Performance comparison of single-view digital breast tomosynthesis plus single-view digital mammography with two-view digital mammography

Objective

To determine the performance of combined single-view mediolateral oblique (MLO) digital breast tomosynthesis (DBT) plus single-view cranio-caudal (CC) mammography (MX) compared with that of standard two-view digital mammography.

Methods

A multi-reader multi-case (MRMC) receiver-operating characteristic (ROC) study was conducted, involving six breast radiologists. Two hundred fifty patients underwent bilateral MX and DBT imaging. MX and DBT images with the adjunct of the CC-MX view from 469 breasts were evaluated and rated independently by six readers. Differences in mean areas under the ROC curves (AUCs), mean sensitivity and mean specificity were analysed by analysis of variance (ANOVA) to assess clinical performance.

Results

The combined technique was found to be non-inferior to standard two-view mammography (MX_(CC+MLO)) in mean AUC (difference: +0.021;95 % LCL = ?0.011), but was not statistically significant for superiority (P?=?0.197). The combined technique had equivalent sensitivity to standard mammography (76.2 % vs. 72.8 %, P?=?0.269) and equivalent specificity (84.9 % vs. 83.0 %, P?=?0.130). Specificity for benign lesions was significantly higher with the combination of techniques versus mammography (45.6 % vs. 36.8 %, P?=?0.002).

Conclusion

In this enriched study population, the combination of single-view MLO tomosynthesis plus single-view CC mammography was non-inferior to that of standard two-view digital mammography in terms of ROC curve area, sensitivity and specificity.

Key Points

? Breast tomosynthesis (DBT) has emerged as a valuable adjunct to mammography (MX). ? Combination DBT/MX demonstrated non-inferior clinical performance to standard two-view MX. ? Combination DBT/MX was superior to two-view MX in recognising benign lesions. ? Combination DBT/MX reduced variability compared with two-view MX.     

全视野数字乳腺摄影结合乳腺数字体层合成摄影的辐射剂量与压迫厚度及乳房密度的相关性研究

目的 对比分析乳腺数字体层摄影及全数字乳腺摄影（DBT/FFDM）模式平均腺体剂量（AGD）与乳房密度、压迫厚度的关系,探讨不同类型（厚度和密度）乳房在具体情况下摄影方式的优化选择与应用。方法 回顾性分析229例乳房Combo （DBT+FFDM）临床资料,分别收集记录双乳正位（CC）及内外斜位（MLO）压迫厚度、AGD、kVp和乳房量化密度（Q_abd）类型,分析DBT/FFDM模式下压迫厚度、密度与AGD之间的关系。结果 DBT/FFDM模式AGD与压迫厚度（CC位：r=0.55、0.53,P<0.001;MLO位：r=0.62、0.48,P<0.001）、乳房密度（CC位：r=0.36、0.39,P<0.001;MLO位：r=0.16、0.30,P<0.001）正相关;DBT模式AGD组间差异小,FFDM模式AGD组间差异大（厚度分组CC位：F=35.29、31.32,P<0.005;MLO位：F=44.83、27.02,P<0.005;Q_abd分类CC位：F=18.68、19.76,P<0.005;MLO位：F=4.58、10.52,P<0.005）;Q_abd分类高的乳房平均压迫厚度较低（CC位：F=16.28,P<0.005;MLO位：F=17.81,P<0.005）;同时考虑压迫厚度与乳房密度交互作用影响,仅在MLO位DM模式对AGD有交互作用（F=3.16,P=0.005）。结论 DBT/FFDM两种模式剂量累积可能增加辐射风险;乳腺摄影优先采用单视图CC/MLO-DBT或CC/MLO-（DBT+FFDM）+单视图MLO/CC-FFDM模式,在减低辐射剂量风险方面有积极作用。     

Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis

Objective

To evaluate the clinical value of combining one-view mammography (cranio-caudal, CC) with the complementary view tomosynthesis (mediolateral-oblique, MLO) in comparison to standard two-view mammography (MX) in terms of both lesion detection and characterization.

