Design, Fabrication, and Evaluation of a Patient-Derived 3D-Printed Anthropomorphic Breast Phantom for Performance Evaluation of Dual-Energy Subtraction in Contrast-Enhanced Mammography

An anthropomorphic patient-derived 3D-printed breast phantom (4.8 cm compressed thickness, 12.2% volumetric breast density) was evaluated for image-quality assessment in contrast-enhanced mammography (CEM). It comprises four 1.2 cm plates printed via fused filament fabrication (PLA/ABS). Five replicates of one of the plates (target) containing a glandular-tissue surrogate and four cavities for iodinated disks with same iodine area density per plate (0.2–0.5–0.75–1.0–1.5 mg/cm2) were fabricated. As a reference, a homogeneous PET-G phantom was printed. CEM images (low-energy (LE), high-energy (HE), and DES) were acquired in three different systems. Iodine signal linearity (mean pixel value, signal difference, signal-difference-to-noise ratio (SdNR)) and background cancellation (residual signals, texture cancellation coefficient (TCC), parameter β from noise power spectrum (1D-NPS)) were estimated. Evaluation across the three systems demonstrated the phantom provides appropriate measurements of iodine signal linearity (R2 > 0.986, based on mean values across the four inserts) and background cancellation (TCC:0.04–0.11). Fitting 1D-NPS = αf−β within 0.25–1.0 mm−1 yielded β values ≈ 3.1–4.0, compatible with the literature, for patient LE and HE images, whereas DES reduced β to ≈1.1. In the homogeneous phantom, β remained invariant between LE and DES images (β ≈ 0.6). The local glandular ratio at each position of the iodinated disks enabled evaluating the impact of background on iodine signal.