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Objective: To compare the visibility of circumscribed masses on digital breast tomosynthesis (DBT) images and 2D mammograms and determine the usefulness of DBT for differentiation between benign and malignant circumscribed masses.Methods: Seventy-one (19 malignant and 52 benign) mammographic well-circumscribed masses were included. Visibility of the masses and halo signs on DBT images were retrospectively compared with 2D mammograms. The effects of mammographic breast density on mass visibility were also evaluated.Results: For DBT, 83% were superior and 17% were equivalent in visibility of the masses to that of 2D, and superiority of DBT was significantly enhanced in the high breast density group compared with the low breast density group (91% vs 68%, respectively, p = 0.016). Three lesions were only detected on DBT. There was no significant difference in the superiority of DBT for lesion visibility between malignant and benign masses. The halo sign was detected in 58% lesions on DBT and in 4% on 2D (p < 0.001).Conclusion: Circumscribed masses were better visualized on DBT than on 2D mammograms, particularly in high-density breasts. The halo sign often appeared on DBT and gave a clearer mass margin. However, circumscribed masses on DBT are not assured of being benign.Key Points: • Circumscribed masses were better visualized on breast tomosynthesis than on 2D mammography. • Tomosynthesis visualized circumscribed masses better than 2D for all breast density categories. • Halo signs often appeared on tomosynthesis and contributed to detect circumscribed margins. • Circumscribed masses on tomosynthesis images are not assured of being benign lesions. [ABSTRACT FROM AUTHOR]

This article summarises the information to be offered to women about mammography. After a delineation of the aim of early diagnosis of breast cancer, the difference between screening mammography and diagnostic mammography is explained. The need to bring images and reports from the previous mammogram (and from other recent breast imaging examinations) is highlighted. Mammography technique and procedure are described with particular attention to discomfort and pain experienced by a small number of women who undergo the test. Information is given on the recall during a screening programme and on the request for further work-up after a diagnostic mammography. The logic of the mammography report and of classification systems such as R1-R5 and BI-RADS is illustrated, and brief but clear information is given about the diagnostic performance of the test, with particular reference to interval cancers, i.e., those cancers that are missed at screening mammography. Moreover, the breast cancer risk due to radiation exposure from mammography is compared to the reduction in mortality obtained with the test, and the concept of overdiagnosis is presented with a reliable estimation of its extent. Information about new mammographic technologies (tomosynthesis and contrast-enhanced spectral mammography) is also given. Finally, frequently asked questions are answered. Key Points : • Direct digital mammography should be preferred to film-screen or phosphor plates. • Screening (in asymptomatic women) should be distinguished from diagnosis (in symptomatic women). • A breast symptom has to be considered even after a negative mammogram. • Digital breast tomosynthesis increases cancer detection and decreases the recall rate. • Contrast-enhanced spectral mammography can help in cancer detection and lesion characterisation. [ABSTRACT FROM AUTHOR]

In this article, we will review the current recommendations for screening breast ultrasound along with its role as an adjunct to mammography and as a primary screening tool. We will discuss the most recent literature pertaining to breast ultrasound screening in high-risk, intermediate-risk, and average-risk women and compare it with other breast screening modalities including breast MRI, tomosynthesis or 3D mammography, and automated breast ultrasound. The current obstacles to screening breast ultrasound's more widespread implementation will also be covered in our discussion. These will include ultrasound's high false positive rate when compared to mammography, overdiagnosis, and cost-effectiveness. Our target audience encompasses breast surgeons, oncologists, and breast radiologists with an interest in screening breast ultrasound. [ABSTRACT FROM AUTHOR]

Digital 2D mammography is the current standard of care for breast cancer screening. False positives and overdiagnosis have been cited as potential harms of screening mammography, and efforts to improve this technology have led to the development of digital breast tomosynthesis (DBT). The literature thus far has shown screening with tomosynthesis to simultaneously decrease recall rates and increase cancer detection. This review evaluates the possibility for 2D plus tomosynthesis mammography to replace conventional 2D screening. It outlines the requirements of an effective screening modality, reviews early and recent literature on performance outcomes, including results by age and density, and highlights potential challenges. [ABSTRACT FROM AUTHOR]