Methods

A free-response receiver operating characteristic (FROC) experiment was conducted independently by six breast radiologists, obtaining data from 463 breasts of 250 patients. Differences in mean lesion detection fraction (LDF) and mean lesion characterization fraction (LCF) were analysed by analysis of variance (ANOVA) to compare clinical performance of the combination of techniques to standard two-view digital mammography.

Results

The 463 cases (breasts) reviewed included 258 with one to three lesions each, and 205 with no lesions. The 258 cases with lesions included 77 cancers in 68 breasts and 271 benign lesions to give a total of 348 proven lesions. The combination, DBT_(MLO)+MX_(CC), was superior to MX (CC+MLO) in both lesion detection (LDF) and lesion characterization (LCF) overall and for benign lesions. DBT_(MLO)+MX_(CC) was non-inferior to two-view MX for malignant lesions.

Conclusions

This study shows that readers’ capabilities in detecting and characterizing breast lesions are improved by combining single-view digital breast tomosynthesis and single-view mammography compared to two-view digital mammography.

Key Points

? Digital breast tomosynthesis is becoming adopted as an adjunct to mammography (MX) ? DBT _(MLO) +MX _(CC) is superior to MX _(CC+MLO) in lesion detection (overall and benign lesions) ? DBT _(MLO) +MX _(CC) is non-inferior to MX _(CC+MLO) in cancer detection ? DBT _(MLO) +MX _(CC) is superior to MX _(CC+MLO) in lesion characterization (overall and benign lesions) ? DBT _(MLO) +MX _(CC) is non-inferior to MX _(CC+MLO) in characterization of malignant lesions     

Quantitative analysis of radiation dosage and image quality between digital breast tomosynthesis (DBT) with two-dimensional synthetic mammography and full-field digital mammography (FFDM)

PurposeCurrently in diagnostic setting for breast cancer, FFDM and DBT are performed conjunctively. However, performing two imaging modalities may increase radiation exposure by double. Two-dimensional reconstructed images created from DBT with 2DSM, has a potential to replace conventional FFDM in concerning both radiation dosage and image quality. With increasing concerns for individual radiation exposure, studies analyzing radiation dosage in breast imaging modalities are needed. This study compared radiation dosage and image quality between DBT + 2DSM versus FFDM.Methods and materials374 patients (mean age 52 years) who underwent both DBT and FFDM were retrospectively reviewed. Radiation dosage data were obtained by radiation dosage scoring and monitoring program Radimetrics (Bayer HealthCare, Whippany, NJ). Entrance dose and mean glandular doses in each breast were obtained for both modalities. To compare image quality of DBT + 2DSM and FFDM, a 5-point scoring system for lesion clarity was assessed. The parameters of radiation dosage (entrance dose, mean glandular dose) and image quality (lesion clarity scoring) were compared.ResultsFor entrance dose, DBT had lower mean dosage (14.8 mGy) compared with FFDM (21.8 mGy, p-value < 0.0001). Mean glandular doses for both breasts were lower in DBT (Left 1.74, Right 2.1) compared with FFDM (Left 2.85, Right 2.74, p-value < 0.0001). Lesion clarity score was higher in DBT with 2DSM (mean score 4.03) compared with FFDM (3.82, p-value < 0.0001).ConclusionDBT showed lower radiation entrance dose and mean glandular doses to both breasts compared with FFDM. DBT + 2DSM had better image quality than FFDM, suggesting that DBT with 2DSM has potential as an alternative to FFDM.     

DBT联合FFDM、FFDM对乳腺疾病诊断效能比较

浸润性导管癌(invasive ductal carcinoma,IDC)为最常见的乳腺癌之一,浸润性生长,具有明显转移倾向.与乳腺超声、乳腺CT及MR相比,乳腺X线摄影在对乳腺内病灶的钙化数量、形态、大小及密度的显示方面具有明显优势;数字化乳腺摄影的出现使乳腺癌的早期检出率大大提高[1].而一些乳腺疾病诸如腺病、炎症等在X线摄影上常与恶性病变难以分辨.     

