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Background: Digital tomosynthesis has shown potential for increasing specificity and sensitivity compared to radiography for low‐dose chest imaging. Prior investigation of the s‐DCT system indicated potential, but additional iteration with improved scan speed, power, and angular span was necessary for translation. Purpose: The study aims to demonstrate and characterize a second‐generation stationary digital chest tomosynthesis (s‐DCT) scanner with increased x‐ray energy, tube current, and larger angular span. Methods: The second‐generation s‐DCT system employed a meter‐long linear carbon nanotube (CNT) source array integrated with a digital detector and patient imaging table. Tube output, focal spot size, modulation transfer function (MTF), artifact spread function (ASF), and imaging performance were evaluated. A lung phantom with simulated nodules was imaged for clinical task‐based demonstration. Results: The scanner achieved a 6 s scan time, significantly improved from the prior generation's 16 s. The x‐ray tube exhibited good current stability, with 20.4 ± 0.6 mA tube current and focal spot size aligned with specifications (IEC 0.8). The MTF confirmed enhanced spatial resolution of 2.4 lp/mm, comparable to commercial chest tomosynthesis systems. The ASF indicated improved depth resolution (5.2 mm, previously 9.5 mm). Phantom imaging showcased visualization of both high and low‐attenuation lung nodules. Conclusion: The second‐generation s‐DCT system exhibited improved performance in terms of tube power, scan time, and image quality. Enhanced in‐plane and depth resolution, along with faster imaging, suggest potential clinical benefits for improved diagnoses. Further clinical validation is warranted to ascertain the system's clinical utility. [ABSTRACT FROM AUTHOR]

Objectives: The randomized TOmosynthesis plus SYnthesized MAmmography (TOSYMA) screening trial has shown that digital breast tomosynthesis plus synthesized mammography (DBT + SM) is superior to digital mammography (DM) in invasive breast cancer detection varying with breast density. On the other hand, the overall average glandular dose (AGD) of DBT is higher than that of DM. Comparing the DBT + SM and DM trial arm, we analyzed here the mean AGD and their determinants per breast density category and related them to the respective invasive cancer detection rates (iCDR). Methods: TOSYMA screened 99,689 women aged 50 to 69 years. Compression force, resulting breast thickness, the calculated AGD obtained from each mammography device, and previously published iCDR were used for comparisons across breast density categories in the two trial arms. Results: There were 196,622 exposures of 49,227 women (DBT + SM) and 197,037 exposures of 49,132 women (DM) available for analyses. Mean breast thicknesses declined from breast density category A (fatty) to D (extremely dense) in both trial arms. However, while the mean AGD in the DBT + SM arm declined concomitantly from category A (2.41 mGy) to D (1.89 mGy), it remained almost unchanged in the DM arm (1.46 and 1.51 mGy, respectively). In relative terms, the AGD elevation in the DBT + SM arm (64.4% (A), by 44.5% (B), 27.8% (C), and 26.0% (D)) was lowest in dense breasts where, however, the highest iCDR were observed. Conclusion: Women with dense breasts may specifically benefit from DBT + SM screening as high cancer detection is achieved with only moderate AGD elevations. Clinical relevance statement: TOSYMA suggests a favorable constellation for screening with digital breast tomosynthesis plus synthesized mammography (DBT + SM) in dense breasts when weighing average glandular dose elevation against raised invasive breast cancer detection rates. There is potential for density-, i.e., risk-adapted population-wide breast cancer screening with DBT + SM. Key Points: Breast thickness declines with visually increasing density in digital mammography (DM) and digital breast tomosynthesis (DBT). Average glandular doses of DBT decrease with increasing density; digital mammography shows lower and more constant values. With the smallest average glandular dose difference in dense breasts, DBT plus SM had the highest difference in invasive breast cancer detection rates. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions In silico clinical trials are becoming more sophisticated and allow for realistic assessment and comparisons of medical image system models. These fully computational models enable fast and affordable trial designs that can closely capture trends seen on real clinical trials.To evaluate three breast imaging system models for digital mammography (DM) and digital breast tomosynthesis (DBT) in a fully‐in‐silico longitudinal study.We developed in silico models for three different breast imaging systems by modeling relevant characteristics such as detector technology, pixel size, number of projections, and angular span. We use a computational image reader to detect masses at different growing stages to compute the relative system performance. Similarly, we compare calcification cluster detectability across systems. The Detectability area under the ROC curve (AUC) was calculated for each combination of breast density, device model, lesion size and type, and search area. We compared the absolute and relative AUC values for DM and DBT. The trial consisted of 45 000 simulated images corresponding to 750 virtual digital patient models.We observed proportional AUC values with increasing mass size. On the other hand, higher breast densities showed lower AUC values. For masses, we found significant performance differences between device models. The highest average AUC difference between DBT and DM was 0.109, benefiting DBT. For calcifications, DM showed higher performance than DBT, especially in highly dense breasts. The highest AUC difference on a model was –0.055, benefiting DM.In this fully‐in‐silico imaging trial, we compared three imaging systems with different detector technologies on the same cohort of virtual digital patient models. We found that breast device systems can lead to visibility differences in masses and calcifications. Our longitudinal, multi‐device in silico study was possible because of the versatility and flexibility of in silico methods. This study shows the advantages of this in silico methodology in lowering the resources needed for device development, optimization, and regulatory evaluation. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions Transbronchial needle biopsy is crucial for diagnosing lung cancer, yet its efficacy depends on accurately localizing the target lesion and biopsy needle. Digital tomosynthesis (DTS) is considered a promising imaging modality for guiding bronchoscopy procedures due to its low radiation dose and small footprint relative to cone‐beam computed tomography (CBCT). However, the image quality of DTS is still not sufficient for an accurate guidance, mainly due to its limited‐angle acquisition.Preoperative computed tomography (CT) scans are often performed prior to bronchoscopy interventions for diagnosis or to plan the procedure. The CT images are of high quality and are characterized by a high spatial resolution compared to intraoperative DTS images. These patient‐specific prior CT images and the intraoperative DTS images share a fair amount of anatomical information. The main differences only stem from patient positioning and respiratory motion. When these differences are addressed properly, prior CT images augment intraoperative DTS image reconstruction with strong prior knowledge and potentially enhance DTS image quality.We propose in this work a prior‐aided DTS image reconstruction technique leveraging prior CT images to improve DTS image quality. This technique is based on a recently published deformable CT‐to‐DTS image registration algorithm which is customized for bronchoscopy interventions. The main idea is to register a prior CT image to an intermediate DTS image reconstructed using the standard iterative algebraic reconstruction technique (ART), then to re‐reconstruct the DTS image using ART and the registered prior CT image as a first estimation.The proposed prior‐aided reconstruction method was tested on a physical phantom and six patient bronchoscopy datasets. Real DTS data acquired with a pseudo‐linear (PL) scan geometry and simulated DTS data generated according to a spherical ellipse (SE) scan geometry were considered. Results evaluated qualitatively by visual inspection and quantitatively by computing Pearson's correlation (PC) with respect to the reference CBCT images suggest significant improvements in image quality using the prior‐aided DTS reconstruction compared to the standard zero‐initialized ART reconstruction. PC coefficients of the six patient datasets were on average 0.64±0.13$0.64\pm 0.13$ and 0.55±0.13$0.55\pm 0.13$ using a zero‐initialized ART reconstruction with SE data and PL data, respectively, and 0.82±0.09$0.82\pm 0.09$ and 0.72±0.09$0.72\pm 0.09$ using the proposed prior‐aided reconstruction with SE data and PL data, respectively.While the initial estimation in iterative reconstruction algorithms is often overlooked, we proved that initial estimation is of critical importance in DTS image reconstruction and we have demonstrated the profound advantages of integrating prior CT images in intraoperative DTS image reconstruction. CT‐augmented DTS offers a viable alternative to CBCT in guiding bronchoscopy interventions at a fraction of the radiation dose. Further clinical studies are needed to validate improved diagnostic yield. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to evaluate the use of a novel imaging modality, digital tomosynthesis (DT), for identification of predefined anatomic dental and maxillomandibular structures in dogs. Methods: DT images were compared to conventional intraoral dental radiography (DR) for the diagnostic yield regarding the presence and quality of visualization of 35 structures. DT imaging and full mouth DR were obtained on 16 canine cadaver heads and a semi-quantitative scoring system was used to characterize the ability of each imaging method to identify the anatomic structures. Results: The results demonstrated that each imaging modality, and orientation, was superior for certain anatomic structures. Discussion: Overall, although one modality did not prove superior to the other, digital tomosynthesis appears to be an appropriate novel tool for identification of specific anatomic structures in the dog skull. [ABSTRACT FROM AUTHOR]

