Systems and methods for measuring the deflection of foam breast compression paddles

Abstract

A method for imaging a breast compressed with a foam paddle includes emitting X-ray energy from an X-ray source toward the breast and a foam paddle having a plurality of upper markers and a plurality of lower markers, the plurality of lower markers being movable relative to the upper marker. The X-ray energy is detected at a detector positioned on an opposite side of the breast from the X-ray source. An image of the compressed breast is generated based on the detected X-ray energy. At least one of the plurality of upper markers and at least one of the plurality of lower markers are identified in the image. A thickness of the compressed breast is determined at a plurality of thickness locations, each of the plurality of thickness locations corresponding to at least one of the plurality of lower markers.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application was filed on March 22, 2021 as a PCT international patent application, the entire disclosure of which is incorporated by reference in its entirety, and claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 000,790, filed on March 27, 2020. [Background technology]

[0002] One known challenge in mammography and breast tomosynthesis is the discomfort that a patient may feel when the breast is compressed, which must be done with enough force to immobilize the breast and spread the breast tissue for x-ray imaging. The discomfort can potentially displace the patient, which negatively impacts image quality. The discomfort can potentially deter a patient from being screened for breast cancer. Another known challenge is ensuring that the imaging field contains the desired amount of breast tissue. This discomfort has led to the development of compression paddles with flexible features (e.g., plastic sheets, flexible mesh, foam compression materials, etc.). These flexible materials present unique challenges with respect to properly imaging the breast. In existing imaging systems that utilize flat rigid compression paddles, the thickness of the compressed breast can be fairly easily determined by measuring or calculating the height of the compression paddle above the breast support platform. However, the use of flexible materials to stabilize the breast makes such simple calculations impossible. Summary of the Invention [Means for solving the problem]

[0003] In one aspect, the technology relates to a method of imaging a breast compressed with a foam paddle, the method including emitting x-ray energy from an x-ray source toward the breast and a foam paddle having a plurality of upper markers and a plurality of lower markers, the plurality of lower markers being movable relative to the upper markers, detecting the x-ray energy at a detector disposed on an opposite side of the breast from the x-ray source, generating an image of the compressed breast based on the detected x-ray energy, identifying at least one of the plurality of upper markers and at least one of the plurality of lower markers in the image, and determining a thickness of the compressed breast at a plurality of thickness locations, each of the plurality of thickness locations corresponding to at least one of the plurality of lower markers. In one example, determining the thickness includes calculating a distance between a first upper marker of the plurality of upper markers and a first lower marker of the plurality of lower markers adjacent on the image in the image. In another example, determining the thickness includes determining a characteristic of at least one lower marker of the plurality of lower markers in the image. In yet another example, determining the thickness includes calculating a distance between a first upper marker of the plurality of upper markers and a second upper marker of the plurality of upper markers in the image. In yet another example, determining the thickness includes calculating a distance between a first lower marker of the plurality of lower markers and a second lower marker of the plurality of lower markers in the image.

[0004] In another example of the above aspect, the x-ray energy includes a scout exposure. In another example, the method further includes calculating an automatic exposure control based at least in part on the thickness determination. In yet another example, the method includes emitting an imaging x-ray energy based at least in part on the calculated automatic exposure control.

[0005] In another example of the above aspect, the method includes modeling a difference in at least two thickness locations of the plurality of thickness locations and applying attenuation to the image based at least in part on the modeled difference.

[0006] In another example of the above aspect, a method includes performing a tomosynthesis imaging procedure, obtaining a set of tomosynthesis images of a compressed breast from the tomosynthesis imaging procedure, and identifying a breast border in at least one tomosynthesis image of the set of tomosynthesis images. In one example, identifying the breast border is based at least in part on a thickness determination. In yet another example, the method includes displaying at least one tomosynthesis image of the set of tomosynthesis images, and displaying a feature indicative of a breast border on the displayed at least one tomosynthesis image of the set of tomosynthesis images. In yet another example, the displayed at least one tomosynthesis image includes a top tomosynthesis image of the breast.

[0007] In another example of the above aspect, the method includes calculating an x-ray imaging dose based at least in part on the determination.

[0008] In another example of the above aspect, the method includes processing the image, identifying at least one reference marker of at least one of the plurality of upper markers and the plurality of lower markers, applying a negative signal to the identified reference marker, the applying resulting in a corrected image, and displaying the corrected image. In another example, applying the negative signal includes adjusting a pixel count at the identified reference marker.

