Dose optimization for dual-energy contrast-enhanced digital mammography based on an energy-resolved photon-counting detector: A Monte Carlo simulation study

Dual-energy contrast-enhanced digital mammography (CEDM) has been used to decompose breast images and improve diagnostic accuracy for tumor detection. However, this technique causes an increase of radiation dose and an inaccuracy in material decomposition due to the limitations of conventional X-ray detectors. In this study, we simulated the dual-energy CEDM with an energy-resolved photon-counting detector (ERPCD) for reducing radiation dose and improving the quantitative accuracy of material decomposition images. The ERPCD-based dual-energy CEDM was compared to the conventional dual-energy CEDM in terms of radiation dose and quantitative accuracy. The correlation between radiation dose and image quality was also evaluated for optimizing the ERPCD-based dual-energy CEDM technique. The results showed that the material decomposition errors of the ERPCD-based dual-energy CEDM were 0.56-0.67 times lower than those of the conventional dual-energy CEDM. The imaging performance of the proposed technique was optimized at the radiation dose of 1.09 mGy, which is a half of the MGD for a single view mammogram. It can be concluded that the ERPCD-based dual-energy CEDM with an optimal exposure level is able to improve the quality of material decomposition images as well as reduce radiation dose.