will be the short optical path lengths from both, compressed, sides of the breast. The potential for high resolution imaging of endogenous contrast, oxy and deoxy-hemoglobin, and, in the future, of targeted exogenous optical contrast agents warrants the substantial development and investigation that is proposed. This system brings the endogenous contrast imaging of S-PAT to practical test, coincident with state-of-the-art competitive and complimentary imaging modes, including US color flow Doppler imaging for comparison with S-PAT. The x-ray DTM system in the current BRP offers capabilities well beyond those of other research and clinical prototypes. The ultrasound in this combined system is meeting the goal of producing good images in essentially the same view as the x-rays and with good patient acceptance. Since the first submission of this renewal proposal, several concerns about the practical clinical performance of automated US scanning of the compressed breast have been investigated. They should be well resolved with the developments of a proposed tilting mesh compression paddle and an efficient acoustic coupling gel distribution system. With these further developments, the system will be ready to address a very serious question, the feasibility of using the first two modes of this system, DTM and automated US (AUS), for breast cancer screening. A large preliminary trial is proposed starting in the second year to demonstrate feasibility of frequent studies with the combined system and to evaluate the following questions in a callback-enriched screening study: 1) whether combined DTM/AUS will result in fewer callbacks than conventional mammography screening; and 2) whether the sensitivity of the combined system will increase significantly from the 72% historical rate for typical modern mammography practice. PUBLIC HEALTH RELEVANCE: The near future of breast imaging includes a 3D version of mammography (digital tomosynthesis mammography or DTM) in combination with ultrasound imaging. This project will marry DTM and mammography to automated ultrasound scanning and a new, optical imaging method "spectroscopic photoacoustic tomography", producing a combined system that will allow rapid comparison of any tissues in one image volume with the corresponding location in the other two image volumes. The system will be tested in simulated screening for provision of increased sensitivity to cancer with fewer unnecessary recalls for further imaging and biopsies.