In this work, we investigated and measured the noise in Digital Breast Tomosynthesis (DBT) slices considering the back-projection (BP) algorithm for image reconstruction. First, we presented our open-source DBT reconstruction toolbox and validated with a freely available virtual clinical trials (VCT) software, comparing our results with the reconstruction toolbox available at the Food and Drug Administration's (FDA) repository. A virtual anthropomorphic breast phantom was generated in the VCT environment and noise-free DBT projections were simulated. Slices were reconstructed by both toolboxes and objective metrics were measured to evaluate the performance of our in-house reconstruction software. For the noise analysis, commercial DBT systems from two vendors were used to obtain x-ray projections of a uniform polymethyl methacrylate (PMMA) physical phantom. One system featured an indirect thallium activated cesium iodide (CsI(TI)) scintillator detector and the other a direct amorphous selenium (a-Se) detector. Our in-house software was used to reconstruct raw projections into tomographic slices, and the mean pixel value, noise variance, signal-to-noise ratio (SNR) and the normalized noise power spectrum (NNPS) were measured. In addition, we investigated the adequacy of a heteroskedastic Gaussian model, with an affine variance function, to describe the noise in the reconstruction domain. The measurements show that the variance and SNR from reconstructed slices report similar spatial and signal dependency from previously reported in the projection domain. NNPS showed that the reconstruction process correlates the noise of the DBT slices in the case of projections degraded with almost uncorrelated noise.
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