Conventional mammographic image contrast is derived from x-ray absorption, resulting in breast structure visualization
due to density gradients that attenuate radiation without distinction between transmitted and scattered or refracted x-rays.
This leads to image blurring and contrast reduction, hindering the early detection of small or otherwise occult cancers.
Diffraction enhanced imaging (DEI) allows for dramatically increased contrast with decreased radiation dose compared
to conventional mammographic imaging due to monochromatic x-rays, its unique refraction-based contrast mechanism
and excellent scatter rejection. However, a lingering drawback to the clinical translation of DEI has been the requirement
for synchrotron radiation. Our laboratory developed a DEI prototype (DEI-PR) utilizing a readily available Tungsten xray
tube source and traditional DEI crystal optics, providing soft tissue images at 60keV. To demonstrate the clinical
utility of our DEI-PR, we acquired images of full-thickness human breast tissue specimens on synchrotron-based DEI,
DEI-PR and digital mammography systems. A reader study was designed to allow unbiased assessment of system
performance when analyzing three systems with dissimilar imaging parameters and requiring analysis of images
unfamiliar to radiologists. A panel of expert radiologists evaluated lesion feature visibility and histopathology correlation
after receiving training on the interpretation of refraction contrast mammographic images. Preliminary data analysis
suggests that our DEI system performed roughly equivalently with the traditional DEI system, demonstrating a
significant step toward clinical translation of this modality for breast cancer applications.