Background: Digital breast tomosynthesis (DBT) has outpaced digital mammography in clinical adoption in the United States; however, substantial technological limitations remain to image quality in DBT, including undersampling from a one‐dimensional (1D) scan geometry, x‐ray source motion during acquisition, and patient motion artifacts from long exam times. Purpose: A thermionic cathode x‐ray system employing two‐dimensional (2D, planar) multiple x‐ray‐source arrays (MXA) is proposed to improve DBT image quality. Methods: A 1D MXA, consisting of a linear array of thermionic cathodes was used to simulate a 2D MXA. The 1D MXA included 11 focal spots separated by a distance of Δd${{\Delta}}d$ = 23 mm. The 11 cathodes were paired with 11 molybdenum 50 mm diameter anode disks, mounted on a rotating shaft within a single vacuum enclosure. Image quality was investigated as a function of MXA configuration by integrating the 1D MXA with a 200 × 250 mm2 flat panel detector at a source‐to‐detector distance of 630 mm, resulting in a 20° tomographic arc. To simulate a 2D MXA, the detector (with phantom) was translated orthogonally to the linear array by a distance (δ$\delta $) ranging from δ$\delta $ = 0 mm (conventional 1D) to δ$\delta $ = 57 mm. All sources operated at 30 kV with 80 mA and 4.5 mAs/pulse, yielding ∼100 mAs per DBT dataset. DBT reconstructions involved 22 projections and used filtered backprojection with a ramp and Hann apodization filter. Volumetric reconstructions for each source were weighted by sampling differences between sources, and averaged. Image quality was assessed in terms of contrast‐to‐noise ratio (CNR), background clutter noise and power spectrum, and slice sensitivity profile (SSP) using a set of physical phantoms, including: (i) contrast‐detail signals coupled to spherical clutter (PMMA in air); (ii) an SSP phantom; (iii) a commercial "breast" phantom (CIRS BR3D, Sun Nuclear, Norfolk, VA); and (iv) bovine muscle. Results: Background clutter noise amplitude reduced monotonically from the 1D MXA (σclutter = 5.9 A.U., δ$\delta $ = 0 mm) and 2D MXA arrays with increasing δ$\delta $, with statistical significance between the 1D MXA and 2D MXA with δ$\delta $ = 57 mm (σclutter = 5.0 A.U., p < 0.001). The contrast‐detail/clutter phantom demonstrated CNR from the 2D MXA (δ = 57 mm) outperforming the 1D MXA in all combinations of contrast and detail. 2D power spectrum analysis of clutter demonstrated a pronounced Fourier domain null cone for the 1D MXA in the anterior field‐of‐view (away from the 1D MXA position), whereas the 2D MXA geometry (δ = 57 mm) did not exhibit the null cone. The SSP was 15%–50% narrower (FWHM) for the 2D versus the 1D geometry, across all reconstruction setups. Conclusions: The advantages of a 2D source geometry for DBT imaging were demonstrated quantitatively compared to a conventional 1D line of x‐ray sources. The improvement in the 2D geometry was attributed both to improved Fourier domain sampling and reduced SSP. We conclude that 2D MXA sources have the potential to substantially improve DBT imaging in comparison to existing commercial DBT systems. [ABSTRACT FROM AUTHOR]

Imaging is the mainstay in breast cancer diagnosis, with mammography being the primary screening tool used to detect small/asymptomatic cancers. Symptomatic patients undergo triple assessment, which includes a clinical assessment, imaging and, if indicated, an image-guided biopsy for histological diagnosis. We discuss current and emerging breast imaging techniques used in breast cancer care. These include mammography, digital breast tomosynthesis, ultrasound and magnetic resonance. We also discuss image-guided biopsy and miscellaneous image-guided interventions that influence the management of breast cancer care. [ABSTRACT FROM AUTHOR]

In breast imaging, there is an unrelenting increase in the demand for breast imaging services, partly explained by continuous expanding imaging indications in breast diagnosis and treatment. As the human workforce providing these services is not growing at the same rate, the implementation of artificial intelligence (AI) in breast imaging has gained significant momentum to maximize workflow efficiency and increase productivity while concurrently improving diagnostic accuracy and patient outcomes. Thus far, the implementation of AI in breast imaging is at the most advanced stage with mammography and digital breast tomosynthesis techniques, followed by ultrasound, whereas the implementation of AI in breast magnetic resonance imaging (MRI) is not moving along as rapidly due to the complexity of MRI examinations and fewer available dataset. Nevertheless, there is persisting interest in AI‐enhanced breast MRI applications, even as the use of and indications of breast MRI continue to expand. This review presents an overview of the basic concepts of AI imaging analysis and subsequently reviews the use cases for AI‐enhanced MRI interpretation, that is, breast MRI triaging and lesion detection, lesion classification, prediction of treatment response, risk assessment, and image quality. Finally, it provides an outlook on the barriers and facilitators for the adoption of AI in breast MRI. Level of Evidence: 5 Technical Efficacy: Stage 6 [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusion Mammographic imaging is essential for breast cancer detection and diagnosis. In addition to masses, calcifications are of concern and the early detection of breast cancer also heavily relies on the correct interpretation of suspicious microcalcification clusters. Even with advances in imaging and the introduction of novel techniques such as digital breast tomosynthesis and contrast‐enhanced mammography, a correct interpretation can still be challenging given the subtle nature and large variety of calcifications.Computer simulated lesion models can serve to develop, optimize, or improve imaging techniques. In addition to their use in comparative (virtual clinical trial) detection experiments, these models have potential application in training deep learning models and in the understanding and interpretation of breast lesions. Existing simulation methods, however, often lack the capacity to model the diversity occurring in breast lesions or to generate models relevant for a specific case. This study focuses on clusters of microcalcifications and introduces an automated, flexible toolbox designed to generate microcalcification cluster models customized to specific tasks.The toolbox allows users to control a large number of simulation parameters related to model characteristics such as lesion size, calcification shape, or number of microcalcifications per cluster. This leads to the capability of creating models that range from regular to complex clusters. Based on the input parameters, which are either tuned manually or pre‐set for a specific clinical type, different sets of models can be simulated depending on the use case. Two lesion generation methods are described. The first method generates three‐dimensional microcalcification clusters models based on geometrical shapes and transformations. The second method creates two‐dimensional (2D) microcalcification cluster models for a specific 2D mammographic image. This novel method employs radiomics analysis to account for local textures, ensuring the simulated microcalcification cluster is appropriately integrated within the existing breast tissue. The toolbox is implemented in the Python language and can be conveniently run through a Jupyter Notebook interface, openly accessible at https://gitlab.kuleuven.be/medphysqa/deploy/breast‐calcifications. Validation studies performed by radiologists assessed the level of malignancy and realism of clusters tuned with specific parameters and inserted in mammographic images.The flexibility of the toolbox with multiple simulation methods is illustrated, as well as the compatibility with different simulation frameworks and image types. The automation allows for the straightforward and fast generation of diverse microcalcification cluster models. The generated models are most likely applicable for various tasks as they can be configured in a variety of ways and inserted in different types of mammographic images of multiple acquisition systems. Validation studies confirmed the capacity to simulate realistic clusters and capture clinical properties when tuned with appropriate parameter settings.This simulation toolbox offers a flexible means of simulating microcalcification cluster models with potential use in both technical and clinical research in mammography imaging. The 3D generation methods allow for specifying many characteristics regarding the calcification shape and cluster architecture, and the 2D generation method presents a novel manner to create microcalcification clusters tailored to existing breast textures. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess local diagnostic reference levels (LDRLs) for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) mammography in India. Data from 1500 women were collected from five different mammography facilities in major cities in Tamil Nadu, India. The mean of mean glandular dose were used to arrive at an LDRL. The noted mean compressed breast thickness was 55.26 ± 3.4. The recorded mean MGDs for the five centres were 3.1 ± 0.1 and 3.8 ± 0.2 mGy for FFDM and DBT, respectively. The 75th percentile value for all five centers is 3.3 and 4.0 mGy for FFDM and DBT, respectively. The LDRLs found in the current study were also compared with those from earlier studies conducted in other nations, such as the United Kingdom, Malaysia, Morocco, and Ghana. The present study is the first of its kind to determine the LDRL for the FFDM and DBT scanners operating in the Tamil Nadu region, India, and is proposed as a starting point that will allow professionals to evaluate and optimize their practice. Furthermore, similar studies in other regions of India are necessary in order to establish National DRLs. [ABSTRACT FROM AUTHOR]

Background/Objectives: Digital mammography (DM) has long been the standard for breast cancer screening, while digital breast tomosynthesis (DBT) offers an advanced 3D imaging modality capable of generating 2D Synthetic Mammography (SM) images. Despite SM's potential to reduce radiation exposure, many clinics favor DM, with DBT and SM, due to its perceived diagnostic reliability. This study investigates whether radiologists can replace DM with SM in breast cancer screening and diagnosis or if both modalities are necessary. Methods: We retrospectively analyzed DM and SM images from 375 women aged 40–65 who underwent DM with DBT at King Khaled University Hospital from 2020–2022. Three radiologists evaluated the images using ACR BI-RADS, assessing diagnostic accuracy via the area under the receiver operating characteristic (ROC) curve (AUC). The agreement in cancer conspicuity, breast density, size, and calcifications were measured using weighted kappa (κ). Results: Among 57 confirmed cancer cases and 290 cancer-free cases, DM demonstrated higher sensitivity (82.5% vs. 78.9%) and diagnostic accuracy (AUC 0.800 vs. 0.783, p < 0.05) compared to SM. However, SM detected more suspicious calcifications in cancer cases (75.6% vs. 51.2%, p < 0.05). Agreement was fair for conspicuity (κ = 0.288) and calcifications (κ = 0.409), moderate for density (κ = 0.591), and poor for size (κ = 0.254). Conclusions: while SM demonstrates enhanced effectiveness in detecting microcalcifications, DM still proves superior in overall diagnostic accuracy and image clarity. Therefore, although SM offers certain advantages, it remains slightly inferior to DM and cannot yet replace DM in breast cancer screening. [ABSTRACT FROM AUTHOR]

