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Objective: To map the shape, location, and thickness of the focal trough of a panoramic radiography device with a multilayer imaging program. Methods: An acrylic plate (148 × 148 × 3 mm) containing 1156 holes distributed in a matrix of 34 × 34 rows was placed in the OP300 Maxio at the levels of the maxilla and mandible. 20 metal spheres (3.5 mm in diameter) were placed on the holes of the plate under 15 different arrangements and panoramic images were acquired for each arrangement at 66 kV, 8 mA, and an exposure time of 16 s. The resulting panoramic radiographs from the five image layers were exported, the horizontal and vertical dimensions of the metal spheres were measured in all images using the Image J software, and the magnification and distortion rates of the spheres were calculated. All metal spheres presenting a magnification rate lower than 30% in both vertical and horizontal dimensions and a distortion rate lower than 10% were considered to map the focal troughs of each of the five image layers. Results: All panoramic image layers had a curved shape ranging from 39° to 51° for both dental arches and varied in position and thickness. The anterior region of maxilla was anteriorly displaced when compared to the anterior region of the mandible for all layers. Image layers are thicker at the level of the mandible than those at the level of the maxilla; also, inner layers were thinner and outer layers were thicker. Conclusion All image layers in the studied panoramic radiography device had a curved shape and varied in position and thickness. The anterior region of maxilla was anteriorly displaced when compared to that of the mandible for all layers.

Introduction Digital Mammography (DM-2D) and more recently Digital Breast Tomosynthesis (DBT), are two of the most effective imaging modalities for breast cancer detection, often used in screening programmes. It may happen that exams using these two imaging modalities are inadvertently performed to pregnant women. The objective of this study is to assess the dose in the uterus due to DM-2D and DBT exams, according to two main irradiation scenarios: in the 1st scenario the exposure parameters were pre-selected directly by the imaging system, while in the 2nd scenario, the maximum exposure parameters were chosen. Methods The mammography equipment used was a Siemens Mammomat Inspiration. A physical anthropomorphic phantom, PMMA plates (simulating a breast thickness of 6 cm) and thermoluminescent dosimeters (TLDs) were used to measure entrance air kerma values on the phantom's breast and abdomen in order to successively estimate the mean glandular dose (MGD) and the dose in the uterus. For the two irradiation scenarios chosen, two-breast imaging modalities were selected: 1) DBT in Cranio-Caudal (CC) view (with 28 kV and 160 mAs as exposure parameters), 2) DBT and DM in Medio Lateral-Oblique (MLO) and CC views (with 34 kV and 250 mAs as exposure parameters). Results In the 1st scenario, the TLD measurements did not detect significant dose values in the abdomen whereas the MGD estimated using the D.R. Dance model was in close agreement with data available in the literature. In the 2nd scenario, there was no significant difference in MGD estimation between the different views, whereas the air kerma values in the abdomen (in DBT mode, CC and MLO) were 0.049 mGy and 0.004 mGy respectively. In CC DM-2D mode the abdomen air kerma value was 0.026 mGy, with no significant detected value in MLO view. Conclusions For the dose in the uterus, the obtained values seem to indicate that DM-2D and DBT examinations inadvertently performed during pregnancy do not pose a significant radiological risk, even considering the case of overexposure in both breasts. Implications for practice The accurate knowledge of the doses in DM-2D and DBT will contribute to raise the awareness among medical practitioners involved in breast imaging empowering them to provide accurate information about dose levels in the uterus, improving their radiation risk communication skills and consequently helping to reduce the anxiety of pregnant women undergoing this type of examinations.

Background Mammography plays a great role in reducing breast cancer mortality as it is the standard method of breast imaging and screening. But the accuracy of mammography performance reduces in cancer detection in women with dense breast due to the summation of images and overlapping of breast tissue. ABUS and tomosynthesis both recently help to detect breast cancer in dense breasted women. This prospective study was done in the female imaging unit and approved by its research and ethical committee; all the patients did an informed consent during the period from October 2018 to March 2019. The study was conducted on 38 patients with 38 lesions subjected to digital mammography, tomosynthesis and automated breast ultrasound (ABUS), who all had dense breast in mammography. Results Automated breast ultrasound (ABUS) showed 100% in all sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) as well as accuracy, while the digital mammography tomosynthesis showed 100% in specificity, 87.5% in sensitivity, 100% in PPV, 82.4% in NPV and 92.1% accuracy. Conclusion Automated breast ultrasound (ABUS) together with tomosynthesis makes a revolution in breast screening and detecting cancer in women with dense breasts.

OBJECTIVE To describe the technique and assess the diagnostic potential and limitations of tomosynthesis for imaging of the metacarpophalangeal joint (MCPJ) of equine cadavers; compare the tomosynthesis appearance of pathological lesions with their conventional radiographic, CT, and MRI appearances; and evaluate all imaging findings with gross lesions of a given MCPJ. SAMPLE Distal portions of 4 forelimbs from 4 equine cadavers. PROCEDURES The MCPJs underwent radiography, tomosynthesis (with a purpose-built benchtop unit), CT, and MRI; thereafter, MCPJs were disarticulated and evaluated for the presence of gross lesions. The ability to identify pathological lesions on all images was assessed, followed by semiobjective scoring for quality of the overall image and appearance of the subchondral bone, articular cartilage, periarticular margins, and adjacent trabecular bone of the third metacarpal bone, proximal phalanx, and proximal sesamoid bones of each MCPJ. RESULTS Some pathological lesions in the subchondral bone of the third metacarpal bone were detectable with tomosynthesis but not with radiography. Overall, tomosynthesis was comparable to radiography, but volumetric imaging modalities were superior to tomosynthesis and radiography for imaging of subchondral bone, articular cartilage, periarticular margins, and adjacent bone. CONCLUSIONS AND CLINICAL RELEVANCE With regard to the diagnostic characterization of equine MCPJs, tomosynthesis may be more accurate than radiography for identification of lesions within subchondral bone because, in part, of its ability to reduce superimposition of regional anatomic features. Tomosynthesis may be useful as an adjunctive imaging technique, highlighting subtle lesions within bone, compared with standard radiographic findings.

Apart from high-risk scenarios such as the presence of highly penetrant genetic mutations, breast screening typically comprises mammography or tomosynthesis strategies defined by age. However, age-based screening ignores the range of breast cancer risks that individual women may possess and is antithetical to the ambitions of personalised early detection. Whilst screening mammography reduces breast cancer mortality, this is at the risk of potentially significant harms including overdiagnosis with overtreatment, and psychological morbidity associated with false positives. In risk-stratified screening, individualised risk assessment may inform screening intensity/interval, starting age, imaging modality used, or even decisions not to screen. However, clear evidence for its benefits and harms needs to be established. In this scoping review, the authors summarise the established and emerging evidence regarding several critical dependencies for successful risk-stratified breast screening: risk prediction model performance, epidemiological studies, retrospective clinical evaluations, health economic evaluations and qualitative research on feasibility and acceptability. Family history, breast density or reproductive factors are not on their own suitable for precisely estimating risk and risk prediction models increasingly incorporate combinations of demographic, clinical, genetic and imaging-related parameters. Clinical evaluations of risk-stratified screening are currently limited. Epidemiological evidence is sparse, and randomised trials only began in recent years.