Objectives: To assess the actual diagnostic impact of digital tomosynthesis (DTS) in oncologic patients with suspected pulmonary lesions on chest radiography (CXR).Methods: A total of 237 patients (135 male, 102 female; age, 70.8 ± 10.4 years) with a known primary malignancy and suspected pulmonary lesion(s) on CXR and who underwent DTS were retrospectively identified. Two radiologists (experience, 10 and 15 years) analysed in consensus CXR and DTS images and proposed a diagnosis according to a confidence score: 1 or 2 = definitely or probably benign pulmonary or extrapulmonary lesion, or pseudolesion; 3 = indeterminate; 4 or 5 = probably or definitely pulmonary lesion. DTS findings were proven by CT (n = 114 patients), CXR during follow-up (n = 105) or histology (n = 18).Results: Final diagnoses included 77 pulmonary opacities, 26 pulmonary scars, 12 pleural lesions and 122 pulmonary pseudolesions. DTS vs CXR presented a higher (P < 0.05) sensitivity (92 vs 15 %), specificity (91 vs 9 %), overall accuracy (92 vs 12 %), and diagnostic confidence (area under ROC, 0.997 vs 0.619). Mean effective dose of CXR vs DTS was 0.06 vs 0.107 mSv (P < 0.05).Conclusions: DTS improved diagnostic accuracy and confidence in comparison to CXR alone in oncologic patients with suspected pulmonary lesions on CXR with only a slight, though significant, increase in radiation dose.Key Points: • Digital tomosynthesis (DTS) improves accuracy of chest radiography (CXR) in oncologic patients. • DTS improves confidence of CXR in oncologic patients. • DTS allowed avoidance of CT in about 50 % of oncologic patients. [ABSTRACT FROM AUTHOR]

To explore the possibility of decreasing the radiation dose during digital tomosynthesis (DT) for arthroplasty, we compared the image qualities of several reconstruction algorithms, such as filtered back projection (FBP) and two iterative reconstruction (IR), methods maximum likelihood expectation maximization (MLEM) and the simultaneous iterative reconstruction technique (SIRT) under different radiation doses. The three algorithms were implemented using a DT system and experimentally evaluated by contrast-to-noise ratio (CNR), artifact spread function (ASF), and power spectrum measurements on a prosthesis phantom. The CNR and ASF data were statistically analyzed by a one-way analysis of variance. The effectiveness of each technique for enhancing the visibility of the prosthesis phantom was quantified by the CNR (reference dose vs. 20 % reduced dose in FBP, P = 0.62; reference vs. 37 % reduced dose in FBP, P = 0.16; reference vs. 55 % reduced dose in FBP, P < 0.05; reference vs. 20 % reduced dose in IR, P = 0.92; reference vs. 37 % reduced dose in IR, P = 0.40; reference vs. 55 % reduced dose in IR, P < 0.05) and ASF (reference dose vs. 20 % reduced dose in FBP, P = 0.25; reference vs. 37 and 55 % reduced dose in FBP, P < 0.05; reference vs. 20 % reduced dose in IR, P = 0.16; reference vs. 37 and 55 % reduced dose in IR, P < 0.05). The power spectra under the reference and reduced doses are equivalent. In this phantom study, the radiation dose of the reference dose could be decreased by 20 % with FBP and IR for consideration of common factors. [ABSTRACT FROM AUTHOR]

Purpose: Evaluation of feasibility and clinical performance of a tomosynthesis-guided vacuum-assisted breast biopsy (TVAB) system compared to Stereotaxy (SVAB).Materials and Methods: All biopsies were performed on consecutive patients: 148 TVAB biopsies and 86 biopsies on different patients using SVAB. Evaluation criteria for each biopsy were technical feasibility, histopathology, procedure time, and complications.Results: All 148 TVAB biopsies were technically successful, and gained the targeted groups of microcalcifications (100 %). In 1 of 86 SVAB procedures, it was not possible to gain the targeted microcalcifications (1 %), in 3 of 86 the needle had to be adjusted (4 %). All TVAB biopsies were performed without clinically relevant complications. Distortions were biopsied exclusively by TVAB, mean size 0.9 cm, p < 0.0001. Of the 24 distortions, 13 were cancer, 11 Radial Scars/ CSL. The mean procedure time for TVAB was 15.4 minutes (range 7-28 min), for SVAB 23 minutes (range 11-46 min), p < 0.0001.Conclusions: TVAB is able to biopsy small architectural distortions with high accuracy. TVAB is easily feasible and appears to have the same degree of clinical performance for diagnosing microcalcifications. The increased number of biopsied distortions by TVAB is presumably due to increased use of tomosynthesis and its diagnostic potential.Key Points: • TVAB is easily feasible. • TVAB is able to target architectural distortions with high accuracy. • TVAB diagnoses microcalcifications with the same clinical performance as SVAB. [ABSTRACT FROM AUTHOR]

