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Mammography is currently the standard imaging modality used to screen women for breast abnormalities, and, as a result, it is a tool of great importance for the early detection of breast cancer. Physical phantoms are commonly used as surrogates of breast tissue to evaluate some aspects of the performance of mammography systems. However, most phantoms do not reproduce the anatomic heterogeneity of real breasts. New fabrication technologies, such as three-dimensional (3-D) printing, have created the opportunity to build more complex, anatomically realistic breast phantoms that could potentially assist in the evaluation of mammography systems. The reproducibility and relative low cost of 3-D printed objects might also enable the development of collections of representative patient models that could be used to assess the effect of anatomical variability on system performance, hence making bench testing studies a step closer to clinical trials. The primary objective of this work is to present a simple, easily reproducible methodology to design and print 3-D objects that replicate the attenuation profile observed in real two-dimensional mammograms. The secondary objective is to evaluate the capabilities and limitations of the competing 3-D printing technologies and characterize the x-ray properties of the different materials they use. Printable phantoms can be created using the open-source code introduced, which processes a raw mammography image to estimate the amount of x-ray attenuation at each pixel, and outputs a triangle mesh object that encodes the observed attenuation map. The conversion from the observed pixel gray value to a column of printed material with equivalent attenuation requires certain assumptions and knowledge of multiple imaging system parameters, such as x-ray energy spectrum, source-to-object distance, compressed breast thickness, and average breast material attenuation. To validate the proposed methodology, x-ray projections of printed phantoms were acquired with a clinical mammography system. The quality of the printing process was evaluated by comparing the mammograms of the printed phantoms and the original mammograms used to create the phantoms. The structural similarity index and the root-mean-square error were used as objective metrics to compare the two images. A detailed description of the software, a characterization of the printed materials using x-ray spectroscopy, and an evaluation of the realism of the sample printed phantoms are presented.
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