[0009] In another aspect, the technology relates to a paddle for compressing a breast, the paddle including a foam shell having an upper surface, a lower surface, and a front wall, a plurality of upper markers disposed proximate the upper surface, the plurality of upper markers disposed a first distance from the front wall, and a plurality of lower markers disposed proximate the lower surface, the plurality of lower markers disposed a second distance from the front wall. In one example, the paddle includes a rigid substrate, the foam shell is secured to the rigid substrate at the upper surface, and the plurality of upper markers are disposed between the rigid substrate and the foam shell. In another example, the plurality of lower markers are disposed within the foam shell. In yet another example, the plurality of markers are configured to move when the lower surface of the paddle is acted upon by an upward force. In yet another example, the plurality of upper markers are configured to remain stationary when the lower surface of the paddle is acted upon by an upward force. In another example, the paddle includes a bottom foam shell secured to the foam shell, and the plurality of lower markers are disposed between the bottom foam shell and the foam shell. The present specification also provides, for example, the following items: (Item 1) 1. A method of imaging a breast compressed with a foam paddle, the method comprising: emitting x-ray energy from an x-ray source toward the breast and the foam paddle having a plurality of upper markers and a plurality of lower markers, the plurality of lower markers being movable relative to the upper markers; detecting the x-ray energy at a detector positioned on an opposite side of the breast from the x-ray source; generating an image of the compressed breast based on the detected x-ray energy; and identifying at least one of the plurality of upper markers and at least one of the plurality of lower markers in the image; determining a thickness of the compressed breast at a plurality of thickness locations; Including, Each of the plurality of thickness locations corresponds to at least one of the plurality of lower markers. (Item 2) 2. The method of claim 1, wherein determining the thickness includes calculating a distance in the image between a first upper marker of the plurality of upper markers and a first lower marker of the plurality of lower markers adjacent on the image. (Item 3) 2. The method of claim 1, wherein determining the thickness includes determining a characteristic of at least one lower marker of the plurality of lower markers in the image. (Item 4) 2. The method of claim 1, wherein determining the thickness includes calculating a distance between a first upper marker of the plurality of upper markers and a second upper marker of the plurality of upper markers in the image. (Item 5) 2. The method of claim 1, wherein determining the thickness includes calculating a distance between a first lower marker of the plurality of lower markers and a second lower marker of the plurality of lower markers in the image. (Item 6) 2. The method of claim 1, wherein the X-ray energy comprises a scout exposure. (Item 7) 7. The method of claim 6, further comprising calculating an automatic exposure control based at least in part on the thickness determination. (Item 8) 13. The method of claim 1, further comprising emitting imaging x-ray energy based at least in part on the calculated automatic exposure control. (Item 9) modeling a difference in at least two thickness locations of the plurality of thickness locations; applying attenuation to the image based at least in part on the modeled difference; and The method of claim 1, further comprising: (Item 10) performing a tomosynthesis imaging procedure; obtaining a set of tomosynthesis images of the compressed breast from the tomosynthesis imaging procedure; identifying a breast boundary in at least one tomosynthesis image of the set of tomosynthesis images; The method of claim 1, further comprising: (Item 11) 11. The method of claim 10, wherein identifying the breast border is based at least in part on the thickness determination. (Item 12) displaying at least one tomosynthesis image of the set of tomosynthesis images; displaying features indicative of the breast boundary on at least one displayed tomosynthesis image of the set of tomosynthesis images; 12. The method of claim 11, further comprising: (Item 13) Item 13. The method of item 12, wherein the at least one tomosynthesis image displayed comprises a top tomosynthesis image of the breast. (Item 14) 2. The method of claim 1, further comprising calculating an x-ray imaging dose based at least in part on said determining. (Item 15) processing the image; and identifying at least one reference marker of at least one of the plurality of upper markers and the plurality of lower markers; applying a negative signal to the identified fiducial markers, said application resulting in a corrected image; and displaying the corrected image; The method of claim 1, further comprising: (Item 16) Item 16. The method of item 15, wherein applying the negative signal includes adjusting a pixel count at the identified reference marker. (Item 17) A paddle for compressing a breast, said paddle comprising: a foam shell having an upper surface, a lower surface, and a front wall; a plurality of upper markers disposed proximate to the upper surface, the plurality of upper markers disposed a first distance from the front wall; a plurality of lower markers disposed proximate to the lower surface, the plurality of lower markers disposed a second distance from the front wall; Equipped with a paddle. (Item 18) Item 18. The paddle of item 17, further comprising a rigid substrate, the foam shell being secured to the rigid substrate at the upper surface, and the plurality of upper markers being disposed between the rigid substrate and the foam shell. (Item 19) Item 18. The paddle of item 17, wherein the plurality of lower markers are disposed within the foam shell. (Item 20) Item 18. The paddle of item 17, wherein the plurality of markers are configured to move when an underside surface of the paddle is acted upon by an upward force. (Item 21) 21. The paddle of claim 20, wherein the plurality of upper markers are configured to remain stationary when a lower surface of the paddle is acted upon by the upward force. (Item 22) Item 18. The paddle of item 17, further comprising a bottom foam shell secured to the foam shell, the plurality of lower markers being disposed between the bottom foam shell and the foam shell. [Brief description of the drawings]

[0010] [Figure 1A] FIG. 1A is a schematic diagram of an exemplary imaging system.

[0011] [Figure 1B] FIG. 1B is a perspective view of the imaging system of FIG. 1A.

[0012] [Figure 2A] 2A-2C are various views of a breast compression paddle having a foam compression element. [Figure 2B] 2A-2C are various views of a breast compression paddle having a foam compression element. [Figure 2C] 2A-2C are various views of a breast compression paddle having a foam compression element.

[0013] [Figure 2D] FIG. 2D is a front view of the breast compression paddle of FIGS. 2A-2C compressing the breast.

[0014] [Diagram 3] 3A and 3B depict partial side views of an imaging system having a paddle utilizing a foam compression element with markers thereon.

[0015] [Figure 4A] FIG. 4A depicts a partial side view of an imaging system having a paddle utilizing a foam compression element and markers thereon in an uncompressed position.

[0016] [Figure 4B] FIG. 4B depicts a top view of an image of the paddle of FIG. 4A in an uncompressed position.

[0017] [Figure 5A] FIG. 5A depicts a partial side view of the imaging system of FIG. 4A in a compressed position.

[0018] [Figure 5B] FIG. 5B depicts a top view of an image of the paddle of FIG. 5A in a compressed position.

[0019] [Figure 6] FIG. 6 illustrates a method of imaging a breast compressed with a foam paddle.

[0020] [Figure 6A] FIG. 6A illustrates a method for calculating automatic exposure control utilizing breast thickness calculations performed in the method of FIG.

[0021] [Figure 6B] FIG. 6B illustrates a method for uniformizing a compressed breast image utilizing breast thickness calculations performed in the method of FIG.

[0022] [Figure 6C] FIG. 6C illustrates a method of identifying the breast boundary of a compressed breast utilizing breast thickness calculations performed in the method of FIG.

[0023] [Figure 6D] FIG. 6D illustrates a method of calculating x-ray imaging dose for imaging a compressed breast utilizing breast thickness calculations performed in the method of FIG.

[0024] [Figure 6E] FIG. 6E illustrates a method for reducing marker artifacts in compressed breast images utilizing breast thickness calculations performed in the method of FIG.

[0025] [Figure 7] FIG. 7 illustrates an example of a suitable operating environment in which one or more of the present examples may be implemented.

[0026] [Figure 8] FIG. 8 depicts an example of a network in which the various systems and methods disclosed herein may operate. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0027] Paddles utilizing foam compression materials reduce patient discomfort during imaging procedures, which may encourage more women to undergo regular screening, and therefore lead to earlier cancer diagnoses. Due to this improved comfort, patients move less during imaging procedures, which may also lead to improved image outcomes. However, paddles utilizing foam compression materials produce breast shapes that are very different from those of breasts compressed using traditional rigid-type paddles. More specifically, when compressed using foam compression elements, the resulting compressed breast does not have a uniform thickness across the field of view. Thus, while paddles utilizing foam compression elements are more comfortable, such paddles introduce numerous challenges to the way breast imaging systems (e.g., mammography, tomosynthesis, or combined mammography / tomosynthesis systems) employ exposures and produce image quality appropriate for diagnosis.