Background: Digital breast tomosynthesis (quasi three-dimensional [3D] mammography) is a relatively novel technique. It creates thin-slice reconstructions of the breast from low-dose digital mammographic images acquired at multiple angles. This evolution of mammography improves lesion visibility by reducing overlapping tissue. Hence, it has the potential to increase BC detection and to reduce false-positive (FP) findings. Objective: To review the role of 3D Digital Mammography in Studying of dense breast Lesions in adult female. Patients and methods: This was a retrospective study conducted on 40 patients who were eligible for examination by 3D Digital Mammography referred to WAFI center (women and fetal imaging center). The study was conducted during 12 months from January 2019 till January 2020 and was carried at Al-Azhar University Hospitals and WAFI Center (Woman and fetal imaging center). Results: There was no statistically significant difference between ultrasound (US) and tomosynthesis (TOMO) as regarding mass detection. There was a statistically significant increase as regarding calcification detection in TOMO than US. There was a statistically significant increase as regarding asymmetry detection in TOMO than US. There was no statistically significant difference between US & TOMO as regards Arch. Distortion detection. There was no statistically significant difference between US & TOMO as regards inflammatory reactions detection. There was statistically significant increase as regarding cyst detection in US than TOMO. There was a statistically significant increase as regarding dilated ducts detection in US than TOMO. There was a statistically significant increase as regarding added value detection in US than TOMO. There was no statistically significant difference between US & TOMO as regarding Breast Imaging-Reporting and Data System (BI-RADS). Conclusion: Both modalities were not similar in the ability to identify malignant lesions. Wide-angle digital breast tomosynthesis (DBT) was able to initially identify two more lesions

BACKGROUND: The present study aimed to investigate whether deep bone suppression imaging (BSI) could increase the diagnostic performance for solitary pulmonary nodule detection compared with digital tomosynthesis (DTS), dual-energy subtraction (DES) radiography, and conventional chest radiography (CCR). METHODS: A total of 256 patients (123 with a solitary pulmonary nodule, 133 with normal findings) were included in the study. The confidence score of 6 observers determined the presence or absence of pulmonary nodules in each patient. These were first analyzed using a CCR image, then with CCR plus deep BSI, then with CCR plus DES radiography, and finally with DTS images. Receiver-operating characteristic curves were used to evaluate the performance of the 6 observers in the detection of pulmonary nodules. RESULTS: For the 6 observers, the average area under the curve improved significantly from 0.717 with CCR to 0.848 with CCR plus deep BSI (P

Tomosynthesis is a modern effective and informative method of low-dose X-ray diagnostics, which allows obtaining a significant number of layered images with the subsequent volumetric image reconstruction. The use of tomosynthesis provides a one-time examination of a large anatomical area without loss of the image quality and diagnostics of difficult-to-visualize pathological changes that are not detected by digital radiography. The article presents an overview of the problem of improving low-dose imaging options in the radiation diagnostics, as well as the authors own data on the use of tomosynthesis for the diagnosis of community-acquired pneumonia in children.

BACKGROUND: Digital tomosynthesis (DTS) is an imaging technique with benefits in reconstructing sequential cross-sectional images. We evaluated the diagnostic performance of DTS for silicone airway stents and stent-related complications in patients who underwent bronchoscopic intervention. METHODS: This retrospective study included patients who underwent bronchoscopic intervention after chest radiography (CXR) and DTS examinations from September 2013 to August 2020. The interval between CXR, DTS, and bronchoscopic intervention was a maximum of 10 days. CXR and DTS images were evaluated using a bronchoscopic view as a reference. We calculated the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for assessing the diagnostic performance. RESULTS: The total CXR, DTS, and bronchoscopic intervention-matching datasets comprised 213 cases from 119 patients and, silicone stents were present in 167 of them. The ability of DTS to detect silicone stents was better than that of CXR (sensitivity, 92.8% vs. 71.3%, P

The early detection of breast cancer has been shown to reduce deaths through randomized, controlled trials. Numerous observational studies, failure analyses, and "incidence of death" studies have confirmed that screening reduces deaths in the general population. Digital Breast Tomosynthesis (DBT) which collects mammographic images from different angles and uses them to synthesize planes through the breast is simply another advance in mammography among others that have been made over the years. DBT "absolutely" detects more cancers at a time when cure is more likely while also having the advantage of reducing recall rates. The Tomosynthesis Mammographic Imaging Screening Trial (TMIST) has been designed to compare DBT with 2-Dimensional Full Field Digital Mammography (FFDM), but it's major design issues may provide misleading results. Instead of using a reduction in deaths as the endpoint, benefit in TMIST is predicated on a reduction in advanced cancers in the DBT group. This is a questionable "endpoint" (a reduction in advanced cancers is not necessary as proof of benefit). In addition, the trial may be underpowered so that even if DBT shows a benefit it may not be able to achieve "statistical significance". The six CISNET models of the National Cancer Institute have shown that annual mammography beginning at the age of 40 will save the most lives. Yet TMIST will only include women ages 45 and over and will screen postmenopausal women every two years instead of annually. Consequently, TMIST results may be used, inappropriately, to limit access to breast cancer screening starting at the age of 45, and only offer biennial screening for post-menopausal women.

Background We aimed to compare radiographic and digital tomosynthesis assessments of early biological fixation of a cementless stem in primary total hip arthroplasty and to investigate the factors associated with early biological fixation. Methods Seventy-three patients underwent total hip arthroplasty using cementless short tapered-wedge stems. Both radiography and digital tomosynthesis were performed at 6 weeks and 3, 6, 12, and 24 months after surgery. The presence of spot welds (SW) was evaluated at each postoperative period to assess biological fixation between the stem and the femur. The area of contact between the femur and the stem was divided into seven zones based on Gruen’s zone classification. Results All 73 patients had no SW 6 weeks after surgery on radiography and digital tomosynthesis. Three months postoperatively, there was no SW on radiography; however, digital tomosynthesis revealed SW in 31 (42%) patients. Six months postoperatively, radiography showed 22 SW in 18 (24.7%) patients and digital tomosynthesis showed 94 SW in 48 patients (65.8%). Conclusion Digital tomosynthesis detected biological fixation between the stem and femur earlier than radiography; biological fixation may appear within 3 months after surgery.

BACKGROUND. Patients with a history of breast cancer are at higher risk of subsequent breast cancers and need close clinical and imaging follow-up. Limited data are available on screening of these ...

Background. Breast cancer is the most common cancer in women worldwide. Despite advances in treatment of breast cancer, early-stage breast cancer detection is limited by screening mammography and often requires additional breast imaging.The purpose of the study was to analyze available data on modern imaging techniques of additional breast visualization used for improving breast cancer screening.Material and methods. The review includes data from randomized controlled trials and meta-analyzes on the effectiveness of breast imaging techniques for early-stage breast cancer detection. The search was carried out in pubmed, Web of science, scopus and cochrane library databases. Out of 100 publications published over the past 7 years, 51 were included in the presented review.Results. Breast cancer screening using various imaging techniques has been carried out in the world for more than 30 years, and over the past 10 years significant progress has been made in improving X-ray, ultrasound and magnetic resonance technologies in the early breast cancer detection. At present, healthcare organizers are faced with the question of choosing a vector for improving the breast cancer screening program by introducing digital tomosynthesis, contrast spectral mammography, or accelerated mri. According to the current results of the analysis of literature data, contrast spectral mammography and accelerated mri have the highest sensitivity, but studies of sensitivity, specificity, positive and negative predictive values (ppv, npv) are ongoing.Conclusion. The data presented in the review confirm the necessity for finding the vector for improving the breast cancer screening program using multicenter prospective trials.

US is widely used in breast imaging for diagnostic purposes and is also used increasingly for supplemental screening in women with dense breasts. US frequently depicts masses that are occult on mammography, even after tomosynthesis, and the vast majority of such masses are benign. Many masses seen only on screening US are easily recognized as benign simple cysts. Probably benign, BI-RADS 3, or low suspicion, BI-RADS 4A masses are also common and often prompt short-interval follow-up or biopsy, respectively, yet the vast majority of these are benign. This review details appropriate characterization, classification, and new approaches to the management of probably benign masses seen on screening US that can reduce false positives and, thereby, reduce costs and patient anxiety.