Radiation dose with digital breast tomosynthesis compared to digital mammography: per-view analysis

Objectives

To compare radiation dose delivered by digital mammography (FFDM) and breast tomosynthesis (DBT) for a single view.

Methods

4,780 FFDM and 4,798 DBT images from 1,208 women enrolled in a screening trial were used to ground dose comparison. Raw images were processed by an automatic software to determine volumetric breast density (VBD) and were used together with exposure data to compute the mean glandular dose (MGD) according to Dance’s model. DBT and FFDM were compared in terms of operation of the automatic exposure control (AEC) and MGD level.

Results

Statistically significant differences were found between FFDM and DBT MGDs for all views (CC: MGD_FFDM=1.366 mGy, MGD_DBT=1.858 mGy; p<0.0001; MLO: MGD_FFDM=1.374 mGy, MGD_DBT=1.877 mGy; p<0.0001). Considering the 4,768 paired views, Bland-Altman analysis showed that the average increase of DBT dose compared to FFDM is 38 %, and a range between 0 % and 75 %.

Conclusions

Our findings show a modest increase of radiation dose to the breast by tomosynthesis compared to FFDM. Given the emerging role of DBT, its use in conjunction with synthetic 2D images should not be deterred by concerns regarding radiation burden, and should draw on evidence of potential clinical benefit.

Key Points

? Most studies compared tomosynthesis in combination with mammography vs. mammography alone. ? There is some concern about the dose increase with tomosynthesis. ? Clinical data show a small increase in radiation dose with tomosynthesis. ? Synthetic 2D images from tomosynthesis at zero dose reduce potential harm. ? The small dose increase should not be a barrier to use of tomosynthesis.

     

Comparative study between breast tomosynthesis and classic digital mammography in the evaluation of different breast lesions

Objective

To evaluate the impact of adding 3D Tomosynthesis to Full Field Digital Mammography (FFDM) in the detection and diagnosis of breast lesions.

Subjects and methods

The study included 166 mammograms with indeterminate findings selected from 1600 mammograms. They were classified into two groups: group 1 ‘Diagnostic mammograms’ of symptomatic women and group 2 ‘Screening mammograms’. Dense breasts assigned as ACR3 and ACR4 presented 69% (n = 114/166) of the studied cases. FFDM and 3D tomosynthesis examination was done and imaging findings were evaluated before and after the use of 3D tomosynthesis images.

Results

Both modalities were compared regarding detection and diagnosis, each individually assessed, using the Pearson Chi Square tests. Detection (P value: 0.006) and diagnosis (P value: 0.048) of breast lesions dramatically improved when 3D tomosynthesis images were considered in the evaluation. The sensitivity, specificity, and accuracy of digital mammography was 60%, 20.7% and 48% have significantly enhanced on applying tomosynthesis to be 94.5%, 74% and 89.7%.

Conclusion

Three-dimensional tomosynthesis significantly enhanced the detection and characterization of breast lesions on digital mammography especially in the context of dense breast parenchyma (ACR 3&4).     

Comparison between two-dimensional synthetic mammography reconstructed from digital breast tomosynthesis and full-field digital mammography for the detection of T1 breast cancer

Objective

To evaluate the interpretative performance of two-dimensional (2D) synthetic mammography (SM) reconstructed from digital breast tomosynthesis (DBT) in the detection of T1-stage invasive breast cancers, compared to 2D full-field digital mammography (FFDM).

Methods

This retrospective study enrolled 214 patients. For each patient, FFDM and DBT were performed between January and June 2013, and SM was reconstructed from DBT data. Three radiologists interpreted images and recorded visibility scores and morphologies of cancers. Diagnostic performances of SM and FFDM were compared. Percentages of detected cancers and visibility scores were compared for tumour size, and presence of calcifications for each observer.

