Breast shape estimation and correction in CESM biopsy

Description of purpose: Contrast-enhanced spectral mammography can be used to guide needle biopsies. However, in vertical approach the compressed breast is deformed generating a so-called bump in the paddle aperture, which may interfere with the visibility of contrast-uptakes. Local thickness estimation would provide an enhanced image quality of the recombined image, increasing the visibility of the contrast-uptakes to be targeted during the biopsy procedure. In this work we propose a method to estimate the shape of the breast bump in biopsy vertical approach. Materials and Methods: Our method consists on two steps: first, we compute a raw thickness which does not take into account the presence of contrast-uptakes; second, we use a physical model to separate the sparse iodine texture from the breast shape. This physical model is composed by a sum of Fourier components, describing the main shape of the bump, a series of low-order polynomials, describing the main compressed thickness, paddle tilt and deflection, and non-linear components describing the translation and rotation of the paddle aperture. A 3D object mimicking a bump was fabricated to test the pertinence of our shape model. Also, clinical images of 21 patients which followed CESM-guided biopsy were visually assessed. Results: Comparison between raw and final estimated thickness of our 3D test object shows an error standard deviation of 0.37 mm similar to the noise standard deviation equals to 0.32 mm. The visual assessment of clinical cases showed that the thickness correction removes the superimposed low-frequency pattern due to non-uniform thickness of the bump, improving the identification of the lesion to be targeted. Conclusion: The proposed method for thickness estimation is adapted to CESM-guided biopsies in vertical approach and it improves the identification of the contrast-uptakes that need to be targeted during the procedure.