Dedicated breast CT is an emerging 3D isotropic imaging technology for breast, which overcomes the limitations of 2D compression mammography and limited angle tomosynthesis while providing some of the advantages of magnetic resonance imaging. This first installment in a 2-part review describes the evolution of dedicated breast CT beginning with a historical perspective and progressing to the present day. Moreover, it provides an overview of state-of-the-art technology. Particular emphasis is placed on technical limitations in scan protocol, radiation dose, breast coverage, patient comfort, and image artifact. Proposed methods of how to address these technical challenges are also discussed. KEY POINTS: • Advantages of breast CT include no tissue overlap, improved patient comfort, rapid acquisition, and concurrent assessment of microcalcifications and contrast enhancement. • Current clinical and prototype dedicated breast CT systems differ in acquisition modes, imaging techniques, and detector types. • There are still details to be decided regarding breast CT techniques, such as scan protocol, radiation dose, breast coverage, patient comfort, and image artifact.

Introduction Medial epicondyle fracture displacement is notoriously difficult to determine on conventional radiography, and follow-up computed tomography (CT) is often obtained to measure precise displacement. Another option for fracture characterization is digital tomosynthesis (DT), a technology providing high in-plane resolution of bony anatomy by acquiring multiple low-dose images in a linear arc. Advantages of DT include lower radiation exposure and lower cost than CT, rapid image acquisition, and a similar patient experience to conventional radiography. The digital application of tomosynthesis is relatively new and is integrated as an add-on feature with modern radiography equipment. This study compares DT, CT and conventional radiography for measurement accuracy in medial epicondyle fractures with the goal of determining relative accuracy in measuring medial epicondyle fracture displacement. Methods Medial epicondyle fractures were created in 5 cadaveric elbow specimens. Each specimen was imaged with conventional radiography, DT, and CT. True displacement measured by digital calipers was compared with "measured" displacement for each image acquisition. CT images included axial, sagittal, and coronal reformats. DT images of the elbow included anteroposterior (AP) longitudinal and transverse, lateral longitudinal and transverse, and axial longitudinal and transverse. Conventional radiographs included AP, lateral, and axial distal humerus images. Four physicians reviewed all images 3 months later. Each reviewer independently measured maximum apparent fracture displacement to the nearest 0.1 mm. Measurement accuracy was calculated as percent difference [(measured displacement-actual displacement)/actual displacement] for each acquisition. Mean, median, and SD for measurement accuracy were calculated. Two-tailed paired t tests were performed on each acquisition to compare the measurement accuracy. Results Compared with conventional radiographs, accuracy of DT was superior in AP longitudinal (P=0.03), AP transverse (P=0.01), axial longitudinal (P=0.0001), and axial transverse projections (P=0.001). Accuracy of CT was superior to conventional radiography in the AP projection (P=0.03), but was equivalent in the axial projection (P=0.9). Accuracy of CT was similar to DT in AP longitudinal (P=0.6), AP transverse (P=0.5), and axial longitudinal projections (P=0.07). Accuracy of DT in the axial transverse projection was superior to CT (P=0.03). Conclusion DT is more accurate than conventional radiography (both AP and axial views) and as accurate as CT in assessing millimeters of displacement of medial epicondyle fracture fragments. Level of evidence Level IV-diagnostic study.

Please see the Editorial Comment by Ellen B. Mendelson discussing this article. BACKGROUND. The literature has reported varying rates of malignancy for architectural distortion (AD) on digital brea...

Background As mammography has its known limitations in dense breast, additional imaging is usually needed. We aimed to evaluate the role of automated breast ultrasound in addition to tomosynthesis in detection and diagnosis of breast lesions in dense breasts. Seventy patients with dense breasts subjected to full-field digital mammography (FFDM) including digital breast tomosynthesis (DBT) and automated breast ultrasound (ABUS). Both studies were evaluated by two experienced radiologists to assess breast composition, mass characterization, asymmetry, calcification, axillary lymphadenopathy, extent of disease (EOD), skin thickening, retraction, architectural distortion, and BIRADS classification. All breast masses were interpreted as above described and then correlated with final pathological diagnosis. Results Study included 70 females presenting with different types of breast lesions. Eighty-two masses were detected: 53 benign (n = 53/82), 29 malignant (n = 29/82). Histopathology of the masses was reached by core biopsy (n = 30), FNAC (n = 14), and excisional biopsy (n = 11). The rest of the masses (n = 27/82) were confirmed by their characteristic sonographic appearances; 20 cases of multiple bilateral anechoic simple cysts, 7 typical fibroadenomas showed stationary course on follow-up. As regards the final BIRADS score given for both modalities, tomosynthesis showed accuracy of 93.1% in characterization of malignant masses with accuracy of 94.3% in benign masses, on the other hand automated ultrasound showed 100% accuracy in characterization of malignant masses with 98.1% accuracy in benign masses. Conclusion Adding ABUS to tomosynthesis has proven a valuable imaging tool for characterization of breast lesions in dense breasts both as screening and diagnostic tool. They proved to be more sensitive and specific than digital mammography alone in showing tissue overlap, tumor characterization, lesion margins, extent, and multiplicity of malignant lesions.

OBJECTIVES: This study was designed to compare the detection of subtle lesions (calcification clusters or masses) when using the combination of digital breast tomosynthesis (DBT) and synthetic mammography (SM) with digital mammography (DM) alone or combined with DBT. METHODS: A set of 166 cases without cancer was acquired on a DBT mammography system. Realistic subtle calcification clusters and masses in the DM images and DBT planes were digitally inserted into 104 of the acquired cases. Three study arms were created: DM alone, DM with DBT and SM with DBT. Five mammographic readers located the centre of any lesion within the images that should be recalled for further investigation and graded their suspiciousness. A JAFROC figure of merit (FoM) and lesion detection fraction (LDF) were calculated for each study arm. The visibility of the lesions in the DBT images was compared with SM and DM images. RESULTS: For calcification clusters, there were no significant differences (p > 0.075) in FoM or LDF. For masses, the FoM and LDF were significantly improved in the arms using DBT compared to DM alone (p < 0.001). On average, both calcification clusters and masses were more visible on DBT than on DM and SM images. CONCLUSIONS: This study demonstrated that masses were detected better with DBT than with DM alone and there was no significant difference (p = 0.075) in LDF between DM&DBT and SM&DBT for calcifications clusters. Our results support previous studies that it may be acceptable to not acquire digital mammography alongside tomosynthesis for subtle calcification clusters and ill-defined masses. KEY POINTS: • The detection of masses was significantly better using DBT than with digital mammography alone. • The detection of calcification clusters was not significantly different between digital mammography and synthetic 2D images combined with tomosynthesis. • Our results support previous studies that it may be acceptable to not acquire digital mammography alongside tomosynthesis for subtle calcification clusters and ill-defined masses for the imaging technology used. ispartof: EUROPEAN RADIOLOGY vol:32 issue:2 pages:806-814 ispartof: location:Germany status: published

Introduction. Breast cancer in the structure of malignancies in women takes the 1st place. There has been an annual increase in morbidity, including due to improvements in diagnostic interventions and screening. Mammography and ultrasound of the breasts is mandatory when diagnosing breast cancer. The difficulties of diagnosis are revealed in small tumors.Methods. Breast ultrasounds were performed on the ultrasound machines of the expert class TOSHIBA APLIO 500, PHILIPS EPIQ 5 and PHILIPS EPIQ 7. Mammography and tomosynthesis were performed on mammogram MAMMOMAT INSPITATION PRIME. Core-biopsia under ultrasound control was carried out on the Logiq9 ultrasound scanner. Eighty women were selected with suspected cancer after breast core-biopsy with the category BI-RADS 3, 4 and 5. The size of the node according to ultrasound data was 6-10 mm.Results. According to core-biopsia has been identified cancer, histologically and immunohystochemically confirmed in 50 cases. In 30 women benign tumors were identified. The most informative mammograms of breast cancer were high tumor density, ray of radiibility and local deformity of soft tissues. Among the characteristic ultrasonic signs of the cancer more often noted vertical orientation, reduced echogenicity, uneven contour, other signs were not so character for the cancer.Conclusion. You can't focus on a separate sign of education! Only a combination of traits, different diagnostic methods contribute to the correct diagnosis.

