Digital Breast Tomosynthesis

What is Breast Tomosynthesis?

 An imaging tool that produces three dimensional
(3D) images of the breast from multiple angles
during a short scan.

http://electronicimaging.spiedigitallibrary.org/article.aspx?articleid=1829593

 Unlike computed tomography (CT), in

tomosynthesis the range of angles used is less than
360°.

http://iopscience.iop.org/book/978-0-7503-1058-1/chapter/bk978-0-7503-1058-1ch5
 DBT units are based on standard mammography units
and often units will provide both types of imaging

It only takes about

30 seconds longer

http://premierwomensradiology.com/2d-3d-mammography/

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How does it Work?
1. Compression of the breast
2. The X-ray tube moves around the breast
3. The X-ray beam passes through the
breast tissue from many different angles
producing a series of projection images
4. The projection image data is
reconstructed into tomographic sections
5. The number of the reconstructed images
depends on the thickness of the
compressed breast.

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 Images from different angles

Incident X-rays

Objects being
imaged

2-D raw
data images

Hologic

Exposure #1 Exposure #8 Exposure #15

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Tomosynthesis Reconstruction

Hologic
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Tomosynthesis Equipment
 Anode/filter combinations: usually a combination of
rhodium, tungsten and molybdenum (similar to DM)

 Detectors: flat panel amorphous silicon or amorphous

selenium are used for DBT.

 A grid : in some DBT equipment, a grid is not used

because of the oblique X-rays
As most units perform both DM and DBT the grid
must be easily and quickly removable.
Technical Factors Affecting Image Quality
in Tomosynthesis
1. Scan motion
2. Angular range
3. Acquisition Geometry
4. Number of acquisitions
 Scan Motion

http://www3.gehealthcare.com/static/senoclaire/
Scan motion
1. Step and shoot: the X-ray tube stops moving to take the
acquisition
- It may reduce blur
- It needs longer time to perform the whole scan

2. Continuous movement: the X-ray tube is in continuous

motion and does not stop to take the exposure.
Angular range

https://www.healthcare.siemens.com.au/mammography/tomosynthesis
Scanning/angular range
Advantages of increased scanning angle :
 Higher out of plane (z) resolution i.e. thinner slices.
 Increased contrast resolution
Disadvantages of increasing the scanning angle:
 Increased noise.
 Reduced in-plane (x-y) spatial resolution.
 Increased streak artefact
Acquisition Geometry
 Partial isocentric geometry: the detector stationary
during acquisition and the X-ray source moving in an arc
 Full isocentric geometry: detector and X-ray source move
synchronously around the imaged object

All the DBT systems currently available work in partial

isocentric geometry
Number of Acquisitions
Increasing the number of acquisitions results in:
 Increase scan time
 Increase electronic noise
Digital Breast Tomosynthesis vs FFDM
Technical Considerations
 DBT has higher contrast resolution than DM because 1)
overlying structures are blurred by the tomographic
motion and 2) blurring is removed by de-blurring
algorithms.
 DBT has slightly worse in-plane spatial resolution than
DM.
Why do breast tomosynthesis?

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2D Mammography

Andrew Smith PD. Fundamentals of Breast Tomosynthesis.

Improving the Performance of Mammography”

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2D Mammography
Limitations
- Production of two dimensional (2D) images
- High number (up to 30%) of missed cancers
- Low positive predictive value (10%) of recalls

- These are of particular importance in high density

breasts

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 CC and MLO DBT
volume images are
reviewed as a movie
or by scrolling
manually through
slices.
 The radiologist is
also able to change
the slice thickness
to focus on specific
anatomic or
pathologic features.
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Combo-mode Imaging
Both the 2D and tomosynthesis images are required
because:
 The 2D images are useful for comparison to priors
 The 2D images are better for microcalcifications
 Tomosynthesis reduces tissue overlap and better
demonstrates masses
Radiation Dose
› The best clinical outcome can be achieved by combining
2-view 2D with 2-view DBT.
However,

› This will result in at least double the dose compared with

2-view DM alone

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 Any potential for dose reduction?

http://appliedradiology.com/articles/the-benefits-of-using-synthesized-2d-c-view-images-in-breast-tomosynthesis-exams

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References
 Digital Breast Tomosynthesis: A Practical Approach
2016 by Tagliafico, Alberto; Houssami, Nehmat;
Calabrese, Massimo