First contrast-enhanced mammography unit integrated with a dual-layer flat-panel-detector

To eliminate motion artifacts in dual-shot (DS) contrast-enhanced (CE) breast imaging, a direct-indirect dual-layer flat-panel- detector (DLFPD) has been developed. It acquires spatio-temporally aligned low-energy (LE) and high-energy (HE) images using a single x-ray exposure, with the spectrum shaped by a K-edge filter. In this work, we integrated a DLFPD prototype and a silver K-edge filter into a clinical mammography system. Image acquisition and post-processing pipelines were developed and implemented for CE digital mammography (CEDM) and digital breast tomosynthesis (CEDBT). A 4 cm BR3D phantom with embedded iodine objects was imaged to evaluate lesion detectability relative to a DS-based system. Projective transformation matrices derived from a registration phantom enabled robust LE/HE image alignment. Modulation transfer function (MTF) matching further suppressed inter-layer misalignment artifacts. DL-based lesion detectability exceeded DS performance with motion artifacts and approached ideal motion-free DS results. Detection of the smallest, lowest-contrast target was limited by image blur and high quantum noise in the HE images, which may be improved by task-specific MTF matching or deep learning-based deblurring and denoising. These results demonstrate the feasibility of a DL-based CE breast imaging system and highlight its promise for clinical translation.