Results

Observer sensitivity showed no difference for detection with SM and FFDM (P?>?0.05). One observer showed a higher specificity (P?=?0.02) and higher positive predictive value with SM (95 % CI 0.6–16.4), but the differences in the corresponding values between SM and FFDM for the other observers were not statistically significant. In subgroup analyses according to tumour size and presence of calcifications, percentages of detected cancers and visibility scores were not significantly different.

Conclusions

Diagnostic performances of SM and FFDM are comparable for detecting T1-stage breast cancers. Therefore, our results indicate that SM may eliminate the need for additional FFDM during DBT-based imaging.

Key Points

? DBT plus FFDM increases radiation dose compared to FFDM alone.? Detecting T1-stage cancers with only SM is comparable to detection with FFDM.? Two-dimensional SM may replace dose-requiring FFDM in DBT-based imaging.

     

Estimation of percentage breast tissue density: comparison between digital mammography (2D full field digital mammography) and digital breast tomosynthesis according to different BI-RADS categories

Objective:

To compare breast density estimated from two-dimensional full-field digital mammography (2D FFDM) and from digital breast tomosynthesis (DBT) according to different Breast Imaging–Reporting and Data System (BI-RADS) categories, using automated software.

Methods:

Institutional review board approval and written informed patient consent were obtained. DBT and 2D FFDM were performed in the same patients to allow within-patient comparison. A total of 160 consecutive patients (mean age: 50±14 years; mean body mass index: 22±3) were included to create paired data sets of 40 patients for each BI-RADS category. Automatic software (MedDensity^©, developed by Giulio Tagliafico) was used to compare the percentage breast density between DBT and 2D FFDM. The estimated breast percentage density obtained using DBT and 2D FFDM was examined for correlation with the radiologists'' visual BI-RADS density classification.

Results:

The 2D FFDM differed from DBT by 16.0% in BI-RADS Category 1, by 11.9% in Category 2, by 3.5% in Category 3 and by 18.1% in Category 4. These differences were highly significant (p<0.0001). There was a good correlation between the BI-RADS categories and the density evaluated using 2D FFDM and DBT (r=0.56, p<0.01 and r=0.48, p<0.01, respectively).

Conclusion:

Using DBT, breast density values were lower than those obtained using 2D FFDM, with a non-linear relationship across the BI-RADS categories. These data are relevant for clinical practice and research studies using density in determining the risk.

Advances in knowledge:

On DBT, breast density values were lower than with 2D FFDM, with a non-linear relationship across the classical BI-RADS categories.To tailor screening and diagnosis protocols, it is important to identify females with an increased risk of breast cancer [1–3]. It has been estimated that females with dense breasts (breast densities of >75%) have 4–6 times higher risk of breast cancer than females with low breast densities [4] and that breast density is increasingly recognised as an independent determinant of breast cancer risk and possibly in prognosis [5]. Assessment of breast density is becoming crucial in epidemiological studies, including the estimation of breast cancer risk and assessing breast density-related risk over time, radiation dose monitoring and monitoring drug-related response [6,7].Different methods and classifications have been reported to assess breast density: the Tabar classification [8], Wolfe''s parenchymal patterns [9], and both semi-quantitative and quantitative computer-aided techniques [10–16]. The Breast Imaging–Reporting and Data System (BI-RADS) classification, considered as the additional quantitative scheme, is routinely used in the USA and was introduced to standardise reporting. Initially, it was based on four qualitative categories but an additional quantitative scheme was added in 2003, based on the extent of fibroglandular tissue [17]. Mammographic breast density estimation may be limited by the two-dimensional (2D) nature of the imaging technique, whereas a three-dimensional (3D) imaging modality, such as digital breast tomosynthesis (DBT), reduces the appearance of the overlapping parenchymal tissue and may therefore influence or alter density assessments [13,14]. In DBT, high-spatial-resolution tomographic images of the breast are reconstructed from multiple low-dose projection images acquired within a limited range of X-ray tube angles [15]. It has been demonstrated in a few studies that the automated estimation of breast density eliminates subjectivity between comparisons of full-field digital mammography (2D FFDM) and DBT and is more reproducible than a quantitative BI-RADS evaluation [14,16]. However, previous research mainly considered patients with relatively high breast density, with the possibility of the results not being applicable across all density categories and showing whether published percentage breast density differences between 2D FFDM and DBT apply to less dense or non-dense breasts. The purpose of our study was to compare the breast tissue density estimated using 2D FFDM and DBT among patients in a balanced data set of the four BI-RADS categories, using fully automated software.     