BackgroundEven though radiologic diagnosis of bone tumors and tumor-like lesions is usually based on radiographs, radiographically faint imaging features sometimes remain challenging due to overlapping anatomical structures.PurposeTo compare tomosynthesis with radiography for the evaluation of bone tumors and tumor-like lesions.Material and MethodsForty-seven bone tumors and tumor-like lesions were assessed with radiographs and tomosynthesis images. Two radiologists independently analyzed imaging features of lesions, including margin, periosteal reaction, cortical thinning, matrix mineralization, cortical destruction (such as pathologic fracture), and extraosseous soft-tissue extension. Computed tomography (CT) imaging was used as a reference method. Diagnostic performances of radiography and tomosynthesis were analyzed and compared based on sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Effective radiation dose was compared among the three imaging modalities by phantom studies.ResultsInter-observer variability (kappa value) for imaging features was slight to moderate on radiography (0.167–0.588), whereas it was nearly perfect on tomosynthesis (0.898–1.000) except for extraosseous soft-tissue extension (0.647 vs. 0.647). Tomosynthesis showed significantly higher sensitivity than radiography in evaluating the margin for bone tumors or tumor-like lesions (1.00 vs. 0.85; P = 0.016), and significantly higher accuracy than radiography in evaluating the margin and matrix mineralization for those (1.00 vs. 0.85; P = 0.016 and 0.91 vs.0.77; P = 0.023, respectively). In phantom studies, mean effective radiation doses were highest in order of CT, tomography, and radiography.ConclusionTomosynthesis increases sensitivity and accuracy of the margin as well as accuracy of the matrix mineralization of bone tumors and tumor-like lesions compared to radiography.

Objectives To evaluate the diagnostic performance in the assessment setting of three protocols: one-view wide-angle digital breast tomosynthesis (WA-DBT) with synthetic mammography (SM), two-view WA-DBT/SM, and two-view digital mammography (DM). Methods Included in this retrospective study were patients who underwent bilateral two-view DM and WA-DBT. SM were reconstructed from the WA-DBT data. The standard of reference was histology and/or 2 years follow-up. Included were 205 women with 179 lesions (89 malignant, 90 benign). Four blinded readers randomly evaluated images to assess density, lesion type, and level of suspicion according to BI-RADS. Three protocols were evaluated: two-view DM, one-view (mediolateral oblique) WA-DBT/SM, and two-view WA-DBT/SM. Detection rate, sensitivity, specificity, and accuracy were calculated and compared using multivariate analysis. Reading time was assessed. Results The detection rate was higher with two-view WA-DBT/SM (p = 0.063). Sensitivity was higher for two-view WA-DBT/SM compared to two-view DM (p = 0.001) and one-view WA-DBT/SM (p = 0.058). No significant differences in specificity were found. Accuracy was higher with both one-view WA-DBT/SM and two-view WA-DBT/SM compared to DM (p = 0.003 and > 0.001, respectively). Accuracy did not differ between one- and two-view WA-DBT/SM. Two-view WA-DBT/SM performed better for masses and asymmetries. Reading times were significantly longer when WA-DBT was evaluated. Conclusions One-view and two-view WA-DBT/SM can achieve a higher diagnostic performance compared to two-view DM. The detection rate and sensitivity were highest with two-view WA-DBT/SM. Two-view WA-DBT/SM appears to be the most appropriate tool for the assessment of breast lesions. Key Points • Detection rate with two-view wide-angle digital breast tomosynthesis (WA-DBT) is significantly higher than with two-view digital mammography in the assessment setting. • Diagnostic accuracy of one-view and two-view WA-DBT with synthetic mammography (SM) in the assessment setting is higher than that of two-view digital mammography. • Compared to one-view WA-DBT with SM, two-view WA-DBT with SM seems to be the most appropriate tool for the assessment of breast lesions.

Background Chest radiography value as a screening tool in those exposed to pulmonary tuberculosis (TB) is reduced by its lower sensitivity to detect small intrapulmonary lesions. Purpose To evaluate the efficacy of digital tomosynthesis (DTS) screening of individuals that had contacted persons with active TB using low-dose computed tomography (CT) as the reference standard methods. Material and Methods This retrospective, community-based screening study of 90 adults who had been in close contact with a TB case was undertaken at our institution. All individuals underwent clinical evaluation, digital radiography (DR), DTS, and low-dose chest CT. Observers assessed and classified DR and DTS images using CT as the reference-standard method. Based on clinical and imaging findings, TB status was classified as normal, latent, minimal, subclinical, and active. Diagnostic performances of DTS and DR for the interpretation of correct diagnosis were calculated. Results The estimated effective doses for DR, DTS, and low-dose CT were 0.01 mSv, 0.1 mSv, and 0.33 mSv, respectively. TB statuses of the 90 individuals were as follows: 62 latent (68.9%); two subclinical (2.2%); and one minimal (1.1%). The sensitivities, specificities, and accuracies of DTS and DR in the interpretation of correct diagnosis were 75.8%, 100%, 91.1% and 48.5%, 96.5%, 78.9%, respectively. Conclusion DTS appears to be superior to DR for the detection of lung lesions in individuals with TB contacts. DTS can offer a reasonable option for TB contact investigation.

The objective of this study was to estimate the risk of radiation-induced injury to the organs due to ionizing radiation following breast screening recommendations employing digital breast tomosynthesis (DBT) and digital mammography (DM). Using the Monte Carlo method, absorbed doses in the tissues and organs were calculated on an adult female phantom, considering two-view craniocaudal (CC) and mediolateral oblique (MLO) projections for each breast. The results showed differences in the total effective risk due to DM (CC + MLO) and DBT (CC + MLO) examinations in Brazil, ranging from 20.73 cases 10-5(DM) to 27.19 cases 10-5(DBT). Significant differences were also observed in the total effective risk of cancer incidence in the lungs due to DM (CC + MLO) and DBT (CC + MLO), ranging from 1.75×10-01cases 10-5(DM) to 1.76×10-01cases 10-5(DBT). The results indicate that the total effective risk of incidence should be considered as an additional parameter for the evaluation of DBT or DBT + DM program performance.

Purpose: The purpose of this study is to describe the safety and efficacy of 9G needle biopsy under tomosynthesis guidance with the patient in the prone position.Materials and methods: This is a retrospective observational study conducted on patients with non-palpable breast mass exclusively detectable through tomosynthesis, performed from the 1st January 2018 to the 1st August 2020. The procedures were performed by taking 12 tissue samples from each mass. The evaluated technical success was considered as a conclusive sample for histological diagnosis. We performed a comparison between the procedural data of interventions in patients who have a lesion 10mm and between high contrast and low contrast masses. The histological data of the samples were analyzed.Results: 500 biopsies of the total 1500 performed from the 1st January 2018 to the 1st August 2020 were included in the study; repetitions for inadequate withdrawal occurred 0.4% (3/500). No major complications have ever been observed. Two cases (0.2%) of minor bleeding were observed with self-limited bleeding from the skin breach at 90 minutes without clinical sequelae in an asymptomatic patient. The biopsy samples showed carcinoma in 55.2% (276/500). Conclusion: Our study suggests that the 9G needle sampling biopsy procedure through tomosynthesis guide with prone patient is a safe and effective procedure for the characterization of indeterminate breast mass.

Compare four groups being screened: women without breast implants undergoing digital mammography (DM), women without breast implants undergoing DM with digital breast tomosynthesis (DM/DBT), women with implants undergoing DM, and women with implants undergoing DM/DBT. Mammograms from February 2011 to March 2017 were retrospectively reviewed after 13,201 were excluded for a unilateral implant or prior breast cancer. Patients had been allowed to choose between DM and DM/DBT screening. Mammography performance metrics were compared using chi-square tests. Six thousand forty-one women with implants and 91,550 women without implants were included. In mammograms without implants, DM (n = 113,973) and DM/DBT (n = 61,896) yielded recall rates (RRs) of 8.53% and 6.79% (9726/113,973 and 4204/61,896, respectively, p 0.999), and PPV1s of 4.29% and 6.0% (17/396 and 15/250, respectively, p > 0.999), respectively. DM/DBT significantly improved recall rates, cancer detection rates, and positive predictive values for recall compared to DM alone in women without implants. DM/DBT performance in women with implants trended towards similar improvements, though no metric was statistically significant. • Digital mammography with tomosynthesis improved recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women without implants. • Digital mammography with tomosynthesis trended towards improving recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone for women with implants, but these trends were not statistically significant — likely related to sample size.