[0028] The techniques described herein provide a method to accurately measure local breast and foam thickness under the foam compression material throughout the field of view. The techniques contemplate systems and methods to measure local thickness at separate locations below the paddle. With this information about breast thickness throughout the breast known, automatic exposure control (AEC) and x-ray dose can be calculated more accurately. Additionally, image processing and display can also be improved. In the former example, because using a foam compression element results in a breast lacking uniform thickness, the resulting x-ray image would appear non-flat after standard image processing, making it more difficult for a radiologist to review the image. In the latter particular example, accurate measurement of breast thickness allows the breast boundary to be determined, whereby areas outside the boundary (e.g., in separate images of a tomosynthesis image set) can be excluded from subsequent review. Thus, these techniques are important to make paddles utilizing foam compression materials viable.

[0029] FIG 1A is a schematic diagram of an exemplary imaging system 100. FIG 1B is a perspective view of the imaging system 100. Referring to FIGS 1A and 1B in parallel, the imaging system 100 immobilizes a patient's breast 102 for X-ray imaging (either or both mammography and tomosynthesis) via a breast compression immobilization unit 104, which includes a stationary breast support platform 106 and a movable compression paddle 108. The breast support platform 106 and the compression paddle 108 each have compression surfaces 110 and 112, respectively, that move toward each other to compress and immobilize the breast 102. In known systems, the compression surfaces 110, 112 are exposed to directly contact the breast 102. The platform 106 also houses an image receptor 116, and optionally a tilt mechanism 118, and optionally an anti-scatter grid. The immobilization unit 104 is in the path of an imaging beam 120 emanating from an X-ray source 122 such that the beam 120 impinges on the image receptor 116 .

[0030] The immobilization unit 104 is supported on a first support arm 124 and the X-ray source 122 is supported on a second support arm 126. For mammography, the support arms 124 and 126 can rotate as a unit about an axis 128 between different imaging orientations, such as CC and MLO, such that the system 100 can capture mammogram projection images in each orientation. In operation, the image receptor 116 remains in a fixed position relative to the platform 106 while an image is captured. The immobilization unit 104 releases the breast 102 for movement of the arms 124, 126 to a different imaging orientation. For tomosynthesis, the support arm 124 remains in a fixed position with the breast 102 immobilized and remaining in a fixed position, while at least the second support arm 126 rotates the source 122 about the axis 128 relative to the X-immobilization unit 104 and the compressed breast 102. The system 100 captures multiple tomosynthesis projection images of the breast 102 at each angle of the beam 120 relative to the breast 102 .

[0031] Simultaneously, and optionally, the image receptor 116 may be tilted relative to the breast support platform 106 and in synchronization with the rotation of the second support arm 126. The tilting may be through the same angles as the rotation of the x-ray source 122, but through different angles selected such that the beam 120 remains substantially at the same location on the image receptor 116 for each of the multiple images. The tilting may be about an axis 130, which may be, but need not be, in the image plane of the image receptor 116. A tilt mechanism 118, coupled to the image receptor 116, may drive the image receptor 116 in a tilting motion. For tomosynthesis and / or CT imaging, the breast support platform 106 may be horizontal or at an angle to the horizontal (e.g., an orientation similar to that for conventional MLO imaging in mammography). System 100 can be a dedicated mammography system, a dedicated CT system, or a dedicated tomosynthesis system, or a "combo" system capable of performing multiple forms of imaging. An example of such a combo system is promoted by the assignee hereof under the trademark "Selenia Dimensions."

[0032] When the system is operated, image receptor 116 generates imaging information in response to illumination by imaging beam 120 and provides it to image processor 132 for processing and generation of a mammogram. A system control and workstation unit 138, including software, controls the operation of the system and interacts with the operator, receiving commands and delivering information including processed line images.

[0033] One challenge with the imaging system 100 is how to immobilize and compress the breast 102 for the desired or required imaging. A medical professional, typically an x-ray technician, generally adjusts the breast 102 in the immobilization unit 104 and moves the compression paddle 108 toward the breast support platform 106 while pulling the tissue toward the imaging area to immobilize the breast 102 and keep it in place with as much breast tissue as practical between the compression surfaces 110, 112. This can cause discomfort to the patient.

[0034] To improve comfort for patients, compression paddles utilizing foam compression materials have been developed. Compression paddles utilizing foam compression materials are generally described in PCT International Patent Application Nos. PCT / US2019 / 033998, PCT / US2019 / 034001, and PCT / US2019 / 034010, all filed May 24, 2019, the disclosures of which are incorporated herein by reference in their entireties. Such paddles somewhat stabilize and compress the breast while reducing the discomfort associated with compression paddles having only a rigid compression surface.

[0035] 2A-2C are various views of an example of a breast compression paddle 200 having a foam compression element 202 secured to a rigid substrate 204. FIGS. 2A-2C are described in parallel. The paddle 200 includes a bracket portion 206 that is generally integral with the substrate 204 for connecting the paddle to a compression arm of an imaging system. The paddle 200 also includes a leading edge surface 208 opposite the bracket portion 206 that is positioned adjacent to the patient's chest wall during compression and imaging procedures. In an example, the substrate may be rigid. As used herein, the term "rigid" does not mean that the substrate 204 does not bend during breast compression, but rather, the substrate 204 exhibits greater resistance to bending or deformation than a foam compression element 202 secured to the bottom of the substrate 204. The elevated wall 204a provides additional rigidity.

[0036] The foam compression element 202 may be secured to the bottom surface of the substrate 204 with a chemical adhesive. In other examples, the upper surface of the compression element may be a hard plastic or other material to which the foam compression element 202 is secured. A number of bolts, hooks, or other mechanical fasteners (not shown) may be used to connect the hard plastic to the rigid substrate 204 of the paddle 200. If such mechanical fasteners are used, it may be desirable to position the fasteners away from areas of the foam compression material 202 that are expected to compress against the breast, to avoid pressure points and the resulting discomfort associated therewith, and to prevent artifacts from appearing in any resulting x-ray images.

