Guidelines in both Italy , UK and US agree that 2D mammography, in the presence of breast implant, does not offer a reliable diagnosis and therefore invite clinicians to perform the Eklund maneuver. Due to the typical radiopacity of implants, Tomosynthesis is not currently the technique of choice for screening this type of breast. In this study, we wanted to experiment a protocol in which Tomosynthesis can be used to provide more diagnostic information even in the presence of breast implants, reconciling the technical, methodological and dosimetric aspects.

We prospectively enrolled 53 women (age range 50-74 yy, average 65 yy) who joined the breast screening program in the ASL Roma 1. These women were asked for informed consent to acquire the images also with Tomosynthesis. Women have been divided in 2 groups. The first group included 15 women undergoing standard protocol with standard configuration for the automatic exposure control algorithm (AEC) present on the IMS Giotto Class mammography unit, including 8 projections: 4 with digital mammography that included the breast implant and 4 with Tomosynthesis (with synthetic image) using Eklund's maneuver.  In a second group, including 38 women, a low-dose configuration of the AEC was activated in order to have a low dose protocol.