Objective: To investigate the advantages of using tomosynthesis (TS) compared to radiographs in the detection, characterization, and follow-up of bisphosphonate-related atypical femur fractures (BP-AFF).Subjects and Methods: Eight patients were identified retrospectively who underwent TS for radiographic findings suspicious for BP-AFF. Two radiologists independently interpreted 15 radiographs and 16 TS examinations, indicating the presence or absence of the following: (1) cortical "beaking" on radiographs, (2) radiolucent fracture line on radiographs, and (3) fracture lucency on TS corresponding to the site of radiographic abnormality. Radiation dose data were calculated for radiographs and TS using Monte Carlo analysis.Results: There was agreement on 100 % of radiographs regarding the presence or absence of a cortical beak. Regarding the presence or absence of a fracture lucency, there was agreement on 100 % of TS examinations (Kappa = 1.0) and 73 % of radiographs (Kappa = 0.40 ± 0.24). For the 46 % of radiographs in which one or both radiologists did not visualize a fracture line, there was 100 % agreement for the presence of a fracture line on the corresponding TS. The interobserver agreement for fracture line detection was significantly higher for TS than for radiographs (p = 0.012). The effective radiation dose using TS was approximately 96 % lower compared to radiography.Conclusion: TS outperformed radiographs in the detection and characterization of BP-AFF. TS may also have advantages over radiography for BP-AFF follow-up through its unique ability to visualize fracture healing with lower effective radiation doses to the patient. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a systemic disease that is caused by autoimmunity. RA causes synovial proliferation, which may result in bone erosion and joint space narrowing in the affected joint. Tomosynthesis is a promising modality which may detect early bone lesions such as small bone erosion and slight joint space narrowing. Nevertheless, so far, the optimal reconstruction filter for detection of early bone lesions of fingers on tomosynthesis has not yet been known. Our purpose in this study was to determine an optimal reconstruction filter setting by using a bone phantom. We obtained images of a cylindrical phantom with holes simulating bone erosions (diameters of 0.6, 0.8, 1.0, 1.2, and 1.4 mm) and joint spaces by aligning two phantoms (space widths from 0.5 to 5.0 mm with 0.5 mm intervals), examining six reconstruction filters by using tomosynthesis. We carried out an accuracy test of the bone erosion size and joint space width, done by one radiological technologist, and a test to assess the visibility of bone erosion, done by five radiological technologists. No statistically significant difference was observed in the measured bone erosion size and joint space width among all of the reconstruction filters. In the visibility assessment test, reconstruction filters of Thickness+− and Thickness−− were among the best statistically in all characteristics except the signal-to-noise ratio. The Thickness+− and Thickness−− reconstruction filter may be optimal for evaluation of RA bone lesions of small joints in tomosynthesis. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate second-look digital breast tomosynthesis (SL-DBT) for additional findings (AFs) at preoperative MRI compared with second-look ultrasound (SL-US). Methods: We included 135 patients with breast cancer who underwent digital mammography (DM), DBT, US, and MRI at two centres. MR images were retrospectively evaluated to find AFs, described as focus, mass, or non-mass; ≤10 mm or >10 mm in size; BI-RADS 3, 4, or 5. DM and DBT exams were reviewed looking for MRI AFs; data on SL-US were collected. Reference standard was histopathology or ≥12-month negative follow-up. Fisher exact test and McNemar test were used. Results: Eighty-four AFs were detected in 53/135 patients (39 %, 95 %CI 31-48 %). A correlate was found for 44/84 (52 %, 95 %CI 41-63 %) at SL-US, for 20/84 (24 %, 95 %CI 11-28 %) at SL-DM, for 42/84 (50 %, 95 %CI 39-61 %) at SL-DBT, for 63/84 (75 %, 95 %CI 64-84 %) at SL-DBT, and/or SL-US, the last rate being higher than for SL-US only, overall ( p < 0.001), for mass or non-mass, ≤ or >10 mm, BI-RADS 4 or 5, or malignant lesions ( p < 0.031). Of 21 AFs occult at both SLs, 17 were malignant (81 %, 95 %CI 58-94 %). Conclusions: When adding SL-DBT to SL-US, AFs detection increased from 52 % to 75 %. MR-guided biopsy is needed for the remaining 25 %. Key Points: • Detection rate of MRI AFs using SL-US was 52 % • Adding SL-DBT, the detection rate of MRI AFs significantly increased to 75 %. • Over 80 % of the remaining 25 % MRI AFs were malignant. • MR-guided biopsy should be used when SL-US and SL-DBT are inconclusive. [ABSTRACT FROM AUTHOR]