[0037] The foam compression element 202 includes several edge surfaces. A leading edge surface 210 is disposed adjacent to the leading edge face 208 of the substrate 204 so as to be disposed adjacent to the patient's chest wall during the compression and imaging procedure. A trailing edge surface 212 is disposed opposite the leading edge surface 210, adjacent to the bracket portion 206. Lateral edge surfaces 214, 216 are also depicted. Generally, these lateral edge surfaces 214, 216 may be described as medial or lateral lateral edge surfaces, consistent with the terminology typically used to describe the medial and lateral aspects of the breast. Of course, one skilled in the art will recognize that the same compression paddle 200 may be used to compress any of the breasts, one at a time, which would effectively change the application of the terms "medial" and "lateral" to the lateral edge surfaces of the foam compression material 202. Additionally, a central plane 220 is disposed between the lateral edge surfaces 214, 216 at approximately their midpoint. The central plane 220 is disposed substantially perpendicular to the compression surface 218 disposed on the underside of the foam compression material 202. A portion of the compression surface 218 will contact the breast during compression. In another example, the foam compression material 202 may be covered with a biocompatible cover, which may prevent the foam compression material 202 from absorbing bodily fluids. In an example, it may be disposable or washable. To improve the patient experience, the cover may be made of a soft material where it contacts the patient. To prevent fluids from migrating into the foam compression material 202, the opposite plastic side may contact the foam compression material 202. The interface 222 is located where the compression surface 218 meets the leading edge surface 210. The shape of the interface 222 helps define the foam compression material 202 and its function during compression.

[0038] FIG. 2D is a front view of a compression system 250 for an imaging system. The compression system 250 includes a first compression element in the form of a compression paddle 200 having a rigid substrate 204 and a foam compression element 202 secured thereto. Also depicted is a second compression element, in this case a breast support platform 252. Also depicted is a breast 254 located on an upper surface 256 of the breast support platform 252. In use, the breast 254 is compressed by the application of a force F by the compression paddle 200. The foam compression material 202 deforms and conforms to the contours of the breast 254 as compression increases. Thus, as the force F is increased, compression of both the breast 254 and the foam compression material 202 occurs. This compression may be defined by the rate of compression of the foam compression material 202 adjacent the mid-plane 220 at the leading edge surface 210 when the breast 254 is substantially centered along the mid-plane 220. In other examples, the contour of the interface 222 may define the compression of the foam compression material 202 .

[0039] As described above, the foam compression material 202 has an uncompressed height H at the front edge surface 210. In an example, the uncompressed height H at the front edge surface 210 can be about 1 inch to about 2 inches. In another example, the uncompressed height H can be about 2 inches to about 3 inches. In another example, the uncompressed height H can be greater than about 3 inches. Through testing, it has been determined that an uncompressed height H of about 3 inches is sufficient for compression of a significant number of breast sizes, from small to large. Prior to a tomosynthesis imaging procedure, the breast 254 can be compressed to an imaging condition, which in one example is a condition to sufficiently stabilize the breast and compress the breast somewhat. Unlike previous systems where compression using a stiff compression paddle resulted in significant flattening of the breast, the imaging condition in which the breast should be compressed need only be to a thickness where the resulting tomosynthesis image is a manageable number. Such a manageable number may be a diagnostically meaningful number such that the resulting breast image slices may provide sufficient differentiation between slices, but without having so many images that they would necessitate significantly longer review times by the clinician.

[0040] In an example, this imaging condition of the breast 254 is reached prior to full compression of the foam compressed material 202 at the leading edge surface 210. FIG. 2D depicts compression of the foam compressed material to a maximum amount required for the breast 254 to be under an imaging condition. For illustrative purposes, FIG. 2D depicts the breast 254 centered on the mid-plane 220 of the foam compressed material 202. Thus, a portion of the foam compressed element 202 at this position is not fully compressed and is depicted in FIG. 2D as an incompletely compressed height H'. While this incompletely compressed height H' is the portion of the foam compressed material 202 measured at the leading edge surface 210, the most compressed portion of the foam compressed material 202 may still be further compressed if additional force is applied to the breast 254. In an example, the imaging condition of the breast may be reached when only a portion of the foam compressed material 202 reaches the fully compressed height H'. This fully compressed height H' changes (i.e., increases) as the distance from the chest wall increases. This is a result of the shape of the breast and the properties of the foam compression material.

[0041] The shape of the interface 222 may define the compression of the foam compression material 202. Unlike prior art thin foam pads in which the interface between the compression surface and the leading edge surface is pressed substantially flat along the entire length of the breast, the foam compression material 202 of the art maintains a curved shape along a majority of the entire breast 254. The interface 222 defines a generally smooth curvature 256, for example, from a first contact point 258 adjacent the inner side of the breast 254 to a second contact point 260 adjacent the outer side of the breast 254. However, prior art thin foam pads are generally flat from the first contact point to the second contact point.

[0042] 3A and 3B depict partial side views of an imaging system 300 having a paddle 302 utilizing a foam compressed material 304 having multiple markers thereon. The multiple markers arranged in multiple rows above and below the foam compressed material 304 (as described in further detail herein) allow for detection of compressed breasts of non-uniform thickness. Unless otherwise noted, the suffixes depicted in FIGS. 3A and 3B correspond to the particular features described without the suffix in the description of those figures. Each paddle 302 includes a rigid substrate 308 and a foam compressed material 304 secured to its bottom surface. In the figures, the rigid substrate 308 is depicted spaced apart from the foam compressed material 304, but this is for illustrative purposes only. A plurality of top markers arranged in a row parallel to the chest wall are secured between the rigid substrate 308 and the foam compressed material 304. The first row of top markers 306 is depicted closest to the chest wall, e.g., proximate the front surface of the rigid substrate 308 and the foam compression element 304. The second row of top markers 310 is positioned a first distance d1 from the first row 306, while the third row of top markers 312 is positioned a second distance d2 from the second row 310. The top markers 306, 310, 312 may be fixed to the rigid substrate 308 or the foam compression material 304 and positioned between those elements. In another example, the top markers may be positioned on the upper surface of the rigid substrate. In such a location, the top markers 306, 310, 312 primarily indicate the level of the top surface of the foam compression material 304 as well as the bottom surface of the rigid substrate 308. The top markers 306, 310, 312 serve as fixed references.

[0043] A plurality of bottom markers arranged in rows parallel to the chest wall are fixed to the bottom surface of the foam compression material 304. A first row of bottom markers 314 is depicted closest to the chest wall and is spaced a third distance d3 from the front surface of the rigid substrate 308 and the foam compression element 304, for example. A second row of bottom markers 316 is positioned a fourth distance d4 from the first row 314, while a third row of bottom markers 318 is positioned a fifth distance d5 from the second row 316. The bottom markers 314, 316, 318 may be exposed at the bottom of the foam compression material 304a, as depicted in FIG. 3A, or may be covered by a thin foam cover 320b, as depicted in FIG. 3B. The thin foam covering 320b may be formed from the same or a different material as the foam compression material 304, and may be about 5%, about 7%, about 10%, about 12%, about 15%, or about 17% of the thickness of the foam compression material 304. In this location, the bottom markers 314, 316, 318 primarily indicate the level of the top surface of the compressed breast (for the portion of the foam compression material 304 that does not contact the breast), or the bottom surface of the foam compression material 304.