Breast cancer detection: Comparison of digital mammography and digital breast tomosynthesis across non-dense and dense breasts

IntroductionBreast density is associated with an increase in breast cancer risk and limits early detection of the disease. This study assesses the diagnostic performance of mammogram readers in digital mammography (DM) and digital breast tomosynthesis (DBT).MethodsEleven breast readers with 1–39 years of experience reading mammograms and 0–4 years of experience reading DBT participated in the study. All readers independently interpreted 60 DM cases (40 normal/20 abnormal) and 35 DBT cases (20 normal/15 abnormal). Sensitivity, specificity, ROC AUC, and diagnostic confidence were calculated and compared between DM and DBT.ResultsDBT significantly improved diagnostic confidence in both dense breasts (p = 0.03) and non-dense breasts (p = 0.003) but not in other diagnostic performance metrics. Specificity was higher in DM for readers with >7 years' experience (p = 0.03) in reading mammography, non-radiologists (p = 0.04), readers who had completed a 3–6 months training fellowship in breast imaging (p = 0.04), and those with ≤2 years’ experience in reading DBT (p = 0.02), particularly in non-dense breasts.ConclusionDiagnostic confidence was higher in DBT when compared to DM. In contrast, other performance metrics appeared to be similar or better with DM and may be influenced by the lack of experience of the reader cohort in reading DBT.Implications for practiceThe benefits of DBT may not be entirely accrued until radiologists attain expertise in DBT interpretation. Specificity of DBT varied according to reader characteristics, and these characteristics may be useful for optimising pairing strategies in independent double reading of DBT as practiced in Australia to reduce false positive diagnostic errors.     

Diagnostic accuracy of contrast-enhanced digital mammography in breast cancer detection in comparison to tomosynthesis,synthetic 2D mammography and tomosynthesis combined with ultrasound in women with dense breast

Objective:To assess the diagnostic efficacy of contrast-enhanced digital mammography (CEDM) in breast cancer detection in comparison to synthetic two-dimensional mammography (s2D MG), digital breast tomosynthesis (DBT) alone and DBT supplemented with ultrasound examination in females with dense breast with histopathology as the gold-standard.Methods:It was a prospective study, where consecutive females presenting to symptomatic breast clinic between April 2019 and June 2020 were evaluated with DBT. Females who were found to have heterogeneously dense (ACR type C) or extremely dense (ACR type D) breast composition detected on s2D MG were further evaluated with high-resolution breast ultrasound and thereafter with CEDM, but before the core biopsy or surgical excision, were included in the study. s2D MG was derived from post-processing reconstruction of DBT data set. Females with pregnancy, renal insufficiency or prior allergic reaction to iodinated contrast agent were excluded from the study. Image interpretation was done by two experienced breast radiologists and both were blinded to histological diagnosis.Results:This study included 166 breast lesions in130 patients with mean age of 45 ± 12 years (age range 24–72 years). There were 87 (52.4%) malignant and 79 (47.6%) benign lesions. The sensitivity of CEDM was 96.5%, significantly higher than synthetic 2D MG (75.6%, p < 0.0001), DBT alone (82.8%, p < 0.0001) and DBT + ultrasound (88.5%, p = 0.0057); specificity of CEDM was 81%, significantly higher than s2D MG (63.3%, p = 0.0002) and comparable to DBT alone (84.4%, p = 0.3586) and DBT + ultrasound (79.7%, p = 0.4135). In receiver operating characteristic curve analysis, the area under the curve was of 0.896 for CEDM, 0.841 for DBT + ultrasound, 0.769 for DBT alone and 0.729 for s2D MG.Conclusion:CEDM is an accurate diagnostic technique for cancer detection in dense breast. CEDM allowed a significantly higher number of breast cancer detection than the s2D MG, DBT alone and DBT supplemented with ultrasonography in females with dense breast.Advances in knowledge:CEDM is a promising novel technology with higher sensitivity and negative predictive value for breast cancer detection in females with dense breast in comparison to DBT alone or DBT supplemented with ultrasound.     

