Digital Breast Tomosynthesis: State of the Art

Vedantham, Srinivasan; Karellas, Andrew; Vijayaraghavan, Gopal; Kopans, Daniel B.

doi:10.1148/radiol.2015141303

Cited by 190 publications

(112 citation statements)

References 164 publications

(132 reference statements)

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“…At present, most of the clinical knowledge is based on the combined DBT+FFDM exam, where projection data for DBT and the digital mammogram are acquired under the same compression. However, this result in approximate doubling of the radiation dose compared to DBT imaging alone (Sechopoulos et al, 2007, Feng and Sechopoulos, 2012, Vedantham et al, 2015). One approach to reduce the radiation dose is to replace the FFDM with the synthesized mammogram generated from data acquired for DBT.…”

Section: Discussionmentioning

confidence: 99%

Digital breast tomosynthesis guided near infrared spectroscopy: volumetric estimates of fibroglandular fraction and breast density from tomosynthesis reconstructions

Vedantham

Shi

Michaelsen

et al. 2015

Biomed. Phys. Eng. Express

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A multimodality system combining a clinical prototype digital breast tomosynthesis with its imaging geometry modified to facilitate near-infrared spectroscopic imaging has been developed. The accuracy of parameters recovered from near-infrared spectroscopy is dependent on fibroglandular tissue content. Hence, in this study, volumetric estimates of fibroglandular tissue from tomosynthesis reconstructions were determined. A kernel-based fuzzy c-means algorithm was implemented to segment tomosynthesis reconstructed slices in order to estimate fibroglandular content and to provide anatomic priors for near-infrared spectroscopy. This algorithm was used to determine volumetric breast density (VBD), defined as the ratio of fibroglandular tissue volume to the total breast volume, expressed as percentage, from 62 tomosynthesis reconstructions of 34 study participants. For a subset of study participants who subsequently underwent mammography, VBD from mammography matched for subject, breast laterality and mammographic view was quantified using commercial software and statistically analyzed to determine if it differed from tomosynthesis. Summary statistics of the VBD from all study participants were compared with prior independent studies. The fibroglandular volume from tomosynthesis and mammography were not statistically different (p=0.211, paired t-test). After accounting for the compressed breast thickness, which were different between tomosynthesis and mammography, the VBD from tomosynthesis was correlated with (r =0.809, p<0.001), did not statistically differ from (p>0.99, paired t-test), and was linearly related to, the VBD from mammography. Summary statistics of the VBD from tomosynthesis were not statistically different from prior studies using high-resolution dedicated breast computed tomography. The observation of correlation and linear association in VBD between mammography and tomosynthesis suggests that breast density associated risk measures determined for mammography are translatable to tomosynthesis. Accounting for compressed breast thickness is important when it differs between the two modalities. The fibroglandular volume from tomosynthesis reconstructions is similar to mammography indicating suitability for use during near-infrared spectroscopy.

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Section: Discussionmentioning

confidence: 99%

Digital breast tomosynthesis guided near infrared spectroscopy: volumetric estimates of fibroglandular fraction and breast density from tomosynthesis reconstructions

Vedantham

Shi

Michaelsen

et al. 2015

Biomed. Phys. Eng. Express

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“…Hence, there is a concern that the Al filter might generate substantially more x-ray scatter. One commercially available DBT/DM system uses either a 50 μm Rh filter or a 50 μm Ag filter during two-dimensional (2D) DM acquisition, and 700 μm Al filter for DBT acquisition (Sechopoulos, 2013, Vedantham et al, 2015). Hence, the scatter properties of 700 μm thick Al, 50 μm thick Rh and 50 μm thick Ag were quantified using Monte Carlo simulations.…”

Section: Methodsmentioning

confidence: 99%

“…Commonly used x-ray beam filters are molybdenum (Mo), rhodium (Rh), silver (Ag) and aluminium (Al). The x-ray beam filter material and its thickness vary among current mammography and digital breast tomosynthesis (DBT) systems (Sechopoulos, 2013, Vedantham et al, 2015). For DM, most systems use K-edge filtration such as Mo, Rh and Ag, and at least one system uses Al filter (Microdose, Koninklijke Philips N.V.).…”

