Congress:
EuroSafe Imaging 2017
Keywords:
Dosimetric comparison, Technical aspects, Radiation safety, Education, Mammography, Breast, Action 6 - Clinical audit tool for imaging, Action 3 - Image quality assessment based on clinical indications, Action 2 - Clinical diagnostic reference levels (DRLs), Action 4 - Quality of radiological equipment, Action 3 - Optimisation, diagnostic reference levels, image quality, Action 2 - Clinical audit
Authors:
D. Caramella, F. Paolicchi, G. Imbarlina, C. Marini, C. Sottocornola
DOI:
10.1594/esi2017/ESI-0031
Conclusion and Recommendations
DBT has the potential to overcome the inherent limitation of standard FFDM that arises from overlapping breast tissues.
By providing 3D images,
the diagnostic accuracy can be improved as lesion conspicuity is increased.
For screening,
this would result in a reduction in the number of both false positives and false negative diagnosis and a decrease in recall rates.
The ability to identify more lesions may result in earlier detection of tumors and in an increased cancer detection rates.
DBT may allow a more accurate delineation of a lesion,
definition of the extent of disease,
and identification of additional lesions,
and this would assist in surgical and treatment planning.
On the contrary,
standard FFDM has suboptimal sensitivity in dense breasts and the improved visibility afforded with the addition of DBT has the potential to increase diagnostic accuracy in these cases.
Over the last ten years,
a number of studies to compare DBT and FFDM techniques have been undertaken.
The results have largely demonstrated the improvement in both sensitivity and specificity [6-9] in DBT.
However,
the identification of microcalcifications is still considered the principal cause of debate since many studies comparing DBT and FFDM had led to discordant results [10-11].
Despite great evidence that the addition of DBT to FFDM has clear advantages for diagnosis,
several issues must be taken into consideration regarding the implementation of DBT as a diagnosis and screening tool.
These include increased radiation dose,
the increased costs associated with using DBT technology,
including IT and data storage,
and changes to diagnostic practice.
For what concerns radiation protection of the patient,
a drawback of using DBT or combining 2D and 3D breast imaging is the increased radiation dose.
Our results clearly show that DTB radiation dose is significantly higher compared to FFDM,
suggesting caution in a widespread use.
Further studies are needed to ascertain whether such increase in radiation dose is compensated by a higher diagnostic accuracy and an improvement in patient management.
Additional issues need to be considered are an increasing reading time which may have an impact on daily activity [12] and higher data storage requirements to manage the amount of images generated by DBT acquisition.
Besides,
dedicated workstations must be given to radiologists to adequately display all the images,
allowing to easily choose between reconstructed 2D C-view and 3D images.
In conclusion,
the increasing use of tomosynthesis needs to be carefully considered in relation to the potential increase in radiation dose,
and the additional resources needed such time to review the cases and additional costs that may have logistical implications for breast screening programmes.