[0044] The distances d1, d2, d3, d4, d5 allow the rows 306, 310, 312, 314, 316, 318, respectively, to be visible in a resultant image (whose focal point is depicted at 320) generated by emission from an x-ray tube. Thus, given the angle of the x-ray energy 322, the second lower row of markers 316 will still be visible in the resultant image due to the separation distance d2 between the second upper row of markers 310 and the third upper row of markers 312. The distances d1, d2, d3, d4, d5 may be determined based at least in part on the thickness of the foam compressed material 304, the length of the individual markers in each row of markers (described in further detail herein), the expected distance between the focal point 322 and the markers, and other factors.

[0045] FIG. 4A depicts a partial side view of an imaging system 400 having a paddle 402 utilizing a foam compression element 406 in an uncompressed position and markers thereon. FIG. 4B depicts a top view of an image of the paddle 402 of FIG. 4A in an uncompressed position. When imaged, all of the markers appear on a single imaged plane. FIGS. 4A and 4B will be described in parallel. The foam compression material 406 is secured to a rigid substrate 404 and is movably positionable with respect to a breast support platform 408 as known in the art. A row of top markers 410, 412, 414 are depicted, each of which includes several separate lines, tick marks, or other markings of known dimensions and separations. For example, each line in each row 410, 412, 414 may have a known length l T Additionally, the distance between adjacent rows 410, 412, 414 is also known. Rows of bottom markers 416, 418, 420 are also depicted, each including several separate lines, tick marks, or other markings of known dimensions and separations. For example, each line in each row 410, 412, 414 has a known length l B Additionally, the distance between adjacent rows 410, 412, 414 is also known. When an x-ray image of the paddle 402 is taken, the distance between adjacent rows can be determined as D (e.g., as depicted in the resulting image of FIG. 4B). Here, the distance D is utilized merely for illustrative purposes, although it is not necessarily the same between all projections of all rows.

[0046] FIG. 5A depicts a partial side view of the imaging system 400 of FIG. 4A in a compressed position. FIG. 5B depicts a top view of an image of the paddle 402 of FIG. 5A in a compressed position. When imaged, all of the markers appear on a single imaged plane. FIGS. 5A and 5B will be described in parallel. Certain components depicted in FIGS. 4A and 4B are also depicted in FIGS. 5A and 5B and therefore will not necessarily be described further. The foam compression material 406 compresses the breast B against the breast support platform 408. During compression, the upper markers 410, 412, 414 generally change their positions and projected lengths l T4B. However, this compression changes either or both the position and projected length of the bottom markers 416, 418 as the foam compression element 406 changes shape to outline the compressed breast B. In the projections of FIG. 5B, these changes are then depicted as a changed separation distance D' between adjacent projected rows. Here, distance D' is not necessarily the same between all projections of all rows, but is utilized merely for illustrative purposes. However, it should be noted that since the position of marker row 420 remains unchanged (in that it is not located on a deflected portion of the foam compression material 406), the separation distance between the adjacent top marker row 414 remains unchanged from that in FIG. 4B. Additionally, the projected length of the bottom marker row 416, 418 is also changed (this changed projected length is l') due to the change in curvature of the foam compression material. B Since the marker row 420 is not located on the deflected portion of the foam compression material 406, its length is l B With these changes in marker length and marker separation known, geometric calculations allow the system to determine information about the curvature of the foam compressed material 406 and therefore the thickness of the breast located directly beneath each marker.

[0047] The length l of the marker depicted in Figures 4A and 5A T , l B and the separation distance D is known, and the length l' of the marker being imaged is T , l' BIt can be seen that the separation distance D' and the separation distance D' are measured in an x-ray image and triangulation calculations can yield the distance between the actual markers 410-420 and the imaging plane. The distances between the markers 410, 412, 414 and the bottom of the rigid substrate 404 and the distance between the imaging plane and the top of the breast platform are known. By measuring the separation distance between the projected adjacent rows of markers (e.g., the top marker row 410 and the bottom marker row 416) and the length of the bottom marker row 416, 418, 420, the deflection of the bottom surface of the foam compression material 406 can be determined. These various calculations are utilized to calculate the geometric thickness of the compressed breast B at a large number of locations to generate a compressed breast profile. Techniques for calculating the thickness of a breast compressed by a rigid paddle are described in U.S. Pat. No. 8,768,026, the disclosure of which is incorporated herein by reference in its entirety. Those techniques address measuring the separation distance between adjacent markers in a single row, and consequently, breast thickness, to determine breast paddle height. Those techniques are applicable to determine the distance of the top markers 410, 412, 414 above the breast support platform.

[0048] The method described in U.S. Pat. No. 8,768,026 determines the separation distances D, D′ between adjacent imaged rows and the length l of the separate markers in the rows. T , l B , l' B It has been discovered that the above calculations can be modified and adapted to calculate: Using these calculations, breast thickness at multiple discrete points of the foam compressed material can be determined.

[0049] More generally, Figure 6 depicts a method 600 of imaging a breast compressed with a paddle having a flexible compression element such as a foam compression material. Method 600 begins with operation 602 of emitting x-ray energy from an x-ray source toward the breast and the foam paddle. The foam paddle is configured as depicted elsewhere herein and includes, at a minimum, a number of upper markers and a number of lower markers. The lower markers are movable relative to the upper markers as the lower markers are disposed proximate to the lower surface of the foam paddle, while the upper markers remain fixed as they are typically disposed adjacent to the rigid substrate of the foam paddle. In operation 604, the x-ray energy is detected at a detector disposed on the opposite side of the breast from the x-ray source (e.g., below the breast support platform). This detection may be a single detection (e.g., in the context of a standard mammogram exposure or a scout image exposure) or there may be multiple detections (e.g., in the context of a tomosynthesis procedure). In operation 606, a compressed image of the breast based on the detected x-ray energy is generated. In operation 608, at least one of the multiple upper markers and at least one of the multiple lower markers are identified in the image generated in operation 606.