The editorial discusses technological advancements and radiopharmaceutical innovations in nuclear medicine, focusing on cardiac perfusion assessment, intraoperative PET imaging, and novel radiopharmaceuticals targeting various biological pathways in oncology and neurology. The editorial highlights advancements in scanner technology, such as digital PET and LAFOV PET, as well as dedicated PET scanners for specific anatomical regions. It also discusses the potential of radiopharmaceuticals like [18F] FES, PSMA-targeted agents, and FAPI inhibitors in improving tumour detection and personalized treatment. The editorial emphasizes the importance of balancing technological advancements and radiopharmaceutical innovation to advance patient care in nuclear medicine. [Extracted from the article]

Background and Objective: As the presentation of pulmonary nodules increases, the importance of a safe and accurate method of sampling peripheral pulmonary nodules is highlighted. First‐generation robotic bronchoscopy has successfully assisted navigation and improved peripheral reach during bronchoscopy. Integrating tool‐in‐lesion tomosynthesis (TiLT) may further improve yield. Methods: We performed a first‐in‐human clinical trial of a new robotic electromagnetic navigation bronchoscopy system with integrated digital tomosynthesis technology (Galaxy System, Noah Medical). Patients with moderate‐risk peripheral pulmonary nodules were enrolled in the study. Robotic bronchoscopy was performed using electromagnetic navigation with TiLT‐assisted lesion guidance. Non‐specific results were followed up until either a clear diagnosis was achieved or repeat radiology at 6 months demonstrated stability. Results: Eighteen patients (19 nodules) were enrolled. The average lesion size was 20 mm, and the average distance from the pleura was 11.6 mm. The target was successfully reached in 100% of nodules, and the biopsy tool was visualized inside the target lesion in all cases. A confirmed specific diagnosis was achieved in 17 nodules, 13 of which were malignant. In one patient, radiological monitoring confirmed a true non‐malignant result. This translates to a yield of 89.5% (strict) to 94.7% (intermediate). Complications included one pneumothorax requiring observation only and another requiring an overnight chest drain. There was one case of severe pneumonia following the procedure. Conclusion: In this first‐in‐human study, second‐generation robotic bronchoscopy using electromagnetic navigation combined with integrated digital tomosynthesis was feasible with an acceptable safety profile and demonstrated a high diagnostic yield for small peripheral lung nodules. [ABSTRACT FROM AUTHOR]

PurposeInvasive lobular carcinoma (ILC) is a distinct histological subtype of breast cancer that can make early detection with mammography challenging. We compared imaging performance of digital breast tomosynthesis (DBT) to digital mammography (DM) for diagnoses of ILC, invasive ductal carcinoma (IDC), and invasive mixed carcinoma (IMC) in a screening population.MethodsWe included screening exams (DM; n = 1,715,249 or DBT; n = 414,793) from 2011 to 2018 among 839,801 women in the Breast Cancer Surveillance Consortium. Examinations were followed for one year to ascertain incident ILC, IDC, or IMC. We measured cancer detection rate (CDR) and interval invasive cancer rate/1000 screening examinations for each histological subtype and stratified by breast density and modality. We calculated relative risk (RR) for DM vs. DBT using log-binomial models to adjust for the propensity of receiving DBT vs. DM.ResultsUnadjusted CDR per 1000 mammograms of ILC overall was 0.33 (95%CI: 0.30-0.36) for DM; 0.45 (95%CI: 0.39-0.52) for DBT, and for women with dense breasts- 0.33 (95%CI: 0.29-0.37) for DM and 0.54 (95%CI: 0.43-0.66) for DBT. Similar results were noted for IDC and IMC. Adjusted models showed a significantly increased RR for cancer detection with DBT compared to DM among women with dense breasts for all three histologies (RR; 95%CI: ILC 1.53; 1.09-2.14, IDC 1.21; 1.02-1.44, IMC 1.76; 1.30-2.38), but no significant increase among women with non-dense breasts.ConclusionDBT was associated with higher CDR for ILC, IDC, and IMC for women with dense breasts. Early detection of ILC with DBT may improve outcomes for this distinct clinical entity.

Digital breast tomosynthesis (DBT) with full‐field digital mammography (FFDM) exposes women to a higher radiation dose. A synthetic 2D mammogram (S2D) is a two‐dimensional image constructed from DBT. We aim to evaluate the S2D performance when used alone or combined with DBT compared to FFDM alone or with DBT. Studies were included if they recruited screening participants and reported on S2D performance. Studies were excluded if they included symptomatic patients, imaging was for diagnostic purposes, or if participants had a breast cancer history. Meta‐analyses for cancer detection rates (CDR) and Specificities were conducted where available. Differences in the performance of imaging modalities were calculated within individual studies, and these were pooled by meta‐analysis. Out of 3241 records identified, 17 studies were included in the review and 13 in the meta‐analysis. The estimated combined difference in CDRs per thousand among individual studies that reported on DBT plus S2D vs. FFDM and those reporting on DBT plus S2D versus DBT plus FFDM was 2.03 (95% CI 0.81–3.25) and − 0.15 (95% CI −1.17 to 0.86), respectively. The estimated difference in percent specificities was 1.13 (95% CI −0.06 to 2.31) in studies comparing DBT plus S2D and FFDM. In studies comparing DBT plus S2D and DBT plus FFDM, the estimated difference in specificities was 1.08 (95% CI 0.59–1.56). DBT plus S2D showed comparable accuracy to FFDM plus DPT and improved cancer detection to FFDM alone. Integrating S2D with DBT in breast cancer screening is safe and preserves performance. [ABSTRACT FROM AUTHOR]

Abstract Background The presence of lymphovascular invasion (LVI) in cases with breast cancer is considered a bad prognostic sign. The purpose of this study is to compare the efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) versus unenhanced magnetic resonance imaging (UE-MRI + DBT) in predicting LVI in women with pathologically confirmed breast cancer. Methods This prospective self-controlled study enrolled a total of 70 cases of pathologically proven breast cancer. All the patients underwent tomosynthesis, non-contrast, and post-contrast MRI. Depending on the broken halo sign seen in tomosynthesis, peritumoral edema, dark rim diffusion at diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) values evaluated in MRI. Results The accuracy of LVI detection by tomosynthesis was 58%; unenhanced and enhanced MRI had the same results at 60%. The accuracy of detecting LVI was raised to 64% by combining the tomosynthesis results with unenhanced MRI. Conclusions Tomosynthesis parameters are promising tools in detecting LVI in breast cancer with better diagnostic accuracy in combination with unenhanced MRI.

We aimed to determine the value of standalone and supplemental automated breast ultrasound (ABUS) in detecting cancers in an opportunistic screening setting with digital breast tomosynthesis (DBT) and compare this combined screening method to DBT and ABUS alone in women older than 39 years with BI‐RADS B‐D density categories. In this prospective opportunistic screening study, 3466 women aged 39 or older with BI‐RADS B‐D density categories and with a mean age of 50 were included. The screening protocol consisted of DBT mediolateral‐oblique views, 2D craniocaudal views, and ABUS with three projections for both breasts. ABUS was evaluated blinded to mammography findings. Statistical analysis evaluated diagnostic performance for DBT, ABUS, and combined workflows. Twenty‐nine cancers were screen‐detected. ABUS and DBT exhibited the same cancer detection rates (CDR) at 7.5/1000 whereas DBT + ABUS showed 8.4/1000, with ABUS contributing an additional CDR of 0.9/1000. Standalone ABUS outperformed DBT in detecting 12.5% more invasive cancers. DBT displayed better accuracy (95%) compared to ABUS (88%) and combined approach (86%). Sensitivities for DBT and ABUS were the same (84%), with DBT + ABUS showing a higher rate (94%). DBT outperformed ABUS in specificity (95% vs. 88%). DBT + ABUS exhibited a higher recall rate (14.89%) compared to ABUS (12.38%) and DBT (6.03%) (p <.001). Standalone ABUS detected more invasive cancers compared to DBT, with a higher recall rate. The combined approach showed a higher CDR by detecting one additional cancer per thousand. [ABSTRACT FROM AUTHOR]

