The statistical evaluation of molecular imaging approaches for detecting, diagnosing, and monitoring molecular response to treatment are required prior to their adoption. The assessment of fluorescence-enhanced optical imaging is particularly challenging since neither instrument nor agent has been established. Small animal imaging does not address the depth of penetration issues adequately and the risk of administering molecular optical imaging agents into patients remains unknown. Herein, we focus upon the development of a framework for OAIQ which includes a lumpy-object model to simulate natural anatomical tissue structure as well as the non-specific distribution of fluorescent contrast agents. This work is required for adoption of fluorescence-enhanced optical imaging in the clinic. Herein, the imaging system is simulated by the diffusion approximation of the time-dependent radiative transfer equation, which describes near infra-red light propagation through clinically relevant volumes. We predict the time-dependent light propagation within a 200 cc breast interrogated with 25 points of excitation illumination and 128 points of fluorescent light collection. We simulate the fluorescence generation from Cardio-Green at tissue target concentrations of 1, 0.5, and 0.25 µM with backgrounds containing 0.01 µM. The fluorescence boundary measurements for 1 cc spherical targets simulated within lumpy backgrounds of (i) endogenous optical properties (absorption and scattering), as well as (ii) exogenous fluorophore crosssection are generated with lump strength varying up to 100% of the average background. The imaging data are then used to validate a PMBF/CONTN tomographic reconstruction algorithm. Our results show that the image recovery is sensitive to the heterogeneous background structures. Further analysis on the imaging data by a Hotelling observer affirms that the detection capability of the imaging system is adversely affected by the presence of heterogeneous background structures. The above issue is also addressed using the human-observer studies wherein multiple cases of randomly located targets superimposed on random heterogeneous backgrounds are used in a “double-blind” situation. The results of this study show consistency with the outcome of above mentioned analyses. Finally, the Hotelling observer’s analysis is used to demonstrate (i) the inverse correlation between detectability and target depth, and (ii) the plateauing of detectability with improved excitation light rejection.