Mammographic density estimation: one-to-one comparison of digital mammography and digital breast tomosynthesis using fully automated software

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?P?r?=?0.54, P?r?=?0.44, P?Conclusion Breast density appeared to be significantly underestimated on digital breast tomosynthesis.

Key Points

• Breast density is considered to be an independent risk factor for cancer
• Density can be assessed on full-field digital mammography and digital breast tomosynthesis
• Objective automated estimation of breast density eliminates subjectivity
• Automated estimation is more accurate than BI-RADS quantitative evaluation
• Breast density may be significantly underestimated on digital breast tomosynthesis

     

乳腺数字化断层摄影分析乳腺实质结构评估罹患乳腺癌风险:与乳腺数字化摄影比较

目的乳腺密度百分比(PD)是已被确认的罹患乳腺癌的风险因子,本研究目的是在筛查人群中评估数字化乳腺断层摄影(DBT)与数字化乳腺摄影显示的乳腺实质结构特征与PD的相关性。材料与方法本研究经专业委员会核准,受试者均签署书面知情同意书。回顾性分析2007年7月—2008年3月进行的一项经专业委员会批准的DBT筛查     

Impact of digital breast tomosynthesis (DBT) on finding types leading to true-positive and false-positive examinations

PurposeTo investigate the frequencies of finding types with combined digital breast tomosynthesis (DBT) and digital mammography (DM) leading to true-positive (TP) and false-positive (FP) examinations.Materials and methodsConsecutive screening mammograms at an academic medical center from March 2008 to February 2011 (DM group) and from January 2013 to December 2017 (DBT/DM group) were retrospectively reviewed. Multivariable logistic regression models were used to compare the proportions of mammographic finding types leading to TP and FP examinations between the two groups.ResultsThe DM group had 554 TP and 7278 FP examinations, and the DBT/DM group had 1271 TP and 14,544 FP examinations. The finding type of calcifications led to a lower proportion of TP examinations in the DBT/DM than DM group (34.3% versus 47.7%, p < 0.001) but also a lower proportion of FP examinations (18.7% versus 21.7%, p < 0.001). Mass led to a higher proportion of TP examinations in the DBT/DM than DM group (5.7% versus 1.3%, p < 0.001) but also a higher proportion of FP examinations (4.6% versus 0.3%, p < 0.001). Asymmetry led to a higher proportion of TP examinations in the DBT/DM than DM group (58.3% versus 50.4%, p = 0.03) and a lower proportion of FP examinations (75.9% versus 77.6%, p < 0.001). Architectural distortion led a similar proportion of TP examinations in the DBT/DM and DM groups (1.7% versus 0.7%, p = 0.12) but a higher proportion of FP examinations (0.8% versus 0.4%, p = 0.007).ConclusionsMammographic findings leading to TP and FP examinations have shifted with the addition of DBT to DM.     

Effects on short-term quality of life of vacuum-assisted breast biopsy: comparison between digital breast tomosynthesis and digital mammography

Objective:

To compare the effects of digital breast tomosynthesis (DBT)-guided and digital mammography (MMx)-guided vacuum-assisted breast biopsy (VABB) on short-term quality of life (QoL).