(1) Background: 3D printable materials with accurately defined iodine content enable the development and production of radiological phantoms that simulate human tissues, including lesions after contrast administration in medical imaging with X-rays. These phantoms provide accurate, stable and reproducible models with defined iodine concentrations, and 3D printing allows maximum flexibility and minimal development and production time, allowing the simulation of anatomically correct anthropomorphic replication of lesions and the production of calibration and QA standards in a typical medical research facility. (2) Methods: Standard printing resins were doped with an iodine contrast agent and printed using a consumer 3D printer, both (resins and printer) available from major online marketplaces, to produce printed specimens with iodine contents ranging from 0 to 3.0% by weight, equivalent to 0 to 3.85% elemental iodine per volume, covering the typical levels found in patients. The printed samples were scanned in a micro-CT scanner to measure the properties of the materials in the range of the iodine concentrations used. (3) Results: Both mass density and attenuation show a linear dependence on iodine concentration (R2 = 1.00), allowing highly accurate, stable, and predictable results. (4) Conclusions: Standard 3D printing resins can be doped with liquids, avoiding the problem of sedimentation, resulting in perfectly homogeneous prints with accurate dopant content. Iodine contrast agents are perfectly suited to dope resins with appropriate iodine concentrations to radiologically mimic tissues after iodine uptake. In combination with computer-aided design, this can be used to produce printed objects with precisely defined iodine concentrations in the range of up to a few percent of elemental iodine, with high precision and anthropomorphic shapes. Applications include radiographic phantoms for detectability studies and calibration standards in projective X-ray imaging modalities, such as contrast-enhanced dual energy mammography (abbreviated CEDEM, CEDM, TICEM, or CESM depending on the equipment manufacturer), and 3-dimensional modalities like CT, including spectral and dual energy CT (DECT), and breast tomosynthesis. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the role of contrast-enhanced mammogram (CEM) in the characterization of circumscribed lesions detected in digital breast tomosynthesis (DBT) and correlated with histopathology. Methods: A retrospective study was done on 205 circumscribed breast masses detected with DBT and for whom CEM was done before core biopsy/excision biopsy. Morphology of lesion enhancement was noted at a 2-min CEM image and depending on the enhancement pattern, they were classified as benign, malignant, and indeterminate. Indeterminate lesions were further characterized by contrast kinetics at 8 min and divided into benign and malignant lesions. The results were correlated with histopathology reports. Results: Among the 205 lesions, 158 were benign and 47 were malignant by histopathology. All 47 malignant cases were diagnosed as malignant (sensitivity-100%) and 150 out of 158 benign lesions were diagnosed as benign by CEM (specificity-95%). Eight benign lesions were reported as malignant (false positive) by CEM. Positive predictive value was 85.4% (47/55); negative predictive value (NPV) was 100% (150/150); accuracy was 96% (197/205). Conclusions: The high sensitivity of CEM in our study suggests that CEM helps in the early diagnosis of benign-looking circumscribed breast malignancies. The high NPV of CEM helps to avoid unnecessary biopsies and interventions in benign lesions. Advances in knowledge: This study describes the contrast enhancement pattern of benign and malignant circumscribed breast lesions and thereby helps in the diagnosis of malignancy at an early stage. CEM is a promising adjunct tool since it offers functional imaging as a supplement to anatomical imaging by DBT. [ABSTRACT FROM AUTHOR]

Breast cancer is the most frequently diagnosed cancer in women accounting for about 30% of all new cancer cases and the incidence is constantly increasing. Implementation of mammographic screening has contributed to a reduction in breast cancer mortality of at least 20% over the last 30 years. Screening programs usually include all women irrespective of their risk of developing breast cancer and with age being the only determining factor. This approach has some recognized limitations, including underdiagnosis, false positive cases, and overdiagnosis. Indeed, breast cancer remains a major cause of cancer-related deaths in women undergoing cancer screening. Supplemental imaging modalities, including digital breast tomosynthesis, ultrasound, breast MRI, and, more recently, contrast-enhanced mammography, are available and have already shown potential to further increase the diagnostic performances. Use of breast MRI is recommended in high-risk women and women with extremely dense breasts. Artificial intelligence has also shown promising results to support risk categorization and interval cancer reduction. The implementation of a risk-stratified approach instead of a "one-size-fits-all" approach may help to improve the benefit-to-harm ratio as well as the cost-effectiveness of breast cancer screening. Key Points: Regular mammography should still be considered the mainstay of the breast cancer screening. High-risk women and women with extremely dense breast tissue should use MRI for supplemental screening or US if MRI is not available. Women need to participate actively in the decision to undergo personalized screening. Key recommendations: Mammography is an effective imaging tool to diagnose breast cancer in an early stage and to reduce breast cancer mortality (evidence level I). Until more evidence is available to move to a personalized approach, regular mammography should be considered the mainstay of the breast cancer screening. High-risk women should start screening earlier; first with yearly breast MRI which can be supplemented by yearly or biennial mammography starting at 35–40 years old (evidence level I). Breast MRI screening should be also offered to women with extremely dense breasts (evidence level I). If MRI is not available, ultrasound can be performed as an alternative, although the added value of supplemental ultrasound regarding cancer detection remains limited. Individual screening recommendations should be made through a shared decision-making process between women and physicians. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate microcalcification detectability in digital breast tomosynthesis (DBT) and synthetic 2D mammography (SM) for different acquisition setups using a virtual imaging trial (VIT) approach. Materials and methods: Medio-lateral oblique (MLO) DBT acquisitions on eight patients were performed at twice the automatic exposure controlled (AEC) dose. The noise was added to the projections to simulate a given dose trajectory. Virtual microcalcification models were added to a given projection set using an in-house VIT framework. Three setups were evaluated: (1) standard acquisition with 25 projections at AEC dose, (2) 25 projections with a convex dose distribution, and (3) sparse setup with 13 projections, every second one over the angular range. The total scan dose and angular range remained constant. DBT volume reconstruction and synthetic mammography image generation were performed using a Siemens prototype algorithm. Lesion detectability was assessed through a Jackknife-alternative free-response receiver operating characteristic (JAFROC) study with six observers. Results: For DBT, the area under the curve (AUC) was 0.97 ± 0.01 for the standard, 0.95 ± 0.02 for the convex, and 0.89 ± 0.03 for the sparse setup. There was no significant difference between standard and convex dose distributions (p = 0.309). Sparse projections significantly reduced detectability (p = 0.001). Synthetic images had a higher AUC with the convex setup, though not significantly (p = 0.435). DBT required four times more reading time than synthetic mammography. Discussion: A convex setup did not significantly improve detectability in DBT compared to the standard setup. Synthetic images exhibited a non-significant increase in detectability with the convex setup. Sparse setup significantly reduced detectability in both DBT and synthetic mammography. Clinical relevance statement: This virtual imaging trial study allowed the design and efficient testing of different dose distribution trajectories with real mammography images, using a dose-neutral protocol. Key Points: • In DBT, a convex dose distribution did not increase the detectability of microcalcifications compared to the current standard setup but increased detectability for the SM images. • A sparse setup decreased microcalcification detectability in both DBT and SM images compared to the convex and current clinical setups. • Optimal microcalcification cluster detection in the system studied was achieved using either the standard or convex dose setting, with the default number of projections. [ABSTRACT FROM AUTHOR]

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Background: The presence of lymphovascular invasion (LVI) in cases with breast cancer is considered a bad prognostic sign. The purpose of this study is to compare the efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) versus unenhanced magnetic resonance imaging (UE-MRI + DBT) in predicting LVI in women with pathologically confirmed breast cancer. Methods: This prospective self-controlled study enrolled a total of 70 cases of pathologically proven breast cancer. All the patients underwent tomosynthesis, non-contrast, and post-contrast MRI. Depending on the broken halo sign seen in tomosynthesis, peritumoral edema, dark rim diffusion at diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) values evaluated in MRI. Results: The accuracy of LVI detection by tomosynthesis was 58%; unenhanced and enhanced MRI had the same results at 60%. The accuracy of detecting LVI was raised to 64% by combining the tomosynthesis results with unenhanced MRI. Conclusions: Tomosynthesis parameters are promising tools in detecting LVI in breast cancer with better diagnostic accuracy in combination with unenhanced MRI. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Breast cancer which has a high mortality rate is now known to decrease due to early detection with the advent of digital mammography screening. During mammography, compression of the breast is highly variable. However, various factors that affect the amount of compression force applied have not been studied thoroughly. Hence, the aim of our study is to enumerate the factors affecting the variability in the applied compression force during mammography. Methods: Data related to breast compression force applied, breast composition, size, and compressed breast thickness along with the details about the technologists who performed the study on each patient were collected from 323 patients who underwent mammography. Intertechnologist variability in compression force application was evaluated using Fisher's exact test and associations between other factors with respect to breast compression force were established using analysis of variance and linear regression models. Results: A positive correlation between the compression force and the age, breast composition, compressed breast thickness, and breast size was obtained. Technologists' years of experience were also positively related to the applied compression force. Conclusions: This study provides evidence of the fact that compression application should be varied as per the requirement with respect to the patient's breast structure, only then can we acquire images with high quality and high diagnostic value, thus reducing recall rates. It also shows that the compression force applied in this study was much lower than those applied in other countries like the UK, US, Netherlands, Norway, etc., which could mean that there is a need to increase the force applied. [ABSTRACT FROM AUTHOR]

Current breast cancer screening relies on mammography, digital breast tomosynthesis and breast ultrasound. In select populations, breast MRI is also of great utility. However, multiple factors limit widespread use of breast MRI for screening. Efforts have been made to increase the availability of breast MRI for screening, in large part due to the increased cancer detection rate of breast MRI compared to mammography. Techniques include shortening standard breast MRI protocols with the potential for accommodating MRI screening in a higher number of patients. This review will explain the role of abbreviated breast MRI and ultrafast breast MRI in breast imaging, and detail how these approaches differ from standard dynamic contrast-enhanced breast MRI. In addition, limitations and advantages of these techniques will also be discussed. [ABSTRACT FROM AUTHOR]