[0050] When the method 600 is utilized in a tomosynthesis imaging procedure, it can be applied to each of the tomosynthesis projection images to perform thickness analysis. In that regard, the method 600 can be applied to the 2D images generated during a standard mammogram and to the individual 2D images acquired during a tomosynthesis imaging procedure. However, in a tomosynthesis procedure, another method of analysis can be used to derive thickness information. Each slice can be examined and slices with stronger marker signals can be identified. The number of slices in a stack of slices allows for the determination of the height of the slice, which can be used to calculate the vertical (e.g., Z-axis) location of the top and bottom markers. By identifying the slice with the strongest marker signal, the marker will appear in a small number of slices instead of a single slice, but the slice with the strongest signal corresponds to the slice's vertical location in the Z-axis.

[0051] Returning to method 600, operation 610 may determine the thickness of the compressed breast at a plurality of thickness locations, each of which corresponds to at least one of a plurality of lower markers. By determining the thickness of the breast (e.g., the height of the top of the breast above the breast platform), a complete profile of the upper surface of the breast may be generated.

[0052] Several operations for calculating breast thickness are depicted in method 600. In some instances, generally only a single one of these operations need be utilized to determine breast thickness. However, multiple operations are typically desired to increase the accuracy of the generated profile, which leads to improved performance and more accurate calculations in downstream processes (as described further herein). For certain context, operation 618 of determining (or calculating) the image distance (e.g., the distance as depicted in an x-ray image) between the upper markers is utilized to determine the height of the upper marker (located proximate to the rigid substrate of the paddle) and is described in U.S. Patent No. 8,768,026, the disclosure of which is incorporated herein by reference in its entirety. This calculation provides baseline or datum information regarding the height of the rigid portion of the paddle and may be used in conjunction with other calculations described herein. Breast thickness at separate locations may be calculated based on a determination or calculation regarding either or both of the characteristics of the markers (e.g., operation 612) and the separation distance between the two markers (e.g., operation 614). For example, determining the thickness may include calculating the length of at least one lower marker of the plurality of lower markers in the image (operation 612a). Because the length of the lower marker is known, a change in that length (as reflected in the image) may help determine the amount of distance the foam compression element has deformed. This deformation would cause the individual markers to appear foreshortened in the resulting image. In operation 612b, the resulting pattern of the markers may be determined and compared to the known pattern of the markers. For example, if the markers are dashed lines and the frequency of the dashes is changed in the resulting image, the deflection of that portion of the foam compression material may be determined.

[0053] With respect to calculating the distance in the image, several calculations or determinations (operation 614) are depicted. In operation 614a, determining the thickness includes calculating a separation distance between a first upper marker of the plurality of upper markers and a first lower marker of the plurality of lower markers that is adjacent on the image in the image. Here, the term "adjacent on the image" is used to indicate that the upper and lower markers will appear in the same two-dimensional image even if they are located at different heights of the paddle. A change in separation distance from a known separation distance (e.g., when the paddle is in a non-compressed condition) indicates that the lower marker has been moved relative to the upper marker. From this information, geometric calculations can be performed to relate the change in separation distance to a change in the height of the second marker. In operation 618b, determining the thickness includes calculating a distance between a first upper marker of the plurality of upper markers and a second upper marker of the plurality of upper markers in the image. Again, that is described in U.S. Pat. No. 8,768,026. In act 614c, determining the thickness includes calculating a separation distance between a first of the plurality of lower markers and a first of the plurality of lower markers in the image. An apparent change in the separation distance indicates the plurality of lower markers being at different elevations and, as a result, above one portion of the breast having a different thickness than another portion. Once the thickness is determined, further methods can be implemented, such as to properly image the breast, generate images for display, and eliminate artifacts, as described below.

[0054] FIG. 6A depicts a method 630 of calculating an automatic exposure control (AEC) utilizing a breast thickness calculation performed in method 600 of FIG. 6. The automatic exposure control calculation requires breast thickness as an input. An operation 632 obtains a breast thickness calculation, for example, from method 600. In method 630, the breast thickness may be calculated from a scout exposure (e.g., emitted x-ray energy) in method 600. Based on the thickness, an operation 634 calculates an AEC. One or more factors may be utilized (or considered) in calculating an AEC for a non-uniformly compressed breast. In an example, the volume of the breast (which may be calculated based on a determined profile of the breast) is considered. In another example, the thickness of the breast at a particular location (e.g., adjacent to the chest wall or adjacent to the nipple) may be considered. In another example, the average thickness of the breast across the area may be considered. In yet another example, an AEC may be calculated for one or more separate portions of the breast (e.g., proximate one or more of the chest wall, nipple, or other locations). Those resulting AECs may be further considered or weighted to determine an AEC for the breast as a whole. In an example, multiple considerations may be utilized. Once this AEC is known, a subsequent imaging x-ray emission (e.g., a standard mammogram and / or a tomosynthesis scan) may be emitted (operation 636). The dose of that subsequent x-ray emission is based at least in part on the calculated automatic exposure control.

[0055] FIG. 6B depicts a method 640 of equalizing compressed breast images utilizing breast thickness calculations performed in method 600 of FIG. 6. If the breast under compression does not have a uniform thickness, the resulting x-ray image will appear non-flat after standard image processing. This non-flatness can make review of mammogram images difficult, since breast images need to appear flat for proper lesion identification. In general, there are few, if any, efficient image processing methods for flattening breast images of irregular thickness. However, if the breast thickness profile is known (e.g., via method 600 of FIG. 6), the physical thickness variations of the breast can be modeled. Additional tissue attenuation can then be utilized to compensate the breast image. The resulting breast image will appear as if the image was of a breast of uniform thickness. Known image processing algorithms can then be utilized to generate diagnostically relevant images for review. In method 640, the breast thickness can be calculated in method 600 and obtained therefrom (operation 642). A profile of the breast may be constructed based on the thickness as it is varied across the entire breast. Differences in breast thickness at at least two different thickness locations may be modeled (operation 644). The model utilized determines which portions of the breast (and by how much) should be attenuated to flatten the appearance of the breast in the image. Based on the modeled differences, attenuation may be applied to the breast (operation 646).