Methods:

From November 2014 through March 2015, females undergoing VABB in an academic medical centre participated in a survey after biopsy. VABB was performed under DBT (Group 1) or MMx guidance (Group 2). Biopsy experience was assessed with a modified testing morbidities index (TMI). 10 attributes were assessed: six related to the procedures (pain or discomfort before and during testing, fear or anxiety before and during testing, physical and mental function after testing) and four not related to the procedures (familiarity for cancer and clinical history, embarrassment during testing and overall satisfaction). Non-parametric standard statistics were used to compare data of Group 1 and data of Group 2.

Results:

A total of 90 females (mean age, 55.8 years; range, 40–87 years) were enrolled: 45 underwent DBT-VABB and 45 MMx-VABB. The sum of the 6 of 10 items related to the procedures was significantly worse for DBT (p < 0.02), but no differences were observed for the single items. The median value for DBT-VABB and MMx-VABB was 95.2 and 90.1, respectively (p < 0.02). The 4 of 10 TMI items not related to the procedures did not differ significantly between the two groups. Four females fainted during DBT-VABB and three females during MMx-VABB; all of these patients underwent VABB procedures in sitting position.

Conclusion:

Females in the DBT-VABB study group have a decreased short-term QoL compared with the MMx-VABB group. DBT-VABBs were less tolerated than MMx-VABBs.

Advances in knowledge:

DBT-VABB was less tolerated than MMx-VABB. Females in the DBT-VABB study group had a decreased short-term QoL compared with the MMx-VABB group. Overall satisfaction was similar for both procedures.     

The effect of different exposure parameters on radiation dose in digital mammography and digital breast tomosynthesis: A phantom study

IntroductionThere are concerns regarding the increase in radiation dose among women undergoing both digital mammography (DM) and digital breast tomosynthesis (DBT). The aim of this study was to evaluate the effect of different exposure parameters on entrance skin dose (ESD) and average glandular dose (AGD) for DM and DBT using a phantom.MethodsThe ESD and AGD of 30 DM and DBT (cranio-caudal projection) examinations using a tissue equivalent phantom where acquired using a GE Senographe Essential DM unit. Commercial phantoms were used to simulate three different breast thicknesses and compositions. Tube potential, tube load, and target/filter combinations were also varied with ESD and AGD recorded directly from the DM unit. Comparisons were made using the non-parametric Kruskal Wallis, Mann–Whitney, and Wilcoxon signed rank tests.ResultsThe individual ESD values for 4 cm, 5 cm, and 6 cm thick phantoms for DM and DBT at Rh/Rh target/filter combination and 30–32 kV/56 mAs levels were 5.06 and 4.18 mGy; 5.82 and 5.08 mGy; and 7.26 and 11.4 mGy, respectively; while AGDs were 1.57 and 1.30 mGy, 1.33 and 1.39 mGy; and 1.29 and 3.60 mGy, respectively. The Kruskal–Wallis test showed a statistically significant difference in AGD for DM (P = .029) but not for DBT (P = 0.368). The Mann–Whitney and Wilcoxon signed rank tests showed no statistically significant difference for ESD or AGD between both DM and DBT techniques (P = .827 and .513). The percentage differences in ESD for phantom thicknesses of 4 cm, 5 cm, and 6 cm between DBT and DM ranged between −21% and 36%; while for AGD between −21% and 64.2%.ConclusionsThe ESD and AGD for single view projection in DM and DBT showed differences at 4 and 6 cm breast thicknesses and compositions but not at 5 cm thickness with 30–32 kV and a Rh/Rh target/filter combination.Implications for practiceA fibro-fatty breast results in less radiation dose variations in terms of ESD and AGD between DM and DBT techniques.     

Digital breast tomosynthesis (DBT)-guided biopsy of calcifications: pearls and pitfalls

As digital breast tomosynthesis (DBT) is quickly becoming the standard of care in clinical practice, DBT-guided procedures are being more frequently utilized. DBT-guided biopsies of calcifications are efficient and easy to perform. As radiologists seek proficiency in these biopsies, there are some unique features of DBT-guided biopsies that they must consider. In this review, we provide a step-by-step guide on performing DBT-guided biopsies of calcifications, with a focus on pearls and pitfalls for problem solving in difficult biopsy cases.