Towards order of magnitude X-ray dose reduction in breast cancer imaging using phase contrast and deep denoising

Breast cancer is the most frequently diagnosed human cancer in the United States at present. Early detection is crucial for its successful treatment. X-ray mammography and digital breast tomosynthesis are currently the main methods for breast cancer screening. However, both have known limitations in terms of their sensitivity and specificity to breast cancers, while also frequently causing patient discomfort due to the requirement for breast compression. Breast computed tomography is a promising alternative, however, to obtain high-quality images, the X-ray dose needs to be sufficiently high. As the breast is highly radiosensitive, dose reduction is particularly important. Phase-contrast computed tomography (PCT) has been shown to produce higher-quality images at lower doses and has no need for breast compression. It is demonstrated in the present study that, when imaging full fresh mastectomy samples with PCT, deep learning-based image denoising can further reduce the radiation dose by a factor of 16 or more, without any loss of image quality. The image quality has been assessed both in terms of objective metrics, such as spatial resolution and contrast-to-noise ratio, as well as in an observer study by experienced medical imaging specialists and radiologists. This work was carried out in preparation for live patient PCT breast cancer imaging, initially at specialized synchrotron facilities.