Purpose In the reconstruction of volume breast images from x-ray projections in breast tomosynthesis, some tomographic systems truncate the image data presented to the radiologist such that a non-negligible amount of tissue may be missing from the breast image. QC tests were conducted to determine if this problem existed in imaging in the TMIST study. Methods Test tools developed for TMIST containing small objects at known heights were used in routine weekly and annual QC testing of tomosynthesis units to assess the degree to which phantom material that was irradiated in imaging was excluded from the reconstructed image. Results from 318 tests on five system types from three manufacturers are reported. Results The presence and extent of this problem varied among system types. The cause was most frequently related to machine errors in the determination of breast thickness or to deflection of components during breast compression. In particular, the problem occurred when a compression paddle other than the one calibrated for tomosynthesis was used for the tests. This was also verified to have occurred in some clinical imaging. Conclusions Missing volume can be avoided by intentionally reconstructing additional image slices above and below the presumed locations of the breast support and compression plate. A compression paddle which has been calibrated for tomosynthesis should be used both for clinical imaging and testing. The prevalence of this phenomenon suggests that more frequent testing for volume coverage may be advisable.

PurposeTo evaluate two chest tomosynthesis (CTS) scoring systems for cystic fibrosis (CF), one system developed by Vult von Steyern et al. (VvS) and one system based on the Brody scoring system for high-resolution computed tomography (HRCT) (modified Brody (mB)). Brody scoring of HRCT was used as reference.MethodsIn conjunction with routine control HRCT at clinical follow-up, 10 consecutive adult CF patients underwent CTS for research purposes. Four radiologists scored the CTS examinations using the mB and VvS scoring systems. All scores were compared to the Brody HRCT scores. The agreement between the evaluated CTS scoring systems and the reference HRCT scoring system was determined using Spearman’s rank correlation coefficient and the intraclass correlation coefficient (ICC).Major findingsSpearman’s rank correlation coefficient showed strong correlations between HRCT score and both the mB and the VvS CTS total scores (median rs = 0.81 and 0.85, respectively). The ICC showed strong correlation between the CTS scoring systems and the reference: 0.88 for mB and 0.85 for VvS scoring. The median time for scoring was 20 and 10 minutes for the mB and VvS scoring systems, respectively.ConclusionsBoth evaluated CTS scoring systems correlate well with the reference standard Brody HRCT scoring. The VvS CTS scoring system has a shorter reading time, suggesting its advantage in clinical practice.

The influence of the angular deviation of the tube during digital breast tomosynthesis (DBT) acquisition to the dose in the examined breast and in other organs and tissues is not well known. In this work, the Monte Carlo method was used with an adult female virtual anthropomorphic phantom to investigate the impact of this angular variation on the breast dose. The absorbed dose in the examined breast was normalized by the air kerma, which resulted in an absorbed dose coefficient (DT/Kair) for the breast. The absorbed dose in each organ was normalized by the glandular dose in the breast, resulting in the relative organ dose (ROD). An adult female virtual anthropomorphic phantom (FSTA_M50_H50) was incorporated into a scenario containing tomosynthesis equipment with Mo/Mo, Mo/Rh, and W/Rh target/filter combinations and tube voltages of 28 kV. The comparison between the results of the simulations considering digital mammography (DM) and DBT data showed that the DT/Kair values for the examined breast obtained with the DBT parameters were up to 24 times higher than with the DT/Kair obtained with DM parameters. A DT/Kair of 0.97 × 10-1 mGy mGy-1 was obtained in a DBT exam of the right breast. Considering the other organs, the highest ROD values were observed in the thyroid (6.45 × 10-4), eyes (3.87 × 10-4), liver (1.95 × 10-5), and eye lenses (3.21 × 10-3). A variation in the absorbed dose values for the breast and other organs was observed for all projections different from 0°.

Background: A thorough clinical breast examination, imaging, and tissue sampling are needed for a definitive diagnosis of breast diseases. Contrast-enhanced digital mammography (CEDM) is the second type of advanced technology stemming from the digital platform (the first being tomosynthesis) that proved to be promising in this field. Objectives: The aim of this study was to evaluate the role of contrast enhanced digital mammography in diagnosis of breast masses. Patients and Methods: The study included 30 participants who visited the hospital for assessing their complaints of breast masses during the period from May 2019 to May 2020 after taking their consent. Results: The contrast enhanced digital mammography (CEDM) proved that 17 patients (56.7%) proved with malignant masses, 10 (33.3%) benign and 3 (10%) normal that was confirmed by final diagnosis of these cases. The sensitivity and specificity of the CEDM (100%, 92.86%) respectively, that expresses high levels of both parameters. Conclusion: CEDM has higher diagnostic value that can enhance the process of early cancer diagnosis, postoperative follow up, and treatment plans.

OBJECTIVE. One central question pertaining to mammography quality relates to discerning the optimal recall rate to maximize cancer detection while minimizing unnecessary downstream diagnostic imaging and breast biopsies. We examined the trade-offs for higher recall rates in terms of biopsy recommendations and cancer detection in a single large health care organization. MATERIALS AND METHODS. We included 2D analog, 2D digital, and 3D digital (tomosynthesis) screening mammography examinations among women 40-79 years old performed between January 1, 2005, and December 31, 2017, with cancer follow-up through 2018. There were 36, 67, and 38 radiologists who read at least 1000 2D analog examinations, 2D digital examinations, and 3D tomosynthesis examinations, respectively, who were included in these analyses. Using logistic regression with marginal standardization, we estimated radiologist-specific mean recall (abnormal interpretations/1000 mammograms), biopsy recommendation, cancer detection (screening-detected in situ and invasive cancers/1000 mammograms), and minimally invasive cancer detection rates while adjusting for differences in patient characteristics. RESULTS. Among 1,060,655 screening mammograms, the mean recall rate was 10.7%, the cancer detection rate was 4.0/1000 mammograms, and the biopsy recommendation rate was 1.60%. Recall rates between 7% and 9% appeared to maximize cancer detection while minimizing unnecessary biopsies. CONCLUSION. The results of this investigation are in contrast to those of a recent study suggesting appropriateness of higher recall rates. The "sweet spot" for optimal cancer detection appears to be in the recall rate range of 7-9% for both 2D digital mammography and 3D tomosynthesis. Too many women are being called back for diagnostic imaging, and new benchmarks could be set to reduce this burden.

Background Navigational bronchoscopy is commonly used to sample lung nodules, with a better safety profile but lower diagnostic yield than computerized tomography-guided transthoracic needle biopsy. The addition of digital tomosynthesis to electromagnetic navigation, using intraprocedural images obtained from a C-arm fluoroscope to identify target lesion location and update navigational guidance, may improve diagnostic yield. Methods Consecutive bronchoscopies using tomosynthesis-assisted fluoroscopic electromagnetic navigational bronchoscopy (F-ENB) at a single institution over a 1-year period were included. The primary outcome was diagnostic yield. A bronchoscopy was defined as diagnostic if pathologic examination revealed malignancy or specific histological findings indicative of lesional sampling with confirmatory 6-month follow-up for benign lesions. Results A total of 324 patients with 363 nodules underwent F-ENB between April 25, 2018 and April 29, 2019. The average nodule size was 1.9±1.1 cm, 65% of the nodules were located in the peripheral third of the lung. A bronchus sign was present in 24% of cases. Of the 363 nodules, 299 (82.4%) had lesional findings. At 6-month follow-up, among these 299 nodules, 6 were found to be false negatives and 12 nodules were lost to follow-up. Considering all nodules lost to follow-up as false negatives, the 6-month diagnostic yield was 77.4%. Pneumothorax complicated 8 (2.5%) of cases. There was 1 episode of respiratory failure. Conclusion This retrospective study suggests the diagnostic yield of F-ENB may exceed that of traditional ENB. Future prospective and comparative studies are needed to confirm these promising data.