Identifying the optimal screening strategies for breast cancer, the second leading cause of female cancer deaths in the US, is a major societal problem creating much controversy. The optimal screening strategies significantly depend on the sensitivity and specificity of the screening modality used. While the current state-of-the-art screening technology is mammography, its sensitivity or specificity may increase over time, or mammography may be replaced by another technology such as tomosynthesis in the near future. The purpose of this study is to identify the optimal use of the next generation of breast cancer screening modalities, whose sensitivity and specificity in clinical practice are either yet unknown or keep improving over time. Contrary to the prior literature that focuses on finding the optimal screening policy for given sensitivity and specificity values, we take an inverse optimization approach and focus on finding the range of sensitivity and specificity values, for which a given screening policy is optimal. To replicate breast cancer progression in the US population under various screening policies, we develop a parametric Partially Observable Markov Chain (POMC) model, which accounts for unobservable and age-specific disease progression, age-specific mortality, and the possibility of detecting cancer without a screening exam (either via self-detection or a clinical breast exam). We then formulate a nonlinear program (NLP) to identify the range of sensitivity and specificity values that optimize a particular screening policy. We show that this NLP is nonconvex for some parameter values, and hence difficult to solve. We prove several structural properties of the model, and by exploiting these properties, we propose a complete solution algorithm for this problem. We use real data in our numerical analysis and show that with the current technology, biennial breast cancer screening is slightly better than annual screening for the average-risk population. We also find that an improvement only in sensitivity (but not in specificity) will not change the current optimal policy. Furthermore, we characterize the lost potential quality-adjusted life years (QALYs) due to suboptimal practice, and show that biennial screening is more robust than annual screening in the sense that it results in fewer lost QALYs due to choosing a suboptimal screening policy. Given that the design of multicenter clinical trials may be prohibitively expensive and lengthy, our findings may be especially valuable to policymakers in deciding about the optimal use of an emerging breast cancer screening modality, and adapting a new technology in different settings. [ABSTRACT FROM AUTHOR]

Objectives: The objectives are To to compare the diagnostic performance of combined digital breast tomosynthesis (DBT) and digital mammography (DM) with that of DM alone, as a function of radiologists' experience with DBT. Methods: Ethical committee approval was obtained. Fifty cases (27 cancer, 23 normal), each containing both digital mammography (DM) and digital breast tomosynthesis (DBT) images, were reviewed by 26 radiologists, divided into three groups according to level of experience with DBT (none, workshop experience, and clinical experience). The radiologists' diagnostic performance using DM was compared with that using DM + DBT, and evaluated by area under receiver-operating characteristic curve (AUC), jackknife free-response receiver-operator characteristics figure of metric (JAFROC FOM), sensitivity, location sensitivity, and specificity. Results: For all readers combined, performance using DM + DBT was significantly higher than for DM alone by both AUC (0.788 vs 0.681, p < 0.001) and JAFROC FOM (0.745 vs 0.621, p < 0.001). Similar results were obtained for readers with no DBT experience (AUC 0.775 vs 0.682, p = 0.004; JAFROC FOM 0.695 vs 0.603, p = 0.016) and with clinical DBT experience (AUC 0.789 vs 0.681, p = 0.042; and JAFROC FOM 0.764 vs 0.632, p = 0.031). Conclusions: Addition of DBT to DM significantly improves radiologists' diagnostic performance whether or not they have prior DBT experience. Key p oints: • Adding DBT to DM increased the number of detected cancers • DBT + DM led to more accurate localization of breast cancers than DM • Addition of DBT improved radiologists' performance regardless of prior DBT experience • High- volume radiologists with different DBT experience levels performed similarly on DM + DBT [ABSTRACT FROM AUTHOR]

