Phase-contrast micro-CT for intra-operative breast tumour margin assessment using a microfocus x-ray source and photon-counting detector

Abstract

Objective: Intra-operative tumour margin assessment during breast-conserving surgery requires rapid, high-resolution imaging of excised tissue, allowing the surgical team to take appropriate action within a single operation. This study evaluates a custom propagation-based phase-contrast micro-computed tomography (micro-CT) system designed to meet these clinical constraints without specialised optical elements. Methods: The experimental setup pairs a microfocus x-ray source with a photon-counting detector in a cone-beam geometry. We explore how the spatial coherence of the source can provide propagation-based phase contrast -- with no additional specialised optical elements -- and balance this against maximising the x-ray flux of the cone-beam geometry. System performance was evaluated across two anode target materials and filtration configurations at various tube power settings. Imaging capabilities were validated using anthropomorphic breast tissue phantoms and a formalin-fixed paraffin-embedded (FFPE) breast tissue specimen, with reconstructions compared against gold-standard histology. Results: An unfiltered tungsten target operated at 40 kVp yielded optimal image quality. The optimised system achieved high-resolution CT reconstructions of a 5 cm diameter sample with an isotropic voxel size of 40.7 $\upmu\text{m}$ in a scan time of 12 minutes. Reconstructed volumes demonstrated strong visual correlation with corresponding histology slides. Conclusion: Combining a microfocus source with a photon-counting detector enables high-resolution, phase-contrast micro-CT within a clinically viable timeframe, demonstrating strong potential for intra-operative margin assessment.