Digital breast tomosynthesis (DBT) has become an increasingly important tool in the diagnosis of breast disease. For those DBT imaging systems based on active matrix, flat-panel imager (AMFPI) arrays, the incident radiation is detected directly or indirectly by means of an a-Se or CsI:Tl x-ray converter, respectively. While all AMFPI DBT devices provide clinically useful volumetric information, their performance is limited by the relatively modest average signal generated per interacting X ray by present converters compared to the electronic additive noise of the system. To address this constraint, we are pursuing the development of a screen-printed form of mercuric iodide (SP HgI<sub>2</sub>) which has demonstrated considerably higher sensitivities (i.e., larger average signal per interacting X ray) than those of conventional a-Se and CsI:Tl converters, as well as impressive DQE and MTF performance under mammographic irradiation conditions. A converter offering such enhanced sensitivity would greatly improve signal-to-noise performance and facilitate quantum-limited imaging down to significantly lower exposures than present AMFPI DBT systems. However, before this novel converter material can be implemented practically, challenges associated with SP HgI<sub>2</sub> must be addressed. Most significantly, high levels of charge trapping (which lead to image lag as well as fall-off in DQE at higher exposures) need to be reduced – while improving the uniformity in pixel-to-pixel signal response as well as maintaining low dark current and otherwise favorable DQE performance. In this paper, a pair of novel strategies for overcoming the challenge of charge trapping in SP HgI<sub>2</sub> converters are described, and initial results from empirical and calculational studies of these strategies are reported.
X-ray mammography is a crucial screening tool for early identification of breast cancer. However, the overlap of anatomical features present in projection images often complicates the task of correctly identifying suspicious masses. As a result, there has been increasing interest in acquisition of volumetric information through digital breast tomosynthesis (DBT) which, compared to mammography, offers the advantage of depth information. Since DBT requires acquisition of many projection images, it is desirable that the noise in each projection image be dominated by the statistical noise of the incident x-ray quanta and not by the additive noise of the imaging system (referred to as quantum-limited imaging) and that the cumulative dose be as low as possible (e.g., no more than for a mammogram). Unfortunately, the electronic noise (~2000 electrons) present in current DBT systems based on active matrix, flat-panel imagers (AMFPIs) is still relatively high compared with modest x-ray gain of the a-Se and CsI:Tl x-ray converters often used. To overcome the modest signal-to-noise ratio (SNR) limitations of current DBT systems, we have developed a large-area x-ray imaging detector with the combination of an extremely low noise (~20 electrons) active-pixel CMOS and a specially designed high resolution scintillator. The high sensitivity and low noise of such system provides better SNR by at least an order of magnitude than current state-of-art AMFPI systems and enables x-ray indirect-detection single photon counting (SPC) at mammographic energies with the potential of dose reduction.