This article discusses the proposed U.S. Preventive Services Task Force recommendation on breast cancer screening for women in their 40s. It addresses the arguments against screening in this age group, such as false-positive results and overdiagnosis, and provides evidence to counter these claims. The article highlights the flaws in the discussion around overdiagnosis and emphasizes the importance of well-designed studies. It also argues that early randomized controlled trials used to inform screening policy are outdated and flawed. The article concludes by emphasizing the benefits of screening for women in their 40s, as breast cancer is diagnosed in thousands of women in this age group annually in the United States. [Extracted from the article]

The article discusses the latest draft recommendations from the U.S. Preventive Services Task Force on breast cancer screening for women in their 40s. The author argues that relying on outdated randomized controlled trials does not serve women well, as technology and screening methods have advanced since then. Meta-analyses and observational trials have shown the clear mortality benefit of screening women in their 40s. The author emphasizes that the risks of screening are nonlethal compared to the potential harm of diagnosing breast cancer at an advanced stage. They advocate for women to have the autonomy to make decisions about their own health. [Extracted from the article]

The current study proposed and evaluated "residual squeeze and excitation attention gate" (rSEAG), a novel network that can improve image quality by reducing distortion attributed to artifacts. This method was established by modifying the Cycle Generative Adversarial Network (cycleGAN)-based generator network using projection data for pre-reconstruction processing in digital breast tomosynthesis. Residual squeeze and excitation were installed in the bridge of the generator network, and the attention gate was installed in the skip connection between the encoder and decoder. Based on the radiation dose index (exposure index and division index) incident on the detector, the cases approved by the ethics committee and used for the study were classified as reference (675 projection images) and object (675 projection images). For the cases, unsupervised data containing a mixture of cases with and without masses were used. The cases were trained using cycleGAN with rSEAG and the conventional networks (ResUNet and U-Net). For testing, predictive processing was performed on cases (60 projection images) that were not used for learning. Images were generated using filtered backprojection reconstruction (kernel: Ramachandran and Lakshminarayanan) from projection data for testing data and without pre-reconstruction processing data (evaluation: in-focus plane). The distortion was evaluated using perception-based image quality evaluation (PIQE) analysis, texture analysis (feature: "Homogeneity" and "Contrast"), and a statistical model with a Gumbel distribution. PIQE has a low rSEAG value. Texture analysis showed that rSEAG and a network without cycleGAN were similar in terms of the "Contrast" feature. In dense breasts, ResUNet had the lowest "Contrast" feature and U-Net had differences between cases. The maximal variations in the Gumbel plot, rSEAG reduced the high-frequency ripple artifacts. In this study, rSEAG could improve distortion and reduce ripple artifacts. [ABSTRACT FROM AUTHOR]

Aiming to offset image quality limitations in radiographs due to superimposition, this study investigates the diagnostic potential of appendicular skeleton tomosynthesis. Eight cadaveric extremities (four hands and feet) were examined employing the prototypical tomosynthesis mode of a twin robotic X-ray scanner. 12 protocols with varying sweep angles (10, 20 vs. 40°), frame rates (13 vs. 26 fps), and tube voltages (60 vs. 80 kV) were compared to radiographs. Four radiologists separately evaluated cortical and trabecular bone visualization and fracture patterns. Interreader reliability was assessed based on the intraclass correlation coefficient (ICC). Radiation dose in radiography was 0.59 ± 0.20 dGy * cm2 versus 0.11 ± 0.00 to 2.46 ± 0.17 dGy * cm2 for tomosynthesis. Cortical bone display was inferior for radiographs compared to 40° and 20° tomosynthesis. Best results were ascertained for the 80 kV/40°/26 fps protocol. Trabecular bone depiction was also superior in tomosynthesis (p ≤ 0.009) and best with the 80 kV/10°/26 fps setting. Interreader reliability was moderate for cortical bone display (ICC 0.521, 95% confidence interval 0.356–0.641) and good for trabecular bone (0.759, 0.697–0.810). Diagnostic accuracy for articular involvement and multifragment situations was higher in tomosynthesis (93.8–100%/92.2–100%) vs. radiography (85.9%/82.8%.). Diagnostic confidence was also better in tomosynthesis (p ≤ 0.003). Compared to radiography, tomosynthesis allows for superior assessability of cortical and trabecular bone and fracture morphology, especially at high framerates. Operating on a multipurpose X-ray system, tomosynthesis of the appendicular skeleton can be performed without additional scanner hardware. [ABSTRACT FROM AUTHOR]

Mammographic density (MD) assessment is subject to inter- and intra-observer variability. An automated method, such as Quantra software, could be a useful tool for an objective and reproducible MD assessment. Our purpose was to evaluate the performance of Quantra software in assessing MD, according to BI-RADS® Atlas Fifth Edition recommendations, verifying the degree of agreement with the gold standard, given by the consensus of two breast radiologists. A total of 5009 screening examinations were evaluated by two radiologists and analysed by Quantra software to assess MD. The agreement between the three assigned values was expressed as intraclass correlation coefficients (ICCs). The agreement between the software and the two readers (R1 and R2) was moderate with ICC values of 0.725 and 0.713, respectively. A better agreement was demonstrated between the software's assessment and the average score of the values assigned by the two radiologists, with an index of 0.793, which reflects a good correlation. Quantra software appears a promising tool in supporting radiologists in the MD assessment and could be part of a personalised screening protocol soon. However, some fine-tuning is needed to improve its accuracy, reduce its tendency to overestimate, and ensure it excludes high-density structures from its assessment. [ABSTRACT FROM AUTHOR]

Background: Mammography (MG) has demonstrated its effectiveness in diminishing mortality and advanced-stage breast cancer incidences in breast screening initiatives. Notably, research has accentuated the superior diagnostic efficacy and cost-effectiveness of digital breast tomosynthesis (DBT). However, the scope of evidence validating the cost-effectiveness of DBT remains limited, prompting a requisite for more comprehensive investigation. The present study aimed to rigorously evaluate the cost-effectiveness of DBT plus MG (DBT-MG) compared to MG alone within the framework of Taiwan's National Health Insurance program. Methods: All parameters for the Markov decision tree model, encompassing event probabilities, costs, and utilities (quality-adjusted life years, QALYs), were sourced from reputable literature, expert opinions, and official records. With 10,000 iterations, a 2-year cycle length, a 30-year time horizon, and a 2% annual discount rate, the analysis determined the incremental cost-effectiveness ratio (ICER) to compare the cost-effectiveness of the two screening methods. Probabilistic and one-way sensitivity analyses were also conducted to demonstrate the robustness of findings. Results: The ICER of DBT-MG compared to MG was US$5971.5764/QALYs. At a willingness-to-pay (WTP) threshold of US$33,004 (Gross Domestic Product of Taiwan in 2021) per QALY, more than 98% of the probabilistic simulations favored adopting DBT-MG versus MG. The one-way sensitivity analysis also shows that the ICER depended heavily on recall rates, biopsy rates, and positive predictive value (PPV2). Conclusion: DBT-MG shows enhanced diagnostic efficacy, potentially diminishing recall costs. While exhibiting a higher biopsy rate, DBT-MG aids in the detection of early-stage breast cancers, reduces recall rates, and exhibits notably superior cost-effectiveness. [ABSTRACT FROM AUTHOR]

Breast cancer remains one of the leading causes of cancer-related deaths among women globally. Early detection through advanced imaging techniques is crucial for improving survival rates. This study evaluates the integration of an artificial intelligence (AI) system into 3D mammography (digital breast tomosynthesis, DBT) for breast cancer diagnosis. A total of 5,000 women who underwent DBT screening between January 2021 and June 2023 were included. The AI system, based on a deep learning convolutional neural network, was trained on a dataset of annotated DBT images and compared against the interpretations of two experienced radiologists. Key performance metrics such as sensitivity, specificity, accuracy, and area under the curve (AUC) were analyzed. Results showed that the AI system achieved higher sensitivity (94.2%) and specificity (92.5%) than the radiologists, with an AUC of 0.968, indicating superior diagnostic performance. Additionally, AI-assisted readings significantly reduced radiologist interpretation time by 44%, suggesting workflow efficiency improvements. While the AI system showed promising results in improving detection accuracy and efficiency, further studies in diverse populations are needed to validate its clinical application. This research highlights the potential of AI as a valuable tool in breast cancer diagnosis, aiding radiologists in enhancing diagnostic accuracy and reducing time to diagnosis. [ABSTRACT FROM AUTHOR]

Although digital breast tomosynthesis has higher sensitivity than digital mammography and at least as high specificity, digital mammography remains the most common method for conducting mammographic screening. At the same time, mammography systems are now delivered "DBT-ready" and can be used for either digital mammography or digital breast tomosynthesis. In this paper, we ask whether it is ethically permissible to use such equipment for digital mammography, given its lower sensitivity. We argue it is not, and that clinics are ethically required to use their DBT-ready equipment to screen with digital breast tomosynthesis whenever this is practically possible. Our argument relies on a comparison between digital breast tomosynthesis and a hypothesized improvement in the image quality of digital mammography. Critical relevance statement: Women may lose out on the benefits of screening with digital breast tomosynthesis when DBT-ready equipment is used to screen with digital mammography; we argue that this practice is ethically problematic. Key Points: Digital breast tomosynthesis finds more cases of breast cancer than digital mammography. Mammography equipment can often be used to screen with both digital breast tomosynthesis and digital mammography. When they can, clinics are ethically required to use existing equipment to screen with digital breast tomosynthesis instead of digital mammography. [ABSTRACT FROM AUTHOR]

