Digital Tomosynthesis of the Chest: Current and Emerging Applications

Abstract

Digital tomosynthesis (DTS) of the chest is a technique whose basic components are similar to those of digital radiography, but that also provides some of the benefits of computed tomography (CT). The major advantages of DTS over conventional chest radiography are improved visibility of the pulmonary parenchyma and depiction of abnormalities such as pulmonary nodules. Calcifications, vessels, airways, and chest wall abnormalities are also much more readily visualized at DTS than at chest radiography. DTS could potentially be combined with chest radiography to follow up known nodules, confirm or rule out suspected nodules seen at radiography, or evaluate individuals who are at high risk for lung cancer or pulmonary metastases. DTS generates coronal "slices" through the chest whose resolution is superior to that of coronal reconstructed CT images, but it is limited by its suboptimal depth resolution and susceptibility to motion; consequently, potential pitfalls in recognizing lesions adjacent to the pleura, diaphragm, central vessels, and mediastinum can occur. However, the radiation dose and projected cost of chest DTS are lower than those of standard chest CT. Besides pulmonary nodule detection, specific applications of DTS that are under investigation include evaluation of pulmonary tuberculous and nontuberculous mycobacterial disease, cystic fibrosis, interstitial lung disease, and asbestos-related thoracic diseases. A basic understanding of chest DTS and of the emerging applications of this technique can prove useful to the radiologist. Online supplemental material is available for this article.

Comparison of digital tomosynthesis and chest radiography for the detection of pulmonary nodules: systematic review and meta-analysis

“…9,12,28 DTS imaging excludes overlapping anatomy, such as vasculature and ribs, and allows a clear view of the lung parenchyma, increasing the conspicuity of pulmonary nodules and providing greater sensitivity. 29,30 In addition to reductions in anatomical noise or composite artefacts, DTS provides greater depth and contrast resolution. 7 Our findings for per-patient data showed that the high diagnostic accuracy of DTS is complemented by greater homogeneity and consistency of results compared with chest radiography.…”

Whole-Body Clinical Applications of Digital Tomosynthesis

“…The main application of chest DT to date has been improving detection of pulmonary nodules compared with conventional radiography (6,24,25), although DT may have other potential uses (7,8), including evaluation of suspected interstitial lung disease and pulmonary mycobacterial disease (26) and metastases (27), early detection of infection in immune-compromised patients, detection of subtle pneumothoraces, visualization and scoring of cystic fibrosis (28,29), airway visualization (30), detection of cardiac or coronary artery and aortic calcification (31), and evaluation of rib, spine, and clavicle fractures or other osseous lesions. According to studies that used CT as the reference standard, pulmonary nodules were definitely visible with higher sensitivity at DT than at posteroanterior chest radiography (25); more pulmonary nodules, particularly less than 9 mm in diameter, were detected with DT than with posteroanterior and lateral chest radiography (24).…”

“…Manufacturers, such as Hologic and GE Healthcare, offer upgrade paths for standard mammography systems to become breast tomosynthesis capable. Other than DBT, DT is also advantageous in a variety of clinical contexts, including chest, head and neck, orthopedic, and emergency imaging (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The aims of this article are (a) to provide radiologists and radiologic technologists with knowledge about the basic facts and acquisition technique of DT, (b) to illustrate whole-body applications of DT by presenting a broad variety of clinical images, and (c) to demonstrate the clinical utilities and limitations of DT for these applications.…”

Prevalence and distribution of sesamoid bones in the hand determined using digital tomosynthesis

“…Digital tomosynthesis (DTS) is a new diagnostic tool that produces sectional images using a moving X-ray tube, a flat digital panel, and a special reconstruction algorithm (Dobbins and Godfrey, 2003). Recently, DTS has been used to evaluate breast (Conant, 2014), lung (Chou et al, 2014), and musculoskeletal disease (Aoki et al, 2014). In musculoskeletal applications, DTS allows 20-to 50-fold dose reductions compared to that of CT.…”