Background and aims Digital tomosynthesis has proven useful in the evaluation of damage to joints. This study aims to describe the most common digital tomosynthesis findings for four rheumatological entities and to compare the usefulness of this technique with that of other imaging techniques. Materials and methods Following the PRISMA guidelines, we systematically searched the literature for articles about the use of digital tomosynthesis in rheumatoid arthritis, osteoarthritis, spondyloarthritis, and gout. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) criteria to evaluate the quality of the articles included. Results We included 13 articles. For rheumatoid arthritis, osteoarthritis, and spondyloarthritis, digital tomosynthesis detected bone abnormalities better than plain-film X-rays; however, for gout, the results were variable. Conclusions Digital tomosynthesis can play an important role in the evaluation of skeletal abnormalities in rheumatological disease, especially compared to plain-film X-rays.

Purpose: Digital tomosynthesis (DTS) is currently undergoing validation for potential clinical implications. The aim of this study was to investigate the potential for DTS as a low-dose alternative to computed tomography (CT) in imaging of pulmonary pathology in patients with cystic fibrosis (CF). Methods: DTS and CT were performed as part of the routine triannual follow-up in 31 CF patients. Extent of disease was quantified according to modality-specific scoring systems. Statistical analysis included Spearman’s rank correlation coefficient (r) and Krippendorff’s alpha (α). Major findings: The median effective dose was 0.14 for DTS and 2.68 for CT. Intermodality correlation was very strong for total score and the subscores regarding bronchiectasis and bronchial wall-thickening (r = 0.82–0.91, P

Screening mammography reduces breast cancer mortality; however, when used to examine women with dense breasts, its performance and resulting benefits are reduced. Increased breast density is an independent risk factor for breast cancer. Digital breast tomosynthesis (DBT), ultrasound (US), molecular breast imaging (MBI), MRI, and contrast-enhanced mammography (CEM) each have shown improved cancer detection in dense breasts when compared with 2D digital mammography (DM). DBT is the preferred mammographic technique for producing a simultaneous reduction in recalls (i.e., additional imaging). US further increases cancer detection after DM or DBT and reduces interval cancers (cancers detected in the interval between recommended screening examinations), but it also produces substantial additional false-positive findings. MBI improves cancer detection with an effective radiation dose that is approximately fourfold that of DM or DBT but is still within accepted limits. MRI provides the greatest increase in cancer detection and reduces interval cancers and late-stage disease; abbreviated techniques will reduce cost and improve availability. CEM appears to offer performance similar to that of MRI, but further validation is needed. Dense breast notification will soon be a national standard; therefore, understanding the performance of mammography and supplemental modalities is necessary to optimize screening for women with dense breasts.

Background Mammography has been the mainstay for the detection of breast cancer over decades. It has gradually advanced from screen film to full-field digital mammography. Tomosynthesis has evolved as advanced imaging for early diagnosis of breast lesions with a promising role in both diagnostic and screening settings, particularly in dense and treated breasts. Results This study included 90 female patients according to our inclusion criteria. All patients perform full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) and were classified according to breast density and age groups. Breast imaging reporting and data system (BI-RADS) scoring was assigned for each case. This was correlated with the final diagnosis; the diagnostic indices of mammography were a sensitivity of 64.44%, a specificity of 77.78%, a positive predictive value (PPV) 74.63%, a negative predictive value (NPV) of 68.63%, and a diagnostic accuracy of 71.11%. Diagnostic indices of DBT were a sensitivity of 100%, a specificity of 97.77%, PPV 97.78%, NPV 100%, and diagnostic accuracy of 97.7%. In patients with dense breasts American College of Radiology (ACR) (c and d), 61% of cases had changed their BIRADS scoring with the addition of tomosynthesis. Yet, in non-dense breast ACR (a and b), 45% of cases had changed BIRADS scoring with the addition of DBT to FFDM. Conclusion DBT is a promising imaging modality offering better detection and characterization of different breast abnormalities, especially in young females, and those with dense breasts with an increase of sensitivity and specificity than FFDM. This leads to a reduction in the recalled cases, negative biopsies, and assessing the efficacy of therapy as it enables improving detection of breast cancer and different breast lesions not visualized by conventional mammography

Zusammenfassung Klinisches/methodisches Problem Bei der Mammadiagnostik gilt es, klinische sowie multimodal bildgebende Informationen mit perkutanen und operativen Eingriffen zu koordinieren. Aus dieser Komplexität entsteht eine Reihe von Problemen: übersehene Karzinome, Überdiagnose, falsch-positive Befunde, unnötige weiterführende Bildgebung, Biopsien und Operationen. Radiologische Standardverfahren Folgende Untersuchungsverfahren werden in der Mammadiagnostik eingesetzt: Röntgenmammographie, Tomosynthese, kontrastangehobene Mammographie, (multiparametrischer) Ultraschall, Magnetresonanztomographie, Computertomographie, nuklearmedizinische Verfahren sowie deren Hybridvarianten. Methodische Innovationen Künstliche Intelligenz (KI) verspricht Abhilfe bei praktisch allen Problemen der Mammadiagnostik. Potenziell lassen sich Fehlbefunde vermeiden, bildgebende Verfahren effizienter einsetzen und möglicherweise auch biologische Phänotypen von Mammakarzinomen definieren. Leistungsfähigkeit Auf KI basierende Software wird für zahlreiche Anwendungen entwickelt. Am weitesten fortgeschritten sind Systeme für das Screening mittels Mammographie. Probleme sind monozentrische sowie kurzfristig am finanziellen Erfolg orientierte Ansätze. Bewertung Künstliche Intelligenz (KI) verspricht eine Verbesserung der Mammadiagnostik. Durch die Vereinfachung von Abläufen, die Reduktion monotoner und ergebnisloser Tätigkeiten und den Hinweis auf mögliche Fehler ist eine Beschleunigung von dann weitgehend fehlerfreien Abläufen denkbar. Empfehlung für die Praxis In diesem Beitrag werden die Anforderungen der Mammadiagnostik und mögliche Einsatzgebiete der der KI beleuchtet. Je nach Definition gibt es bereits praktisch anwendbare Softwaretools für die Mammadiagnostik. Globale Lösungen stehen allerdings noch aus.

Background Management of scaphoid fractures often requires advanced imaging to achieve accurate diagnoses and appropriate treatment. Digital tomosynthesis (DTS) is a cross-sectional imaging modality that may be used to substitute magnetic resonance imaging or computed tomographic scans. The purpose of this study is to: (1) determine the diagnostic accuracy of DTS in occult scaphoid fractures; and (2) report on the reduction of other advanced imaging when using DTS. Methods From May 2014 to October 2017, the charts of all patients who underwent scaphoid tomogram were retrospectively reviewed. The diagnostic accuracy of DTS for occult fracture was compared with 2-week follow-up plain films. To measure the reduction in utilization of advanced imaging, it was determined whether DTS eliminated the need for advanced imaging by providing adequate information regarding the clinical question. Results A total of 78 patients underwent scaphoid tomography in this time frame: 39 for occult fracture, 33 for fracture union, 5 for fracture morphology, and 1 for hardware positioning. For the detection of occult fracture, DTS had a sensitivity of 100%, specificity of 83%, positive predictive value of 64%, and negative predictive value of 100%. Advanced imaging was not used in 35 of the remaining 39 patients based on the results obtained by DTS. In patients who did receive advanced imaging, 83% of tomograms provided conclusive diagnostic information. Conclusions Digital tomosynthesis increases the diagnostic sensitivity of occult scaphoid fractures, reducing unnecessary immobilization and advanced imaging. Digital tomosynthesis provides clinical detail beyond plain film, which reduces the need to obtain advanced imaging when assessing union, fracture pattern, and hardware placement.

