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Breast Density Assessment via Quantitative Sound-Speed Measurement Using Conventional Ultrasound Transducers
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division Vi3. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.ORCID iD: 0000-0003-1737-0756
Department of Radiology, Kantonsspital Baden, Switzerland.
Computer Assisted Applications in Medicine, ETH Zurich, Switzerland.ORCID iD: 0000-0003-1539-6493
Department of Radiology, Kantonsspital Baden, Switzerland.ORCID iD: 0000-0002-3636-8697
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2025 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 35, no 3, p. 1490-1501Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim is to assess the feasibility and accuracy of a novel quantitative ultrasound (US) method based on global speed-of-sound (g-SoS) measurement using conventional US machines, for breast density assessment in comparison to mammographic ACR (m-ACR) categories.

Materials and methods: In a prospective study, g-SoS was assessed in the upper-outer breast quadrant of 100 women, with 92 of them also having m-ACR assessed by two radiologists across the entire breast. For g-SoS, ultrasonic waves were transmitted from varying transducer locations and the image misalignments between these were then related analytically to breast SoS. To test reproducibility, two consecutive g-SoS acquisitions each were taken at two similar breast locations by the same operator.

Results: Measurements were found highly repeatable, with a mean absolute difference +/- standard deviation of 3.16 +/- 3.79 m/s. Multiple measurements were combined yielding a single g-SoS estimate per each patient, which strongly correlated to m-ACR categories (Spearman's = 0.773). The g-SoS values for categories A-D were 1459.6 +/- 0.74, 1475.6 +/- 15.92, 1515.6 +/- 27.10, and 1545.7 +/- 20.62, with all groups (except A-B) being significantly different from each other. Dense breasts (m-ACR C&D) were classified with 100% specificity at 78% sensitivity, with an area under the curve (AUC) of 0.931. Extremely dense breasts (m-ACR D) were classified with 100% sensitivity at 77.5% specificity (AUC = 0.906).

Conclusion: Quantitative g-SoS measurement of the breast was shown feasible and repeatable using conventional US machines, with values correlating strongly with m-ACR assessments.

Key Points: Breast density is a strong predictor of risk for breast cancer, which frequently develops in dense tissue regions. Therefore, density assessment calls for refined non-ionizing methods.

Findings: Quantitative global speed-of-sound (g-SoS) measurement of the breast is shown to be feasible using conventional US machines, repeatable, and able to classify breast density with high accuracy.

Clinical relevance: Being effective in classifying dense breasts, where mammography has reduced sensitivity, g-SoS can help stratify patients for alternative modalities. Ideal day for mammography or MRI can be determined by monitoring g-SoS. Furthermore, g-SoS can be integrated into personalized risk assessment.

Place, publisher, year, edition, pages
Springer, 2025. Vol. 35, no 3, p. 1490-1501
Keywords [en]
Ultrasonography, Breast density, Breast neoplasm, Mammography
National Category
Radiology and Medical Imaging Cancer and Oncology Medical Imaging
Identifiers
URN: urn:nbn:se:uu:diva-552040DOI: 10.1007/s00330-024-11335-wISI: 001425217600014PubMedID: 39798006Scopus ID: 2-s2.0-85217208028OAI: oai:DiVA.org:uu-552040DiVA, id: diva2:1943816
Note

Can Deniz Bezek and Monika Farkas contributed equally to this work.

Available from: 2025-03-11 Created: 2025-03-11 Last updated: 2026-07-28Bibliographically approved
In thesis
1. Pulse-Echo Speed-of-Sound Reconstruction for Quantitative Ultrasound Imaging
Open this publication in new window or tab >>Pulse-Echo Speed-of-Sound Reconstruction for Quantitative Ultrasound Imaging
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Speed of sound (SoS) is the longitudinal propagation speed of ultrasound waves in a medium, and it plays a central role in ultrasound imaging in several ways: Beamforming, which is the conversion of received time-domain echo signals into spatially resolved images, requires an assumed SoS. An inaccurate beamforming SoS leads to aberration artifacts, degrading the quality of conventional brightness-mode (B-mode) images and impairing other ultrasound modalities that rely on accurately beamformed data. SoS is also an emerging quantitative ultrasound biomarker that can inform about tissue composition and pathological state.

This thesis focuses on pulse-echo SoS estimation using conventional handheld ultrasound transducers. In particular, the thesis investigates displacement-based SoS estimation, where apparent shifts between images acquired with different transmit sequences are used to infer the underlying SoS. While displacement-based approaches are promising, their performance depends on several factors, including the accuracy of utilized imaging model, the choice of regularization, the quality of measurements, and the robustness of the reconstruction method.

This thesis addresses several of these challenges, developing accurate and robust pulse-echo SoS estimation methods and evaluating their utility in clinically relevant applications. The key methodological contributions include: an analytical global (single-value) SoS estimator based on transmission geometry; its extension to windowed SoS estimation in a region of interest; formulating plane-wave SoS imaging as a convolution problem for effectively learning an improved imaging model from data; and a model-based deep learning framework that combines plug-and-play reconstruction with a measurement-refinement module that simultaneously denoises measurements, inpaints missing ones, and compensates for simplifications in assumed imaging models. The proposed methods are successfully evaluated in breast ultrasound applications through breast density classification with our global SoS estimation and through breast lesion characterization with local SoS imaging. Overall, this thesis contributes to the development of robust pulse-echo SoS imaging methods and supports the continued translation of SoS toward a practical quantitative biomarker in clinical ultrasound.  

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2026. p. 79
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Science and Technology, ISSN 1651-6214 ; 2694
Keywords
Beamforming, Inverse problems, Image reconstruction, Model-based deep learning, Breast density, Breast cancer
National Category
Medical Imaging Radiology and Medical Imaging Signal Processing Cancer and Oncology Computer Vision and Learning Systems Computer graphics and computer vision
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-588526 (URN)978-91-513-2891-1 (ISBN)
Public defence
2026-09-04, Room 2001, Ångströmlaboratoriet, Regementsvägen 10, Uppsala, 09:15 (English)
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Supervisors
Available from: 2026-08-17 Created: 2026-06-21 Last updated: 2026-08-17

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Bezek, Can DenizGöksel, Orcun

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