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Physics and Clinical Perspectives On Tomosynthesis

A Maidment1*, E Conant2*, (1) Univ Pennsylvania, Philadelphia, PA, (2) The University of Pennsylvania Health System, Philadelphia, PA


(Tuesday, 4/2/2019) 8:00 AM - 10:00 AM

Room: Orange Blossom Ballroom

Digital breast tomosynthesis (DBT) is the new, better mammogram based on observed increases in specificity and cancer detection when compared to digital mammography (DM) alone. However, when DBT is combined with 2D planar imaging, the dose of the DM/DBT study is more than double that of a DM-only mammogram. Synthesized digital mammographic (SM) images, that are “2D-like� yet reconstructed from the tomosynthesis acquisition, have been developed to maintain the benefits of planar 2D imaging while decreasing the dose received from dual acquisition. Estimates of dose reduction with SM imaging are from 39-45% and both population based studies and reader studies have found comparable specificity and cancer detection when screening is performed with either DM/DBT or SM/DBT. The incorporation of DBT into clinical practice is also associated with improvements in workflow efficiency. DBT offers improved lesion conspicuity and the ability to localize lesions within the 3D image stack, allowing more direct patient flow to targeted ultrasound and improved reader confidence in lesion characterization. DBT-guided biopsy devices also allow tissue sampling of lesions previously not accessible by stereotactic-guided core biopsy, often at a reduced radiation dose. In this course, the fundamental physics of DBT imaging will be reviewed in light of commercial and future system designs, and the dosimetry and clinical physics of DBT systems will be discussed. Clinically, case-based examples will be shown demonstrating improvements in specificity, cancer detection, and workflow for both DM/DBT and SM/DBT.

Learning Objectives:
1. Understand the physics and technology of tomosynthesis, available today and in the near future.
2. Appreciate the determinants of image quality, and gain insight into the source and presentation of image artifacts in DBT.
3. Compare the outcomes from screening with digital breast tomosynthesis to those of digital mammography alone.
4. Assess the benefits of digital breast tomosynthesis in the diagnostic evaluation of breast lesions.
5. Evaluate the impact of digital breast tomosynthesis on the breast imaging clinical workflow.


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