A mamografia digital é, atualmente, o pilar do programa de rastreio do cancro da mama, contudo a densidade mamária afeta negativamente a sua performance de diagnóstico, diminuindo a sua sensibilidade devido ao efeito – designado em Radiologia “efeito máscara”. Com o objetivo de superar este inconveniente, a tomossíntese tem conseguido bons resultados em mulheres com elevada densidade mamária, devido à sua capacidade de reduzir as falsas imagens resultantes da sobreposição dos tecidos. Este estudo pretende explorar a literatura no que diz respeito à integração da tomossíntese nos programas de rastreio para avaliação de mulheres com elevada densidade mamária, com base nos indicadores clínicos: taxa de rechamada – recall rate, fração de falsos positivos (FFP) e taxa de deteção de lesões. Da pesquisa na literatura resultaram 79 estudos, dos quais 11 foram incluídos para análise. Verifica-se que a utilização da tomossíntese mais mamografia está associada à redução da recall rate, em todas as categorias ACR, mas maioritariamente na categoria C (Starikov A. et al, 2016) atingindo 8,83% para a tomossíntese e 10,98% para a mamografia (Alsheik N. et al, 2019), e 10,4% para a tomossíntese e 19,9% para a mamografia no estudo de Conant E. et al, 2019. A FFP também beneficia duma diminuição, porém, aumenta com o aumento das categorias ACR sendo cerca de 5 vezes superior na categoria D. A taxa de deteção de lesões também aumentou com a adoção da tomossíntese sendo cerca de 1,41 vezes superior em cada 1000 mulheres, e com maior expressão em mulheres com tecido mamário denso. Conclui-se que o uso isolado da tomossíntese ou a sua adição à mamografia demonstra resultados muito positivos, dado que esta modalidade de imagem contribui para a deteção de lesões de menores dimensões e, consequentemente, aumento da taxa de deteção de lesões, aumento da especificidade, diminuição da recall rate e FFP. Por este motivo a tomossíntese demonstra ser uma técnica promissora e pode representar uma resposta eficaz nos programas de rastreio.

Background To explore the clinical significance of digital tomographic fusion imaging in the diagnosis of avascular disease of the femoral head in adults. Methods Eighty-two adult patients with avascular necrosis of the femoral head confirmed by MRI in the department of orthopedics of our hospital were studied retrospectively. The related signs of adult avascular necrosis of the femoral head were diagnosed by digital tomographic fusion imaging, and the detection rates of digital X-ray (DR) and digital tomosynthesis (DTS) were compared to clarify the clinical value of digital tomographic fusion imaging in the diagnosis of adult avascular necrosis of the femoral head. Results DTS detected DR and 78 cases identified 55 cases. Taking the results of CT/MRI as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value of DR and DTS in the diagnosis of ANFH were calculated. There was a significant difference in the detection rate between the two methods (P Conclusion The digital tomographic fusion imaging technique has the advantages of high detection rate and excellent image quality, is economical, and is worth popularizing. For those with negative X-rays, DTS diagnosis and CT or/and MRI can avoid unnecessary CT and MRI examinations, which is helpful to reduce the waste of medical resources.

Objective To examine the breast cancer detection rate by single reading of an experienced radiologist supported by an artificial intelligence (AI) system, and compare with two-dimensional full-field digital mammography (2D-FFDM) double reading. Materials and methods Images (3D-tomosynthesis) of 161 biopsy-proven cancers were re-read by the AI algorithm and compared to the results of first human reader, second human reader and consensus following double reading in screening. Detection was assessed in subgroups by tumour type, breast density and grade, and at two operating points, referred to as a lower and a higher sensitivity threshold. Results The AI algorithm method gave similar results to double-reading 2D-FFDM, and the detection rate was significantly higher compared to single-reading 2D-FFDM. At the lower sensitivity threshold, the algorithm was significantly more sensitive than reader A (97.5% vs. 89.4%, p = 0.02), non-significantly more sensitive than reader B (97.5% vs. 94.4%, p = 0.2) and non-significantly less sensitive than the consensus from double reading (97.5% vs. 99.4%, p = 0.2). At the higher sensitivity threshold, the algorithm was significantly more sensitive than reader A (99.4% vs. 89.4%, p Conclusion In this proof of principle study, we show that sensitivity using single reading with a suitable AI algorithm is non-inferior to that of standard of care using 2D mammography with double reading, when tomosynthesis is the primary screening examination.

Introduction: The classification of multiple, simultaneous, ipsilateral breast cancer after localization in arbitrarily delimited quadrants, according to BI-RADS criteria, is in disagreement with pathological and cytogenetic investigations and with the evolution of the disease. This classification is related to the non-anatomical examination in two standard mammographic projections, including tomosynthesis, and to the non-anatomical orthogonal scanning in the classical ultrasonography and magnetic resonance imaging of the breasts. Case Report: We illustrate a case of a 69-year-old woman with multicentric breast cancer detected and characterized by a non-invasive technique of diagnosis, based on the triad: anatomical ductal radial and antiradial breast ultrasound, Doppler study and strain sonoelastography, briefly named the full breast ultrasonography. Conclusion: The complete technique of ultrasonography has the advantages of high availability, low costs, standardization of scanning and reporting, and especially a detailed imaging illustration of the breast anatomical normal and abnormal structures correlated with the pathological findings.

This study evaluates targeting success, pathologic results, and complications of upright digital breast tomosynthesis-guided biopsies (DBTB) compared to prone stereotactic breast biopsies (PSBB) performed during the same time period. In this retrospective study, 252 consecutive mammographically guided vacuum-assisted 9-gauge breast biopsies performed at a single institution from December 2017 to August 2018 were evaluated. This included 153 DBTBs compared to 99 PSBBs. A total of 153 DBTBs (in 139 patients) and 99 PSBBs (in 96 patients) were performed during the study period. Targeting success was similar for DBTB (99%) and PSBB (99%). DBTB was used to target both calcifications (110) as well as non-calcified targets (43), while PSBB only targeted calcifications. Malignant biopsies from DBTB were more likely to be invasive (n = 12, 8%) than PSBB (n = 2, 2%), with P = .03. Moreover, DBTB targets classified as calcifications only were less likely to yield invasive malignancy (2/109, 2% vs 10/43, 23%), with P = .0001. PPV3 was similar for DBTB (24%) and PSBB (27%) as were high-risk pathology results (23% and 18%, respectively). Tissue marker migration > 1cm occurred at a similar frequency (14% vs 13%). Hematomas were slightly more frequent with DBTB (19/152, 13%) than with PSBB (4/98, 4%), with P = .026. Finally, the average number of core biopsies with DBTB was higher than with PSBB (8.32 vs 7.39, respectively), with P = .02. Compared to prone stereotactic breast biopsy, upright digital breast tomosynthesis biopsy has a similar high targeting success frequency, low complication frequency, and additionally allows targeting of calcified and non-calcified targets.

To determine the best screening modality for breast cancer, a large randomized clinical trial is underway to compare the mammographic accuracy between the standard digital and tomosynthesis mammography. The Tomosynthesis Mammographic Imaging Screening Trial (TMIST) is also building the world's largest biorepository of breast cancer specimens from all biopsies at screening and wants to ensure it is representative of the US population. We invite the National Medical Association physicians, as leaders in the health care of African Americans, to continue their commitment to eliminating disparities by promoting the TMIST among African American women. The outcome of the trial will help to advance precision screening, individually tailoring screening decisions based on breast density, tumor subtyping and genomics. The partnership with NMA is essential to building trust, dispelling misconceptions about clinical trials in the community as well as to support a cadre of African American physicians and researchers who can contribute to the current understanding of the social determinants of breast cancer.

