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

描述(申请人提供)：在接下来的十年中，乳腺癌筛查很可能是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执行的话。为此，提出了一种概念验证多模式系统，在该系统中，X光、US和光学乳房图像都在相同的乳房X光摄影几何图形中获取，使得有可能直接将美国和光学图像的复杂图案与3D版本的乳房X光摄影、数字断层合成乳房X光摄影(DTM)中的这些图案进行比较，其中从其与乳房X光摄影的相似性来看，存在着大量丰富的经验。据推测，有了这个系统，不仅可以获得乳房X光/US/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，它通过红光和近红外光的吸收提供对比度，并通过超声换能器的热声信号检测提供高分辨率和高灵敏度。这些换能器将是专门的宽带阵列，允许形成合成孔径。进一步提高灵敏度的将是乳房压缩两侧的短光路长度。内源性造影剂、氧合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，值得我们进行实质性的开发和研究。该系统对S-帕特的内源性对比成像进行了实际测试，与最先进的竞争和互补成像模式相吻合，包括与S-帕特进行比较的美国彩色血流多普勒成像。目前BRP中的x射线DTM系统提供的能力远远超过其他研究和临床原型。这种组合系统中的超声波达到了目标，即在基本上与X射线相同的视角下产生良好的图像，并具有良好的患者接受性。自从第一次提交这项更新建议以来，关于自动US扫描压缩乳房的实际临床性能的几个问题已经被调查。随着倾斜网状压缩桨和高效声学耦合凝胶分布系统的开发，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重的问题，即使用该系统的前两种模式DTM和自动化US(AUS)进行乳腺癌筛查的可行性。建议从第二年开始进行一项大型的初步试验，以证明使用联合系统进行频繁研究的可行性，并在回调丰富的筛查研究中评估以下问题：1)联合DTM/AUS是否会导致比传统乳房X光检查更少的回叫；以及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%的历史比率大幅提高。 与公众健康相关：在不久的将来，乳房成像包括3D版本的乳房X光检查(数字断层合成乳房X光检查或DTM)与超声成像相结合。该项目将DTM和乳房X光摄影与自动超声波扫描和一种新的光学成像方法“光谱光声断层成像”相结合，产生一个组合系统，使一个图像体积中的任何组织能够与其他两个图像体积中的相应位置进行快速比较。该系统将在模拟筛查中进行测试，以提高对癌症的敏感性，并减少进一步成像和活组织检查的不必要召回。

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.