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Boone JM. Color mammography: image generation and receiver operating characteristic evaluation. Invest Radiol 1991;26:521-527.Color mammography is a technique whereby dual-energy mammographic image data are used to calculate a calcium image; the calcium image is colorized and overlaid onto the conventional (lower energy) gray scale mammogram for radiologist viewing. This technique is presented as a practical way to use the increased calcium sensitivity of dual-energy mammography without requiring an increase in the number of images that the radiologist must read, and without subjecting the radiologist to the unfamiliar appearance of the dual-energy subtracted images. Using straightforward imaging theory, the acquisition techniques for both conventional and dual-energy mammography were optimized, and the optimal technique factors were used to generate a series of computer-simulated mammographic images that were used in a receiver operating characteristic (ROC) comparative study. Ideal observer ROC experiments indicate that (dual-energy) calcium images yield consistently higher sensitivity and specificity to the presence of calcifications, regardless of the amount of tissue “clutter,” whereas conventional mammography results show degraded detectability performance as tissue contrast increases. Using human observers viewing simulated images, color mammography delivered greater calcification detectability than conventional mammography.