The diagnosis of and decision-making for early revision surgery to treat failure of biological fixation with a proximally coated cementless stem are challenging. A 73-year-old woman was referred to our hospital with thigh pain 2 years after the initial total hip arthroplasty. Although a plain radiograph showed no signs indicating biological fixation failure, digital tomosynthesis showed a highly radiodense line along the proximal part, and bone scintigraphy showed uptake at the distal part. With the diagnosis of biological fixation failure due to the proximal-distal mismatch, the cementless stem was revised to a cemented stem, and the thigh pain was improved after the revision surgery. Digital tomosynthesis and bone scintigraphy can be helpful for the diagnosis of biological fixation failure due to proximal-distal mismatch.

To evaluate a tomosynthesis screening mammography automated outcomes feedback application's adoption and impact on performance.This prospective intervention study evaluated a feedback application that provided mammographers subsequent imaging and pathology results for patients that radiologists had personally recalled from screening. Deployed to 13 academic and 5 private practice attending radiologists, adoption was studied from March 29, 2018, to March 20, 2019. Radiologists indicated if reviewed feedback would influence future clinical decisions. For a subset of eight academic radiologists consistently interpreting screening mammograms during the study, performance metrics were compared pre-intervention (January 1, 2016, to September 30, 2017) and post-intervention (October 1, 2017 to June 30, 2018). Abnormal interpretation rate, positive predictive value of biopsies performed, sensitivity, specificity, and cancer detection rate were compared using Pearson's χThe 18 radiologists reviewed 68.5% (1,398 of 2,042) of available feedback cases and indicated that 17.4% of cases (243 of 1,398) could influence future decisions. For the eight academic radiologist subset, after multivariable adjustment with comparison to pre-intervention, average abnormal interpretation rate decreased (from 7.5% to 6.7%, adjusted odds ratio [aOR] 0.86, P.01), positive predictive value of biopsies performed increased (from 40.6% to 51.3%, aOR 1.48, P = .011), and specificity increased (from 93.0% to 93.9%, aOR 1.17, P.01) post-intervention. There was no difference in cancer detection rate per 1,000 examinations (from 5.8 to 6.1, aOR 1.01, P = .91) or sensitivity (from 81.2% to 78.7%, aOR 0.84, P = .47).Radiologists used a screening mammography automated outcomes feedback application. Its use decreased false-positive examinations, without evidence of reduced cancer detection.

This study assessed effective doses (E) from conventional and stationary intraoral tomosynthesis (s-IOT) radiography for posterior bitewing (PBW) examinations and evaluated the effect of sensor attenuation.An adult human tissue-equivalent phantom and optically stimulated luminescent dosimeters were used. Series of 4 PBW radiographs were acquired with circular and rectangular collimation. s-IOT PBW radiographs were acquired with built-in rectangular collimation. Radiographs were acquired without and with a sensor in the beam path.E (in µSv) was 15.7 and 8.2 for conventional-circular, 4.6 and 1.1 for conventional-rectangular, and 11.9 and 5.9 for s-IOT in sensor-absent and sensor-present scenarios, respectively. For sensor-absent exposures, E for conventional-rectangular was 29.3% and E for s-IOT was 75.8% of the conventional-circular dose. With the sensor present, these values were 13.4% and 72.0%, respectively (P.001). Sensor-present E was lower than sensor-absent E for all modalities (P.001). Reductions in equivalent doses were similar to effective dose reductions.For PBW examinations, E for s-IOT was smaller than for conventional radiography with circular collimation, but larger than for conventional radiography with rectangular collimation. The presence of a sensor maintained these differences but reduced E for all modalities.

To compare inter-reader agreement and diagnostic confidence in detecting sacroiliitis by the modified New York criteria (mNY) on digital radiography (DR) versus digital pelvic tomosynthesis assisted DR (DR+DPT), and to evaluate changes in the presence of axial spondyloarthritis (axSpA) according to the Assessment of Spondyloarthritis International Society (ASAS) criteria. One hundred and thirty-eight patients who underwent both DR and DPT with suspicious axSpA in our rheumatologic clinic were included from February 2017 to February 2018. Three radiologists independently graded sacroiliitis and confidence level on DR first and then re-graded them on DPT in a paired manner. Agreement, confidence, and diagnostic accuracy were evaluated for readers. Changes in the presence of disease by mNY and ASAS criteria were assessed between DR alone and DR+DPT. On DR alone, 73 patients were assessed with radiographic sacroiliitis, and 85 were classified into axSpA by the ASAS criteria; however, 78 and 85, respectively, were classified on DR+DPT. With the assistance of DPT, 17 and 12 patients changed to the disease positivity according to the mNY and ASAS criteria, respectively; the negative results changed to positive in 11 and six patients, respectively. For all readers, agreement improved with DPT (0.79 to 0.89). DR+DPT achieved higher diagnostic accuracy (AUC, P < 0.05). The combination of DR and DPT achieved a higher diagnostic performance than that of DR alone, with better agreement. On DR+DPT, the diagnoses of 9.0% of patients with suspicious axSpA (12 of 134) were changed to the status of disease by the ASAS criteria.

Three imaging techniques were compared using porcine spines. To compare image acquisition time, radiation exposure, pedicle width measurement, assessment of screw breach, and image artifact between cone-beam tomosynthesis (CBT) single mode, CBT dual mode (stereotactic CBT), and computed tomography (CT) imaging with and without spinal implants. CT is the standard for axial imaging of orthopedic procedures. CBT technology is being developed, allowing real-time intraoperative imaging and 3D surgical guidance. CBT may deliver useful axial imaging quicker with less radiation than current technologies. Six porcine spines were instrumented with bilateral pedicle screws at six levels connected with 5.5 mm rods. Dosimeters were attached to four surfaces of spines. CT, CBT single and CBT dual images were acquired pre-implant and post-implant. Image acquisition and 3D reconstruction times were recorded. Pedicle widths were measured before and after instrumentation. Screw medial breaches were graded (0: no breach, 1: 4 mm). Artifact and/or distortion of each image was ranked (0 = none, 1 = mild, 2 = moderate, 3 = large). Image acquisition and reconstruction times, radiation dose, pedicle width, screw breach and artifact were compared between techniques. Total image acquisition and reconstruction times of CBT was significantly less (single: 9.9 ± 0.2 s, p 0.5, post-implant: p > 0.9) and pedicle width change (p > 0.4) was similar amongst all techniques. Breach assessment was not different between groups (p = 0.257). CBT images had consistently lower artifact grades than CT. Although CBT axial image quality appeared subjectively inferior to CT, it enabled consistent assessment of pedicle width and screw breach, at half time and 10× lower radiation exposure. With continued refinements, CBT technology may allow for adequate intra-operative axial imaging using low radiation exposure.

Digital tomosynthesis is a radiological method having an intermediate position between x-ray and computed tomography (CT). Benefits with the imaging technology include improved image quality, post-processing (reconstructed to 1 mm thick slices), minimal tissue overlap in the projection image and a lower X-ray dose as compared to CT. Tomosynthesis is most commonly used in breast, chest (pulmonary tuberculosis), musculoskeletal and intraoral screening examinations. There is disagreement among professionals on feasibility and clinical effectiveness of tomosynthesis in the diagnosis of musculoskeletal injuries and diseases. Our goal was to summarize evidence relating to efficacy and feasibility of tomosynthesis in the diagnosis of musculoskeletal injuries and diseases. Russian and foreign literature was reviewed based on methodological principles of the PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions. The review included 34 articles in English and in Russian (referenced 16 to 49) describing an original study with focus on phantom, diagnostic, clinical studies. We considered articles which investigated use of tomosynthesis in the diagnosis of musculoskeletal injuries and diseases including rheumatoid arthritis affecting the hands and feet, specific and nonspecific spine lesions and injuries, nonspecific lesions and injuries to the joints; subtle fractures and dislocations. With the advantages of tomosynthesis in clinical practice, the imaging modality can be recommended for the diagnosis of the above conditions.