[Image: see text] Quantitative assessment of breast density using transmission ultrasound tomography

PURPOSE: Breast density is important in the evaluation of breast cancer risk. At present, breast density is evaluated using two‐dimensional projections from mammography with or without tomosynthesis using either (a) subjective assessment or (b) a computer‐aided approach. The purpose of this work is twofold: (a) to establish an algorithm for quantitative assessment of breast density using quantitative three‐dimensional transmission ultrasound imaging; and (b) to determine how these quantitative assessments compare with both subjective and objective mammographic assessments of breast density. METHODS: We described and verified a threshold‐based segmentation algorithm to give a quantitative breast density (QBD) on ultrasound tomography images of phantoms of known geometric forms. We also used the algorithm and transmission ultrasound tomography to quantitatively determine breast density by separating fibroglandular tissue from fat and skin, based on imaged, quantitative tissue characteristics, and compared the quantitative tomography segmentation results with subjective and objective mammographic assessments. RESULTS: Quantitative breast density (QBD) measured in phantoms demonstrates high quantitative accuracy with respect to geometric volumes with average difference of less than 0.1% of the total phantom volumes. There is a strong correlation between QBD and both subjective mammographic assessments of Breast Imaging ‐ Reporting and Data System (BI‐RADS) breast composition categories and Volpara density scores — the Spearman correlation coefficients for the two comparisons were calculated to be 0.90 (95% CI: 0.71–0.96) and 0.96 (95% CI: 0.92–0.98), respectively. CONCLUSIONS: The calculation of breast density using ultrasound tomography and the described segmentation algorithm is quantitatively accurate in phantoms and highly correlated with both subjective and Food and Drug Administration (FDA)‐cleared objective assessments of breast density.