Objectives: To compare double readings when interpreting full field digital mammography (2D) and tomosynthesis (3D) during mammographic screening. Methods: A prospective, Ethical Committee approved screening study is underway. During the first year 12,621 consenting women underwent both 2D and 3D imaging. Each examination was independently interpreted by four radiologists under four reading modes: Arm A-2D; Arm B-2D + CAD; Arm C-2D + 3D; Arm D-synthesised 2D + 3D. Examinations with a positive score by at least one reader were discussed at an arbitration meeting before a final management decision. Paired double reading of 2D (Arm A + B) and 2D + 3D (Arm C + D) were analysed. Performance measures were compared using generalised linear mixed models, accounting for inter-reader performance heterogeneity ( P < 0.05). Results: Pre-arbitration false-positive scores were 10.3 % (1,286/12,501) and 8.5 % (1,057/12,501) for 2D and 2D + 3D, respectively ( P < 0.001). Recall rates were 2.9 % (365/12,621) and 3.7 % (463/12,621), respectively ( P = 0.005). Cancer detection was 7.1 (90/12,621) and 9.4 (119/12,621) per 1,000 examinations, respectively (30 % increase, P < 0.001); positive predictive values (detected cancer patients per 100 recalls) were 24.7 % and 25.5 %, respectively ( P = 0.97). Using 2D + 3D, double-reading radiologists detected 27 additional invasive cancers ( P < 0.001). Conclusion: Double reading of 2D + 3D significantly improves the cancer detection rate in mammography screening. Key Points: • Tomosynthesis-based screening was successfully implemented in a large prospective screening trial. • Double reading of tomosynthesis-based examinations significantly reduced false-positive interpretations. • Double reading of tomosynthesis significantly increased the detection of invasive cancers. [ABSTRACT FROM AUTHOR]

We introduce a cone-beam computed tomography with insufficient projections obtained from a limited-angle scan, the socalled digital tomosynthesis, and demonstrate its feasibility for the industrial applications by implementing to the reconstruction of internal slice images of a multilayer printed circuit board. The image reconstruction algorithm is based on the filtered-backprojection approach for the cone-beam geometry with isocentric linear motion in the scanning trajectory of the X-ray source and imaging detector pair. Although the slice image reconstructed at the plane of interest was affected by the structures outside, we could reconstruct the plane of interest with the total scan angle less than 20 degrees and 11 projections. The digital tomosynthesis is expected to be practical for industrial tomography restricted to the limited-angle scan. [ABSTRACT FROM AUTHOR]

Objective: To compare breast density on digital mammography and digital breast tomosynthesis using fully automated software. Methods: Following institutional approval and written informed consent from all participating women, both digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) were obtained. Breast percentage density was calculated with software on DBT and FFDM. Results: Fifty consecutive patients (mean age, 51 years; range, 35-83 years) underwent both FFDM and DBT. Using a method based on the integral curve, breast density showed higher results on FFDM (68.1 ± 12.1 for FFDM and 51.9 ± 6.5 for DBT). FFDM overestimated breast density in 16.2% ( P < 0.0001). Using a method based on maximum entropy thresholding, breast density showed higher results on FFDM (68.1 ± 12.1 for FFDM and 51.9 ± 6.5 for DBT). FFDM overestimated breast density in 11.4% ( P < 0.0001). There was a good correlation among BI-RADS categories on a four-grade scale and the density evaluated with DBT and FFDM ( r = 0.54, P < 0.01 and r = 0.44, P < 0.01). Conclusion: Breast density appeared to be significantly underestimated on digital breast tomosynthesis. Key Points: [ABSTRACT FROM AUTHOR]

Diffuse optical tomography (DOT) non-invasively measures the functional characteristics of breast lesions using near infrared light to probe tissue optical properties. This study aimed to evaluate a new digital breast tomosynthesis (DBT)/DOT fusion imaging technique and obtain preliminary data for breast cancer detection. Twenty-eight women were prospectively enrolled and underwent both DBT and DOT examinations. DBT/DOT fusion imaging was created after acquisition of both examinations. Two breast radiologists analyzed DBT and DOT images independently, and then finally evaluated the fusion images. The diagnostic performance of each reading session was compared and interobserver agreement was assessed. The technical success rate was 96.4%, with one failure due to an error during DOT data storage. Among the 27 women finally included in the analysis, 13 had breast cancer. The areas under the receiver operating characteristic curve (AUCs) for DBT were 0.783 and 0.854 for readers 1 and 2, respectively. DOT showed comparable diagnostic performance to DBT for both readers. The AUCs were significantly improved (P = 0.004) when the DBT/DOT fusion images were used. Interobserver agreements were highest for the DBT/DOT fusion images. In conclusion, this study suggests that DBT/DOT fusion imaging technique appears to be a promising tool for breast cancer diagnosis. [ABSTRACT FROM AUTHOR]