Background: Although DBT is the standard initial imaging modality for women with focal breast symptoms, the importance of ultrasound has grown rapidly in the past decades. Therefore, the Breast UltraSound Trial (BUST) focused on assessing the diagnostic value of ultrasound and digital breast tomosynthesis (DBT) for the evaluation of breast symptoms by reversing the order of breast imaging; first performing ultrasound followed by DBT. This side-study of the BUST evaluates patients' perceptions of ultrasound and DBT in a reversed setting. Methods: After imaging, 1181/1276 BUST participants completed a survey consisting of open and closed questions regarding both exams (mean age 47.2, ±11.74). Additionally, a different subset of BUST participants (n = 29) participated in six focus group interviews 18–24 months after imaging to analyze their imaging experiences in depth. Results: A total of 55.3% of women reported reluctance to undergoing DBT, primarily due of pain, while the vast majority also find bilateral DBT reassuring (87.3%). Thematic analysis identified themes related to 1) imaging reluctance (pain/burden, result, and breast harm) and 2) ultrasound and DBT perceptions. Regarding the latter, the theme comfort underscores DBT as burdensome and painful, while ultrasound is largely perceived as non-burdensome. Ultrasound is also particularly valued for its interactive nature, as highlighted in the theme interaction. Perceived effectiveness reflects women's interest in bilateral breast evaluation with DBT and the visibility of lesions, while they express more uncertainty about the reliability of ultrasound. Emotional impact portrays DBT as reassuring for many women, whereas opinions on the reassurance provided by ultrasound are more diverse. Additional themes include costs, protocols and privacy. Conclusions: Ultrasound is highly tolerated, and particularly valued is the interaction with the radiologist. Nearly half of women express reluctance towards DBT; nevertheless, a large portion report feeling more confident after undergoing bilateral DBT, reassuring them of the absence of abnormalities. Understanding patients' perceptions of breast imaging examinations is of great value when optimizing diagnostic pathways. [ABSTRACT FROM AUTHOR]

Background: This case series highlights the role of Hologic Genius AI™ Detection solution in improving breast cancer detection rates. Through AI-driven technology, Genius AI Detection solution enhances the accuracy and efficiency of identifying suspicious breast lesions, leading to early diagnosis and intervention. By leveraging deep learning algorithms, Genius AI Detection solution provides actionable computer-aided detection (CAD) findings in identifying and aiding in the interpretation of potential abnormalities in breast tomosynthesis images. It also helps prioritize cases to potentially improve reading efficiency ultimately impacting breast imaging and patient care. Case Presentation: We present three challenging cases from a routine screening population, wherein patients flagged as high-priority or suspicious for malignancy by Genius AI Detection solution were subsequently diagnosed with invasive ductal carcinoma (IDC), ductal carcinoma in situ (DCIS), and invasive lobular carcinoma that were all validated through biopsy and histopathological examination. We demonstrate the clinical utility of Hologic Genius AI Detection solution in detecting various types of breast cancers, including DCIS in a young patient with dense breast tissue and a family history of breast cancer, IDC in a patient with scattered fibroglandular densities and no family history, and invasive lobular carcinoma in a patient with similar breast density characteristics and no family history of breast cancer. Conclusion: The cases exemplify how Hologic Genius AI Detection solution can potentially improve breast cancer detection in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: To assess the diagnostic performance of 3D automated breast ultrasound (3D-ABUS) in breast cancer screening in a clinical setting. Materials and methods: All patients who had 3D-ABUS between January 2014 and January 2022 for screening were included in this retrospective study. The images were reported by 1 of 6 breast radiologists based on the Breast Imaging Reporting and Data Systems (BI-RADS). The 3D-ABUS was reviewed together with the digital breast tomosynthesis (DBT). Recall rate, biopsy rate, positive predictive value (PPV) and cancer detection yield were calculated. Results: In total, 3616 studies were performed in 1555 women (breast density C/D 95.5% (n = 3455/3616), breast density A/B 4.0% (n = 144/3616), density unknown (0.5% (n = 17/3616)). A total of 259 lesions were detected on 3D-ABUS (87.6% (n = 227/259) masses and 12.4% (n = 32/259) architectural distortions). The recall rate was 5.2% (n = 188/3616) (CI 4.5–6.0%) with only 36.7% (n = 69/188) cases recalled to another date. Moreover, recall declined over time. There were 3.4% (n = 123/3616) biopsies performed, with 52.8% (n = 65/123) biopsies due to an abnormality detected in 3D-ABUS alone. Ten of 65 lesions were malignant, resulting in a positive predictive value (PPV) of 15.4% (n = 10/65) (CI 7.6–26.5%)). The cancer detection yield of 3D-ABUS is 2.77 per 1000 screening tests (CI 1.30–5.1). Conclusion: The cancer detection yield of 3D-ABUS in a real clinical screening setting is comparable to the results reported in previous prospective studies, with lower recall and biopsy rates. 3D-ABUS also may be an alternative for screening when mammography is not possible or declined. Clinical relevance statement: 3D automated breast ultrasound screening performance in a clinical setting is comparable to previous prospective studies, with better recall and biopsy rates. Key Points: • 3D automated breast ultrasound is a reliable and reproducible tool that provides a three-dimensional representation of the breast and allows image visualisation in axial, coronal and sagittal. • The diagnostic performance of 3D automated breast ultrasound in a real clinical setting is comparable to its performance in previously published prospective studies, with improved recall and biopsy rates. • 3D automated breast ultrasound is a useful adjunct to mammography in dense breasts and may be an alternative for screening when mammography is not possible or declined. [ABSTRACT FROM AUTHOR]

Purpose: This work aims to compare the interval cancer rate and interval cancer characteristics between women screened with digital breast tomosynthesis (DBT) + digital mammography (DM) and those screened with DM alone. Methods: The interval cancer rate and interval cancer characteristics of the study population included in the Córdoba Breast Tomosynthesis Screening Trial (CBTST) were compared to a contemporary control population screened with DM. The tumour characteristics of screen-detected and interval cancers were also compared. Contingency tables were used to compare interval cancer rates. The chi-square test and Fisher's exact test were used to compare the qualitative characteristics of the cancers whereas Student's t test and the Mann–Whitney U test were used to analyse quantitative features. Results: A total of 16,068 screening exams with DBT + DM were conducted within the CBTST (mean age 57.59 ± 5.9 [SD]) between January 2015 and December 2016 (study population). In parallel, 23,787 women (mean age 58.89 ± 5.9 standard deviation [SD]) were screened with DM (control population). The interval cancer rate was lower in the study population than in the control population (15 [0.93‰; 95% confidence interval (CI): 0.73, 1.14] vs 43 [1.8‰; 95% CI: 1.58, 2.04] respectively; p = 0.045). The difference in rate was more marked in women with dense breasts (0.95‰ in the study population vs 3.17‰ in the control population; p = 0.031). Interval cancers were smaller in the study population than in the control population (p = 0.031). Conclusions: The interval cancer rate was lower in women screened with DBT + DM compared to those screened with DM alone. These differences were more pronounced in women with dense breasts. Clinical relevance statement: Women screened using tomosynthesis and digital mammography had a lower rate of interval cancer than women screened with digital mammography, with the greatest difference in the interval cancer rate observed in women with dense breasts. Key Points: • The interval cancer rate was lower in the study population (digital breast tomosynthesis [DBT] + digital mammography [DM]) than in the control population (DM). • The difference in interval cancer rates was more pronounced in women with dense breasts. • Interval cancers were smaller in the study population (DBT + DM) than in the control population (DM). [ABSTRACT FROM AUTHOR]

Showing the mammogram images in different view enables the radiological to recognize more early details about the cancer tumour. The synthetic view was addressed to find the overlapping among the overlapped structural information of the x-ray breast mammography images. The details of the proposed method to produce a synthetic mammography image using the x-ray breast cancer mammogram images from each CranioCaudual (CC) and MedioLateral-Oblique (MLO) view have been introduced in this article. There are five phases to the proposed method. In the first phase, the cancer tumor has been identified in the full-field x-ray mammography images. The cancerous tumor has been secondly recognized and highlighted as a region of interest. A technique to collect data from the cancer tumor and identify the areas of interest on the cancer mass has been discussed in the third phase. In the fourth phase, formatting the points of interest within the context of advanced features has been implemented. The final phase demonstrates how to execute the synthetic digital process using the supervised learning methodology. Several contributions have been presented based on the proposed method, which are facilitate the computer aided detection application in context of the digital breast Tomosynthesis. Compared with other method, the proposed method has shown its ability to save memory and running time resources. Beside of the digital synthetic view, the proposed method was detected the breast tumour in x-ray breast mammography images. [ABSTRACT FROM AUTHOR]

The article discusses the benefits of using digital breast tomosynthesis (DBT) in breast cancer screening, particularly for women with dense breasts. The TOSYMA trial showed that DBT, when combined with synthetic mammography (SM), led to a significant increase in invasive cancer detection rates, especially in women with extremely dense breasts. The study also highlighted the importance of personalized screening strategies, such as DBT, ultrasound, MRI, and contrast-enhanced mammography, for women with dense breasts. Overall, the findings suggest that DBT could replace digital mammography as a stand-alone screening method for women with extremely dense breasts, with careful consideration of the associated radiation dose increase. [Extracted from the article]

