The benefits and challenges of tomosynthesis

Digital breast tomosynthesis (DBT) is a technology generating lots of buzz in imaging, and it was the focus of two of this week’s top stories.

The first involved a pilot study, published online Dec. 6 in Academic Radiology, that examined the interaction between DBT and the availability of prior images in reducing recall recommendations during mammographic interpretations. Researchers from Magee-Womens Hospital of the University of Pittsburgh Medical Center noted that previous studies had looked at DBT’s effect on recall and cancer detection rates, but they hadn’t assessed the effect of including prior exams.

For the retrospective study, eight radiologists independently interpreted 36 mammography exams twice to capture the effect of adding prior mammography images and DBT. Only two of the cases included verified cancers, with the rest being benign cases that either were or were not recalled in clinical practice.

Results showed that the average recall rates in noncancer cases were significantly reduced by adding DBT and prior exams. The addition of DBT reduced recall rates from 0.67 to 0.54 and from 0.54 to 0.27 when DBT was available before and after priors. Recall reductions went from 0.64 to 0.54 and 0.42 to 0.33 when priors were available before and after DBT.

The researchers plan on expanding their study to include larger sample sizes. More tomosynthesis studies would be welcome, as there is limited proof of the modality’s clinical relevance and cost-effectiveness, according to an article published in the December issue of the Journal of the American College of Radiology.

The rapid installation of DBT could amount to placing the cart in front of the horse, as radiology groups have little guidance on how to implement the technology, wrote Christoph I. Lee, MD, MSHS, and Constance D. Lehman, MD, PhD, both of the University of Washington School of Medicine in Seattle.

For practices looking to embrace DBT, there are some challenges to overcome, including a lack of third-party reimbursement and increased interpretation time, wrote Lee and Lehman. Practices will also have to account for increased interaction and communication with patients.

Have you recently implemented tomosynthesis at your practice? We’d love to hear your experiences.

Evan Godt
Editor – Health Imaging