A review of breast tomosynthesis. Part II. Image reconstruction, processing and analysis, and advanced applications

Abstract

Many important post-acquisition aspects of breast tomosynthesis imaging can impact its clinical performance. Chief among them is the reconstruction algorithm that generates the representation of the three-dimensional breast volume from the acquired projections. But even after reconstruction, additional processes, such as artifact reduction algorithms, computer aided detection and diagnosis, among others, can also impact the performance of breast tomosynthesis in the clinical realm. In this two part paper, a review of breast tomosynthesis research is performed, with an emphasis on its medical physics aspects. In the companion paper, the first part of this review, the research performed relevant to the image acquisition process is examined. This second part will review the research on the post-acquisition aspects, including reconstruction, image processing, and analysis, as well as the advanced applications being investigated for breast tomosynthesis.

The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme – a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone

“…Two major differences among the modalities were that cancers missed by 2D alone tended to be of size 11-20 mm or to have a mass as the major radiological sign, compared with the other two modalities; and cancers missed by 2D + DBT were less likely to be of grade 2 or to have density less than 50% than the other two modalities. (29) 26 (29) 27 (27) 164 (24) 2 67 (56) 43 (48) 57 (56) 373 (55) 3 18 (15) 21 (23) 17 (17) 140 (21) Breast density < 50% 80 (66) 69 (73) 70 (66) 488 (70) ≥ 50% 42 (34) 26 (27) 36 (34) 195 (30) Dominant radiological feature Mass 68 (55) 45 (47) 52 (49) 479 (69) Microcalcification 12 (10) 12 (13) 16 (15) 88 (12) Distortion/ASD 42 (34) 37 (39) 37 (35) 126 (18) None 1 (1) 1 (1) 1 (1) 4 (1) Receiver operating characteristic analysis…”

“…71 A number of publications have summarised and reviewed both the technical and the clinical aspects of DBT and have speculated on its potential application in breast imaging. 23,[25][26][27]61,63,64,72,73 The AETNA policy report, 74 a combined recommendation from the American College of Radiologists, the American Cancer Society and the American College of Obstetrics and Gynaecologists, considers that breast tomosynthesis imaging is experimental and investigational because of insufficient evidence of its effectiveness. An Australian health technology review acknowledged that DBT systems were likely to replace 2D in screening when existing 2D equipment is due for replacement 75 and an overview of the evidence and issues to be considered in relation DBT and breast cancer screening raised concerns regarding additional radiation exposure and the learning curve for radiologists to accurately interpret DBT results.…”

X‐ray scatter correction in breast tomosynthesis with a precomputed scatter map library

“…In DBT, multiple low dose projections of the breast are acquired over a limited angular range; these projections are then used to calculate a pseudo-3D reconstruction of the imaged tissue. [2][3][4][5][6] Preliminary studies have shown that DBT has the potential to improve the clinical performance of breast cancer screening and/or diagnosis. [7][8][9][10][11][12] Current DBT systems, including the Selenia Dimensions (Hologic Inc., Bedford, MA) used in this study, lack x-ray scatter reduction measures, be it in software or hardware.…”

Impact of lesion segmentation metrics on computer-aided diagnosis/detection in breast computed tomography

“…3-D breast imaging modalities that mitigate tissue superimposition effects include magnetic resonance imaging, digital breast tomosynthesis, and more recently, dedicated breast computed tomography (bCT) and 3-D automated breast ultrasound. [1][2][3][4]5,6 Studies involving these latter two emerging technologies are promising, but more research is needed to determine their potential role in breast cancer screening and/or diagnosis. [7][8][9][10][11][12] The use of 3-D imaging modalities, however, requires viewing 3-D image volumes on two-dimensional displays and increases the amount of data that radiologists need to interpret.…”