Abstract To explore the diagnostic efficacy of tomosynthesis spot compression (TSC) compared with conventional spot compression (CSC) for ambiguous findings on full-field digital mammography (FFDM). In this retrospective study, 122 patients (including 108 patients with dense breasts) with ambiguous FFDM findings were imaged with both CSC and TSC. Two radiologists independently reviewed the images and evaluated lesions using the Breast Imaging Reporting and Data System. Pathology or at least a 1-year follow-up imaging was used as the reference standard. Diagnostic efficacies of CSC and TSC were compared, including area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The mean glandular dose was recorded and compared for TSC and CSC. Of the 122 patients, 63 had benign lesions and 59 had malignant lesions. For Reader 1, the following diagnostic efficacies of TSC were significantly higher than those of CSC: AUC (0.988 vs. 0.906, P = 0.001), accuracy (93.4% vs. 77.8%, P = 0.001), specificity (87.3% vs. 63.5%, P = 0.002), PPV (88.1% vs. 70.5%, P = 0.010), and NPV (100% vs. 90.9%, P = 0.029). For Reader 2, TSC showed higher AUC (0.949 vs. 0.909, P = 0.011) and accuracy (83.6% vs. 71.3%, P = 0.022) than CSC. The mean glandular dose of TSC was higher than that of CSC (1.85 ± 0.53 vs. 1.47 ± 0.58 mGy, P

Purpose: To construct and validate radiomics models that utilize ultrasound (US) and digital breast tomosynthesis (DBT) images independently and in combination to non-invasively predict the Ki-67 status in breast cancer. Materials and Methods: 149 breast cancer women who underwent DBT and US scans were retrospectively enrolled from June 2018 to August 2023 in total. Radiomics features were acquired from both the DBT and US images, then selected and reduced in dimensionality using several screening approaches. Establish radiomics models based on DBT, and US separately and combined. The area under the receiver operating characteristic curve (AUC), accuracy, specificity, and sensitivity were utilized to validate the predictive ability of the models. The decision curve analysis (DCA) was used to evaluate the clinical applicability of the models. The output of the classifier with the best AUC performance was converted into Rad-score and was regarded as Rad-Score model. A nomogram was constructed using the logistic regression method, integrating the Rad-Score and clinical factors. The model's stability was assessed through AUC, calibration curves, and DCA. Results: Support vector machine (SVM), logistic regression (LR), and random forest (RF) were trained to establish radiomics models with the selected features, with SVM showing optimal results. The AUC values for three models (US_SVM, DBT_SVM, and merge_SVM) were 0.668, 0.704, and 0.800 respectively. The DeLong test indicated a notable disparity in the area under the curve (AUC) between merge_SVM and US_SVM (p = 0.048), while there was no substantial variability between merge_SVM and DBT_SVM (p = 0.149). The DCA curve indicates that merge_SVM is superior to unimodal models in predicting high Ki-67 level, showing more clinical values. The nomogram integrating Rad-Score with tumor size obtained the better performance in test set (AUC: 0.818) and had more clinical net. Conclusion: The fusion radiomics model performed better in predicting the Ki-67 expression level of breast carcinoma, but the gain effect is limited; thus, DBT is preferred as a preoperative diagnosis mode when resources are limited. Nomogram offers predictive advantages over other methods and can be a valuable tool for predicting Ki-67 levels in BC. [ABSTRACT FROM AUTHOR]

To explore the diagnostic efficacy of tomosynthesis spot compression (TSC) compared with conventional spot compression (CSC) for ambiguous findings on full-field digital mammography (FFDM). In this retrospective study, 122 patients (including 108 patients with dense breasts) with ambiguous FFDM findings were imaged with both CSC and TSC. Two radiologists independently reviewed the images and evaluated lesions using the Breast Imaging Reporting and Data System. Pathology or at least a 1-year follow-up imaging was used as the reference standard. Diagnostic efficacies of CSC and TSC were compared, including area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The mean glandular dose was recorded and compared for TSC and CSC. Of the 122 patients, 63 had benign lesions and 59 had malignant lesions. For Reader 1, the following diagnostic efficacies of TSC were significantly higher than those of CSC: AUC (0.988 vs. 0.906, P = 0.001), accuracy (93.4% vs. 77.8%, P = 0.001), specificity (87.3% vs. 63.5%, P = 0.002), PPV (88.1% vs. 70.5%, P = 0.010), and NPV (100% vs. 90.9%, P = 0.029). For Reader 2, TSC showed higher AUC (0.949 vs. 0.909, P = 0.011) and accuracy (83.6% vs. 71.3%, P = 0.022) than CSC. The mean glandular dose of TSC was higher than that of CSC (1.85 ± 0.53 vs. 1.47 ± 0.58 mGy, P < 0.001) but remained within the safety limit. TSC provides better diagnostic efficacy with a slightly higher but tolerable radiation dose than CSC. Therefore, TSC may be a candidate modality for patients with ambiguous findings on FFDM. [ABSTRACT FROM AUTHOR]

Contrast-enhanced mammography (CEM) is a relatively new imaging technique that allows morphologic, anatomic and functional imaging of the breast. The aim of our study was to validate contrast-enhanced mammography (CEM) compared to mammography (MMG) and digital breast tomosynthesis (DBT) in daily clinical practice. This retrospective study included 316 consecutive patients who underwent MMG, DBT and CEM at the Centre for Prevention and Diagnosis of Chronic Diseases of Primorsko-goranska County. Two breast radiologists independently analyzed the image data, without available anamnestic information and without the possibility of comparison with previous images, to determine the presence of suspicious lesions and their morphological features according to the established criteria of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The diagnostic value of MMG, DBT and CEM was assessed by ROC analysis. The interobserver agreement was excellent. CEM showed higher diagnostic accuracy in terms of sensitivity and specificity compared to MMG and DBT, the reporting time for CEM was significantly shorter, and CEM findings resulted in a significantly lower proportion of equivocal findings (BI-RADS 0), suggesting fewer additional procedures. In conclusion, CEM achieves high diagnostic accuracy while maintaining simplicity, reproducibility and applicability in complex clinical settings. [ABSTRACT FROM AUTHOR]

Objectives: In April 2020, standard two-dimensional (2D) full-field digital mammograms were replaced with digital breast tomosynthesis (DBT) and synthesised 2D views for symptomatic breast clinics. This study aimed to evaluate the positive predictive value (PPV) for malignancy in DBT-detected Architectural distortion (AD). Methods: All mammogram reports with the word "distortion" were assessed between April 2020 and October 2022. There were 458 mammograms with the word "distortion." After excluding mammograms with no distortion (n = 128), post-surgical distortion (n = 173), distortion with mass (n = 33), and unchanged distortion (n = 14), there were 111 patients with pure distortion. Correlation with histopathology was obtained where possible. All patients were followed for a minimum of 2 years. Results: Forty-two out of 111 patients (37.84%) with AD had a normal ultrasound (US) and were discharged. Fifty-five (49.5%) patients had sonographic correlation corresponding to the distortion, leading to US-guided biopsy. Thirteen (23.6%) had tomosynthesis-guided biopsy, and one had a skin biopsy. The PPV for malignancy was 42.34%. Malignancy diagnoses were higher with US-guided biopsies than tomosynthesis-guided biopsies, 78.1% and 30%, respectively. Conclusion: With a total malignancy rate of 42.34%, DBT-detected AD has a high enough PPV for malignancy to justify selective tissue sampling if a sonographic correlate is present or with suspicious mammograms. The chances of malignancy are higher when a sonographic correlate corresponding to AD is present. Advances in knowledge: AD on DBT/synthesized mammograms views in symptomatic breast clinic patients justifies selective sampling. [ABSTRACT FROM AUTHOR]