Section: Introductionmentioning

confidence: 99%

Towards standardization of x-ray beam filters in digital mammography and digital breast tomosynthesis: Monte Carlo simulations and analytical modelling

2017

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In digital breast tomosynthesis and digital mammography, the x-ray beam filter material and thickness vary between systems. Replacing K-edge filters with Al was investigated with the intent to reduce exposure duration and to simplify system design. Tungsten target x-ray spectra were simulated with K-edge filters (50μm Rh; 50μm Ag) and Al filters of varying thickness. Monte Carlo simulations were conducted to quantify the x-ray scatter from various filters alone, scatter-to-primary ratio (SPR) with compressed breasts, and to determine the radiation dose to the breast. These data were used to analytically compute the signal-difference-to-noise ratio (SDNR) at unit (1 mGy) mean glandular dose (MGD) for W/Rh and W/Ag spectra. At SDNR matched between K-edge and Al filtered spectra, the reductions in exposure duration and MGD were quantified for three strategies: (i) fixed Al thickness and matched tube potential in kilovolts (kV); (ii) fixed Al thickness and varying the kV to match the half-value layer (HVL) between Al and K-edge filtered spectra; and, (iii) matched kV and varying the Al thickness to match the HVL between Al and K-edge filtered spectra. Monte Carlo simulations indicate that the SPR with and without the breast were not different between Al and K-edge filters. Modelling for fixed Al thickness (700μm) and kV matched to K-edge filtered spectra, identical SDNR was achieved with 37–57% reduction in exposure duration and with 2–20% reduction in MGD, depending on breast thickness. Modelling for fixed Al thickness (700μm) and HVL matched by increasing the kV over [0,4] range, identical SDNR was achieved with 62–65% decrease in exposure duration and with 2–24% reduction in MGD, depending on breast thickness. For kV and HVL matched to K-edge filtered spectra by varying Al filter thickness over [700,880]μm range, identical SDNR was achieved with 23–56% reduction in exposure duration and 2–20% reduction in MGD, depending on breast thickness. These simulations indicate that increased fluence with Al filter of fixed or variable thickness substantially decreases exposure duration while providing for similar image quality with moderate reduction in MGD.

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“…This technology was designed to eliminate overlapping breast tissue, which may either mimic or obscure breast cancer on standard mammography, and to increase conspicuity of true lesions [35] and is poised to replace mammography as the front-line imaging modality for breast cancer screening and surveillance.…”

Section: Synopsis and Synthesis Of Evidencementioning

confidence: 99%

Imaging Surveillance After Primary Breast Cancer Treatment

Lam

Houssami

Lee

2017

American Journal of Roentgenology

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OBJECTIVE Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard digital mammography, including digital breast tomosynthesis (DBT), breast ultrasound, and MRI, may improve outcomes. This article reviews the evidence on the performance and effectiveness of breast imaging modalities available for surveillance after treatment of sporadic unilateral primary breast cancer and identifies additional factors to be considered when selecting an imaging surveillance regimen. CONCLUSION Evidence review supports the use of mammography for surveillance after primary breast cancer treatment. Variability exists in guideline recommendations for surveillance initiation, interval, and cessation. DBT offers the most promise as a potential modality to replace standard digital mammography as a front-line surveillance test; a single published study to date has shown a significant decrease in recall rates compared with standard digital mammography alone. Most guidelines do not support the use of whole-breast ultrasound in breast cancer surveillance, and further studies are needed to define the characteristics of women who may benefit from MRI surveillance. The emerging evidence about surveillance imaging outcomes suggests that additional factors, including patient and imaging characteristics, tumor biology and gene expression profile, and choice of treatment, warrant consideration in selecting personalized posttreatment imaging surveillance regimens.

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Digital Breast Tomosynthesis: State of the Art

Cited by 190 publications

References 164 publications

Digital breast tomosynthesis guided near infrared spectroscopy: volumetric estimates of fibroglandular fraction and breast density from tomosynthesis reconstructions

Digital breast tomosynthesis guided near infrared spectroscopy: volumetric estimates of fibroglandular fraction and breast density from tomosynthesis reconstructions

Towards standardization of x-ray beam filters in digital mammography and digital breast tomosynthesis: Monte Carlo simulations and analytical modelling

Imaging Surveillance After Primary Breast Cancer Treatment

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