Researchers survey radiology’s attitude toward synthesized digital mammography in DBT

Synthesized digital mammography (SM) was created to help reduce the radiation dose for patients undergoing digital mammography (DM) in digital breast tomosynthesis (DBT), so why haven’t more clinics adopted it?

Researchers of a new study published in the Journal of the American College of Radiology administered a survey to the 2,600 members of the Society of Breast Imaging to find out.

“Combination-dose DM and DBT screening over the lifetime of a screened woman will result in higher radiation dose than screening with DM alone,” wrote Samantha Zuckerman, MD, with the University of Pennsylvania, and colleagues. “Thus, it would be most beneficial to patients if the ‘dose DM’ portion of a DBT screen is replaced by an acceptable SM image so that the benefits of DBT could be maintained at a lower radiation dose than DM–DBT screening.”

An anonymous 20-question survey was sent to members of the Society of Breast Imaging in June 2018 to assess their use of SM in DBT screening—312 members responded. They were asked to describe their practice, utilization of DBT and SM, perception of change in recall rates (RRs) and cancer detection rates (CDRs) among the methods and attitudes toward SM versus DM.

In total, 96% of respondents said they had DBT capability, with 83% reporting SM capability. Additionally, 40% said they used combined SM and DM in DBT screening while 52% reported using SM without DM when using the modality. Additional results are as follows:

  • Those who did not have SM cited cost or administration (32%) and imaging quality concerns (32%) as their top reason.
  • Respondents were somewhat satisfied with SM, giving it a 3.4 on a scale of 1-5.
  • Most cited the decreased dose (85%) as the biggest advantage of SM. Increased lesions conspicuity was the next most-cited advantage at 27%. In contrast, 61% of respondents said calcification characterization and decreased image quality (31%) were SM’s biggest disadvantage.
  • A majority were unsure if CDRs changed (44%) and if RR rate changed (30%); only 6% of respondents reported RR increase and 1% reported CDR decrease.

“Our results reveal that DBT is now widely used by most breast imagers and in most breast cancer screening studies, the researchers concluded.

The majority of practices responding to the survey screening with DBT have SM capability; however, SM usage with DM in DBT screening varies, as does radiologist satisfaction. Future research studies will be necessary to evaluate the continually evolving platform of synthetic imaging and the long-term outcomes of screening with SM–DBT.”