Objective: To improve breast radiographers' individual performance by using automated software to assess the correctness of breast positioning and compression in tomosynthesis screening. Materials and methods: In this retrospective longitudinal analysis of prospective cohorts, six breast radiographers with varying experience in the field were asked to use automated software to improve their performance in breast compression and positioning. The software tool automatically analyzes craniocaudal (CC) and mediolateral oblique (MLO) views for their positioning quality by scoring them according to PGMI classifications (perfect, good, moderate, inadequate) and checking whether the compression pressure is within the target range. The positioning and compression data from the studies acquired before the start of the project were used as individual baselines, while the data obtained after the training were used to test whether conscious use of the software could help the radiographers improve their performance. The percentage of views rated perfect or good and the percentage of views in target compression were used as overall metrics to assess changes in performance. Results: Following the use of the software, all radiographers significantly increased the percentage of images rated as perfect or good in both CCs and MLOs. Individual improvements ranged from 7 to 14% for CC and 10 to 16% for MLO views. Moreover, most radiographers exhibited improved compression performance in CCs, with improvements up to 16%. Conclusion: Active use of a software tool to automatically assess the correctness of breast compression and positioning in breast cancer screening can improve the performance of radiographers. Clinical relevance statement: This study suggests that the use of a software tool for automatically evaluating correctness of breast compression and positioning in breast cancer screening can improve the performance of radiographers on these metrics, which may ultimately lead to improved screening outcomes. Key Points: • Proper breast positioning and compression are critical in breast cancer screening to ensure accurate diagnosis. • Active use of the software increased the quality of craniocaudal and mediolateral oblique views acquired by all radiographers. • Improved performance of radiographers is expected to improve screening outcomes. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the long-term outcomes of trans-articular intramedullary fixation using cannulated headless screws for proximal phalanx fractures in the hand. Background: Various surgical techniques have been described for the fixation of proximal phalanx fractures, with Kirschner wires, plates, and screws being commonly used. The objective of this study was to evaluate the long-term outcomes of trans-articular intramedullary fixation using cannulated headless screws for proximal phalanx fractures in the hand. Methods Eight patients, with nine proximal phalanx fractures, treated with intramedullary screw fixation, were included for a follow-up visit three years post-surgery. Subjective and objective outcome measures were assessed using the Michigan Hand Questionnaire (MHQ), active range of motion (aROM), grip strength, conventional X-rays, and digital tomosynthesis images. Methods: Eight patients, with nine proximal phalanx fractures, treated with intramedullary screw fixation, were included for a follow-up visit three years post-surgery. Subjective and objective outcome measures were assessed using the Michigan Hand Questionnaire (MHQ), active range of motion (aROM), grip strength, conventional X-rays, and digital tomosynthesis images. Results: We observed a mean MHQ score of 83%, a total aROM of 216.4°, and a Jamar grip strength of 29.9 kg in the injured hand. Digital tomosynthesis revealed complete fracture consolidation in all cases. Joint arthrosis was detected in only one case, attributed to a misplaced screw. Conclusions: Our findings indicate favorable long-term clinical outcomes, including range of motion, grip strength, patient satisfaction, and prevention of joint damage, with the use of intramedullary headless screw fixation. Level of evidence: Level IV, Therapeutic [ABSTRACT FROM AUTHOR]

Background/Objectives: Nephrolithiasis is a heterogeneous disease with a high prevalence and recurrence rate. Although there has been much progress regarding the surgical treatment of stones, a standardized follow-up, especially in recurrent stone formers (SFs), has yet to be decided. This fact leads to the overuse of computed tomography (CT) scans and many reoperations in patients, thus increasing their morbidity and the financial burden on the health systems. This review systematically searched the literature for original articles regarding imaging strategies and endoscopic treatment for patients with recurrent urolithiasis, aiming to identify optimal strategies to deal with these patients. Methods: We systematically searched the Medline database (accessed on 1 April 2024) for articles regarding imaging modalities and endoscopic treatment for patients with recurrent urinary tract lithiasis. Results: No specific follow-up or endoscopic treatment strategy exists for patients with recurrent urolithiasis. CT scan was the imaging modality most used in the studies, followed by X-ray, ultrasonography, and digital tomosynthesis. A transparent algorithm could not be identified. Percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and ureteroscopy (URS) were used in the studies for endoscopic treatment. PCNL showed the best stone-free (SFr) rate and lowest hazard ratio (HR) for reoperation. RIRS showed superiority over extracorporeal shockwave lithotripsy for recurrent SFs, but fragments over 4 mm increased the recurrent rate. URS has an increased HR for reoperation for bilateral stones. Conclusions: The heterogeneity of urolithiasis leaves urologists without a standardized plan for recurrent SFs. Thus, each patient's follow-up should be planned individually and holistically. Pre-stenting is not to be avoided, especially in high-risk patients, and SFr status needs to be the aim. Finally, CT scans should not be generally overused but should be part of a patient's treatment plan. Prospective studies are required to define SFr status, the size of significant residual fragments, and the modalities of intervention and follow-up. [ABSTRACT FROM AUTHOR]

Key Points: Question: What are the benefits and harms of different screening mammography strategies? Findings: Six validated CISNET models found that, compared with no screening, biennial mammography screening with digital breast tomosynthesis from age 40 to 74 yielded a median of 8.2 breast cancer deaths averted per 1000 women screened, equal to a 30% reduction in breast cancer mortality, and 165 life-years gained, 1376 false-positive recalls, 201 benign biopsies, and 14 overdiagnosed cases per 1000 women screened. For each strategy, benefits were larger for Black women than for all women. Meaning: Biennial mammography from ages 40 to 74 years has favorable benefit-to-harm tradeoffs. Importance: The effects of breast cancer incidence changes and advances in screening and treatment on outcomes of different screening strategies are not well known. Objective: To estimate outcomes of various mammography screening strategies. Design, Setting, and Population: Comparison of outcomes using 6 Cancer Intervention and Surveillance Modeling Network (CISNET) models and national data on breast cancer incidence, mammography performance, treatment effects, and other-cause mortality in US women without previous cancer diagnoses. Exposures: Thirty-six screening strategies with varying start ages (40, 45, 50 years) and stop ages (74, 79 years) with digital mammography or digital breast tomosynthesis (DBT) annually, biennially, or a combination of intervals. Strategies were evaluated for all women and for Black women, assuming 100% screening adherence and "real-world" treatment. Main Outcomes and Measures: Estimated lifetime benefits (breast cancer deaths averted, percent reduction in breast cancer mortality, life-years gained), harms (false-positive recalls, benign biopsies, overdiagnosis), and number of mammograms per 1000 women. Results: Biennial screening with DBT starting at age 40, 45, or 50 years until age 74 years averted a median of 8.2, 7.5, or 6.7 breast cancer deaths per 1000 women screened, respectively, vs no screening. Biennial DBT screening at age 40 to 74 years (vs no screening) was associated with a 30.0% breast cancer mortality reduction, 1376 false-positive recalls, and 14 overdiagnosed cases per 1000 women screened. Digital mammography screening benefits were similar to those for DBT but had more false-positive recalls. Annual screening increased benefits but resulted in more false-positive recalls and overdiagnosed cases. Benefit-to-harm ratios of continuing screening until age 79 years were similar or superior to stopping at age 74. In all strategies, women with higher-than-average breast cancer risk, higher breast density, and lower comorbidity level experienced greater screening benefits than other groups. Annual screening of Black women from age 40 to 49 years with biennial screening thereafter reduced breast cancer mortality disparities while maintaining similar benefit-to-harm trade-offs as for all women. Conclusions: This modeling analysis suggests that biennial mammography screening starting at age 40 years reduces breast cancer mortality and increases life-years gained per mammogram. More intensive screening for women with greater risk of breast cancer diagnosis or death can maintain similar benefit-to-harm trade-offs and reduce mortality disparities. This modeling study uses Cancer Intervention and Surveillance Modeling Network models and national data on breast cancer incidence, mammography performance, treatment effects, and other-cause mortality in US women without previous cancer diagnoses to estimate outcomes of various mammography screening strategies. [ABSTRACT FROM AUTHOR]

Importance: Breast cancer is a leading cause of cancer mortality for US women. Trials have established that screening mammography can reduce mortality risk, but optimal screening ages, intervals, and modalities for population screening guidelines remain unclear. Objective: To review studies comparing different breast cancer screening strategies for the US Preventive Services Task Force. Data Sources: MEDLINE, Cochrane Library through August 22, 2022; literature surveillance through March 2024. Study Selection: English-language publications; randomized clinical trials and nonrandomized studies comparing screening strategies; expanded criteria for screening harms. Data Extraction and Synthesis: Two reviewers independently assessed study eligibility and quality; data extracted from fair- and good-quality studies. Main Outcomes and Measures: Mortality, morbidity, progression to advanced cancer, interval cancers, screening harms. Results: Seven randomized clinical trials and 13 nonrandomized studies were included; 2 nonrandomized studies reported mortality outcomes. A nonrandomized trial emulation study estimated no mortality difference for screening beyond age 74 years (adjusted hazard ratio, 1.00 [95% CI, 0.83 to 1.19]). Advanced cancer detection did not differ following annual or biennial screening intervals in a nonrandomized study. Three trials compared digital breast tomosynthesis (DBT) mammography screening with digital mammography alone. With DBT, more invasive cancers were detected at the first screening round than with digital mammography, but there were no statistically significant differences in interval cancers (pooled relative risk, 0.87 [95% CI, 0.64-1.17]; 3 studies [n = 130 196]; I2 = 0%). Risk of advanced cancer (stage II or higher) at the subsequent screening round was not statistically significant for DBT vs digital mammography in the individual trials. Limited evidence from trials and nonrandomized studies suggested lower recall rates with DBT. An RCT randomizing individuals with dense breasts to invitations for supplemental screening with magnetic resonance imaging reported reduced interval cancer risk (relative risk, 0.47 [95% CI, 0.29-0.77]) and additional false-positive recalls and biopsy results with the intervention; no longer-term advanced breast cancer incidence or morbidity and mortality outcomes were available. One RCT and 1 nonrandomized study of supplemental ultrasound screening reported additional false-positives and no differences in interval cancers. Conclusions and Relevance: Evidence comparing the effectiveness of different breast cancer screening strategies is inconclusive because key studies have not yet been completed and few studies have reported the stage shift or mortality outcomes necessary to assess relative benefits. This systematic review to support a 2024 US Preventive Services Task Force Recommendation Statement summarizes published evidence on the benefits and harms of screening for breast cancer in adult females. [ABSTRACT FROM AUTHOR]