[0056] FIG. 6C depicts a method 650 of identifying breast boundaries of a compressed breast utilizing the breast thickness calculation performed in method 600 of FIG. 6. In a tomosynthesis image set, the last slice of the reconstructed breast volume often lacks a clear indication of the breast boundary due to limited Z-axis resolution. The problem is exacerbated when a paddle with foam compression elements is utilized, as the physical breast boundary may lie across two or more slices (indeed, several slices are often affected). As the proposed technique accurately measures breast thickness within the field of view, that thickness information may be utilized to identify the breast boundary. Additional software may be utilized to digitally label the boundaries of the breast volume in each reconstructed slice. This helps image stack reviewers (e.g., clinicians) save time since they would not now need to review portions of slices located outside the breast volume. In method 650, the breast thickness may be calculated in method 600 and obtained therefrom (operation 652). In operation 654, a tomosynthesis imaging procedure is performed. In one example, the tomosynthesis imaging procedure performed may be the emitted x-ray energy as act 602 of method 600. In another example, the tomosynthesis imaging procedure may be separate therefrom. In act 656, a set of tomosynthesis images of the compressed breast is obtained from the tomosynthesis imaging procedure. In act 658, a breast boundary is identified in at least one tomosynthesis image of the set of tomosynthesis images. Often, this boundary will be identified in multiple slices, often one or more of the top slices, based at least in part on the thickness determination. In one example, the boundary may be identified by comparing the thickness of the breast at multiple separate locations to the various slices generated. The thickness at these multiple separate locations corresponds to the upper contour or vertical boundary of the breast (e.g., the top skin surface). Thus, all portions of the slices lying outside the thickness of the breast at each particular location may be excluded from further processing and / or display. In operations 660 and 662, slice display and breast boundary, respectively, are performed.Specifically, at least one tomosynthesis image of the set of tomosynthesis images is displayed in act 660. In act 662, a feature indicative of a breast boundary is displayed on the displayed tomosynthesis image. The boundary may be a line, a contour, or a curve that encircles the relevant area. In other examples, all areas outside the breast boundary may be occluded, covered, or otherwise distorted. In another example, portions of the image outside the breast boundary may be entirely excluded from display.

[0057] FIG. 6D depicts a method 670 of calculating an x-ray imaging dose for imaging a compressed breast utilizing the breast thickness calculation performed in method 600 of FIG. 6. Without using the breast thickness as an input, the x-ray radiation dose cannot be calculated correctly. In method 670, the breast thickness may be calculated in method 600 and obtained therefrom (operation 672). In operation 674, the x-ray imaging dose may be calculated based thereon. In examples, a dose correction factor may be applied, or the dose may be based on a local thickness (e.g., adjacent a particular portion of the breast), or the dose may be based on an area-based average calculated over the entire breast thickness.

[0058] FIG. 6E depicts a method 680 for reducing marker artifacts in compressed breast images utilizing the breast thickness calculation performed in method 600 of FIG. 6. In method 680, markers are selected such that they are not normally visible in breast images and they become visible only after complementary image processing. After image processing, the upper and lower marker intensities and their locations in the image are known. A negative marker signal can then be added to the image to make the image markers artifact-free. This is especially important for quality control images of the system. In method 680, breast thickness can be calculated in method 600 and obtained therefrom (operation 682). In operation 684, the image is processed via known processing techniques. In operation 686, at least one of the multiple upper markers and at least one of the multiple lower markers are identified in the image. In operation 688, a negative signal is applied to the identified reference marker, which results in a corrected image. In one example, the negative signal may correspond to an adjustment of the total number of pixels at the location of the identified marker (operation 690). These identification and application operations may be performed on the entire image to effectively remove the marker artifacts therefrom. In other examples, only markers located within the breast border (e.g., as identified in method 650 of FIG. 6C) may be so identified. In operation 692, the corrected image is displayed.

[0059] 7 illustrates an example of a suitable operating environment 700 in which one or more of the present examples may be implemented. This operating environment may be directly incorporated into the imaging system disclosed herein, or may be incorporated into a computer system separate from, but used to control, the imaging and compression system described herein. This is only one example of a suitable operating environment and is not intended to suggest any limitation as to the scope of use or functionality. Other well-known computing systems, environments, and / or configurations that may be suitable for use include, but are not limited to, imaging systems, personal computers, server computers, handheld or laptop devices, multiprocessor systems, microprocessor-based systems, programmable consumer electronics, such as smartphones, network PCs, minicomputers, mainframe computers, tablets, distributed computing environments including any of the above systems or devices, and the like.

[0060] In its most basic configuration, the operating environment 700 typically includes at least one processing unit 702 and memory 704. Depending on the exact configuration and type of computing device, the memory 704 (which stores, among other things, instructions for calculating breast thickness, determining x-ray radiation dose, or performing other methods disclosed herein) can be volatile (such as RAM), non-volatile (such as ROM, flash memory, etc.), or some combination of the two. This most basic configuration is illustrated in FIG. 7 by dashed line 706. Additionally, the environment 700 can include storage devices (removable 708 and / or non-removable 710), including, but not limited to, magnetic or optical disks or tapes. Similarly, the environment 700 can have input devices 714, such as a touch screen, keyboard, mouse, pen, voice input, etc., and / or output devices 716, such as a display, speakers, printer, etc. One or more communication connections 712, such as a LAN, WAN, point-to-point, Bluetooth, RF, etc., are also included within the environment.

[0061] The operating environment 700 typically includes at least some form of computer-readable media. Computer-readable media can be any available media that can be accessed by the processing unit 702 or other devices having an operating environment. By way of example, and not limitation, computer-readable media can include computer storage media and communication media. Computer storage media includes volatile and non-volatile, removable and non-removable media implemented in any method or technology for storage of information, such as computer-readable instructions, data structures, program modules, or other data. Computer storage media includes RAM, ROM, EEPROM, flash memory or other memory technology, CD-ROM, digital versatile disks (DVDs) or other optical storage devices, magnetic cassettes, magnetic tapes, magnetic disk storage devices or other magnetic storage devices, solid-state storage devices, or any other tangible media that can be used to store the desired information. Communication media embodies computer-readable instructions, data structures, program modules, or other data in a modulated data signal, such as a carrier wave or other transport mechanism, and includes any information delivery media. The term "modulated data signal" means a signal that has one or more of its characteristics set or changed in such a manner as to encode information in the signal. By way of example, and not limitation, communication media includes wired media such as a wired network or direct-wired connection, and wireless media such as acoustic, RF, infrared and other wireless media. Combinations of any of the above should also be included within the scope of computer-readable media. A computer-readable device is a hardware device that incorporates a computer storage medium.

[0062] The operating environment 700 can be a single computer operating in a networked environment using logical connections to one or more remote computers. The remote computers can be personal computers, servers, routers, network PCs, peer devices, or other common network nodes, and typically include many or all of the elements described above and others not mentioned. The logical connections can include any method supported by the available communications media. Such networking environments are commonplace in offices, enterprise-wide computer networks, intranets, and the Internet.

[0063] In some embodiments, the components described herein include such modules or instructions executable by computer system 700 that may be stored on computer storage media and other tangible media and transmitted in communication media. Computer storage media includes volatile and non-volatile, removable and non-removable media implemented in any method or technology for storage of information such as computer readable instructions, data structures, program modules, or other data. Combinations of any of the above should also be included within the scope of readable media. In some embodiments, computer system 700 is part of a network that stores data in remote storage media for use by computer system 700.

[0064] FIG. 8 is an embodiment of a network 800 in which various systems and methods disclosed herein may operate. In an embodiment, a client device, such as client device 802, may communicate with one or more servers, such as servers 804 and 806, via a network 808. In an embodiment, the client device may be a standalone imaging system including all the functionality described herein (e.g., imaging system 120 depicted in FIG. 1A). The client device may include or incorporate any other type of computing device, such as a laptop, personal computer, smartphone, PDA, netbook, or computing device in FIG. 7. In an example, such a client device may be connected to an imaging system. In an embodiment, the servers 804 and 806 may be any type of computing device, such as the computing devices illustrated in FIG. 7. The network 808 may be any type of network capable of facilitating communication between the client device and one or more servers 804 and 806. For example, surface image data and interior image data may be acquired locally via the imaging system and communicated to another computing device for further processing, such as an image acquisition workstation or a cloud-based service. Examples of such networks include, but are not limited to, a LAN, a WAN, a cellular network, and / or the Internet.

[0065] In embodiments, the various systems and methods disclosed herein may be implemented by one or more server devices. For example, in one embodiment, a single server, such as server 804, may be employed to implement the systems and methods disclosed herein, such as the methods for imaging discussed herein. The client device 802 may interact with the server 804 via a network 808. In further embodiments, the client device 802 may also implement functionality disclosed herein, such as scanning and image processing, which may then be provided to the server 804 and / or 806.

[0066] This disclosure has described several examples of the technology with reference to the accompanying drawings, in which only some of the possible examples are shown. However, other aspects may be embodied in many different forms and should not be construed as limiting the examples described herein. Rather, these examples are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the possible examples to those skilled in the art.

[0067] Although specific examples have been described herein, the scope of the technology is not limited to those specific examples. Those skilled in the art will recognize other examples or improvements within the scope of the technology. Thus, specific structures, acts, or mediums are disclosed as illustrative examples only. Examples according to the technology may also combine elements or components that are generally disclosed but not explicitly illustrated in combination, unless otherwise stated herein. The scope of the technology is defined by the following claims and any equivalents thereof.

Claims

1. 1. A method of imaging a breast compressed with a foam paddle, the method comprising: emitting x-ray energy from an x-ray source toward the breast and the foam paddle having a plurality of upper markers and a plurality of lower markers, the lower markers being movable relative to the upper markers; detecting the x-ray energy at a detector positioned on an opposite side of the breast from the x-ray source; generating an image of the compressed breast based on the detected x-ray energy; and identifying at least one of the plurality of upper markers and at least one of the plurality of lower markers in the image; determining a thickness of the compressed breast at a plurality of thickness locations; Including, Each of the plurality of thickness locations corresponds to at least one of the plurality of lower markers.

2. 2. The method of claim 1 , wherein determining the thickness includes calculating a distance in the image between a first upper marker of the plurality of upper markers and a first lower marker of the plurality of lower markers adjacent on the image.

3. The method of claim 1 , wherein determining the thickness comprises determining a characteristic of at least one lower marker of the plurality of lower markers in the image.

4. 2. The method of claim 1 , wherein determining the thickness comprises calculating a distance in the image between a first upper marker of the plurality of upper markers and a second upper marker of the plurality of upper markers.

5. 2. The method of claim 1 , wherein determining the thickness comprises calculating a distance in the image between a first one of the plurality of lower markers and a second one of the plurality of lower markers.

6. The method of claim 1 , wherein the x-ray energy comprises a scout exposure.

7. The method of claim 6 , further comprising calculating an automatic exposure control based at least in part on the thickness determination.

8. The method of claim 1 , further comprising emitting imaging x-ray energy based at least in part on the calculated automatic exposure control.

9. modeling a difference in at least two thickness locations of the plurality of thickness locations; applying attenuation to the image based at least in part on the modeled difference; and The method of claim 1 further comprising:

10. performing a tomosynthesis imaging procedure; obtaining a set of tomosynthesis images of the compressed breast from the tomosynthesis imaging procedure; identifying a breast boundary in at least one tomosynthesis image of the set of tomosynthesis images; The method of claim 1 further comprising:

11. The method of claim 10 , wherein identifying the breast boundary is based at least in part on the thickness determination.

12. displaying at least one tomosynthesis image of the set of tomosynthesis images; displaying features indicative of the breast boundary on at least one displayed tomosynthesis image of the set of tomosynthesis images; The method of claim 11 further comprising:

13. The method of claim 12 , wherein the at least one tomosynthesis image displayed comprises a top tomosynthesis image of the breast.

14. The method of claim 1 , further comprising calculating an x-ray imaging dose based at least in part on the determination.

15. processing the image; and identifying at least one reference marker of at least one of the plurality of upper markers and the plurality of lower markers; applying a negative signal to the identified fiducial markers, said application resulting in a corrected image; and displaying the corrected image; The method of claim 1 further comprising:

16. The method of claim 15 , wherein applying the negative signal comprises adjusting a pixel count at the identified reference marker.

17. A paddle for compressing a breast, said paddle comprising: a foam shell having an upper surface, a lower surface, and a front wall; a plurality of upper markers disposed proximate to the upper surface, the plurality of upper markers disposed a first distance from the front wall; a plurality of lower markers disposed proximate to the lower surface, the plurality of lower markers disposed a second distance from the front wall; Rigid substrate and wherein the foam shell is secured to the rigid substrate at the upper surface, and the plurality of upper markers are disposed between the rigid substrate and the foam shell.

18. The paddle of claim 17 , wherein the plurality of lower markers are disposed within the foam shell.

19. The paddle of claim 17 , wherein the plurality of lower markers are configured to move when a lower surface of the paddle is acted upon by an upward force.

20. 20. The paddle of claim 19, wherein the plurality of upper markers are configured to remain stationary when a lower surface of the paddle is acted upon by the upward force.

21. 20. The paddle of claim 17, further comprising a bottom foam shell secured to said foam shell, said plurality of lower markers being disposed between said bottom foam shell and said foam shell.

Images