Digital Breast Tomosynthesis Images Research Articles

Functional hemodynamic imaging markers for the prediction of pathological outcomes in breast cancer patients treated with neoadjuvant chemotherapy.

Achieving pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) is a significant predictor of increased likelihood of survival in breast cancer patients. Early prediction of pCR is of high clinical value as it could allow personalized adjustment of treatment regimens in non-responding patients for improved outcomes. We aim to assess the association between hemoglobin-based functional imaging biomarkers derived from diffuse optical tomography (DOT) and the pathological outcome represented by pCR at different timepoints along the course of NACT. Twenty-two breast cancer patients undergoing NACT were enrolled in a multimodal DOT and X-ray digital breast tomosynthesis (DBT) imaging study in which their breasts were imaged at different compression levels. Logistic regressions were used to study the associations between DOT-derived imaging markers evaluated after the first and second cycles of chemotherapy, respectively, with pCR status determined after the conclusion of NACT at the time of surgery. Receiver operating characteristic curve analysis was also used to explore the predictive performance of selected DOT-derived markers. Normalized tumor HbT under half compression was significantly lower in the pCR group compared to the non-pCR group after two chemotherapy cycles (). In addition, the change in normalized tumor upon reducing compression from full to half mammographic force was identified as another potential indicator of pCR at an earlier time point, i.e., after the first chemo cycle (). Exploratory predictive assessments showed that AUCs using DOT-derived functional imaging markers as predictors reach as high as 0.75 and 0.71, respectively, after the first and second chemo cycle, compared to AUCs of 0.50 and 0.53 using changes in tumor size measured on DBT and MRI. These findings suggest that breast DOT could be used to assist response assessment in women undergoing NACT, a critical but unmet clinical need, and potentially enable personalized adjustments of treatment regimens.

Assessment of volumetric dense tissue segmentation in tomosynthesis using deep virtual clinical trials

The adoption of artificial intelligence (AI) in medical imaging requires careful evaluation of machine-learning algorithms. We propose the use of a “deep virtual clinical trial” (DeepVCT) method to effectively evaluate the performance of AI algorithms. In this paper, DeepVCTs have been proposed to elucidate limitations of AI applications and predictions of clinical outcomes, avoiding biases in study designs. The DeepVCT method was used to evaluate the performance of nnU-Net models in assessing volumetric breast density (VBD) from digital breast tomosynthesis (DBT) images. In total, 2010 anatomical breast models were simulated. Projections were simulated using the acquisition geometry of a clinical DBT system. The projections were reconstructed using 0.1, 0.2, and 0.5 mm plane spacing. nnU-Net models were developed using the center-most planes of the reconstructions with the respective ground-truth. The results show that the accuracy of the nnU-Net improves significantly with DBT images reconstructed with 0.1 mm plane spacing (78.4×205.3×40.1 mm3). The segmentations resulted in Dice values up to 0.84 with area under the receiver operating characteristic curve of 0.92. The optimization of plane spacing for VBD assessment was used as an exemplar of a DeepVCT application, allowing better interpretation of the input parameters and outcomes of the nnU-Net. Thus, DeepVCTs can provide evidence to predict the efficacy of AI algorithms using large-scale simulation-based data.

Adaptive fuzzy weighted median filter for microcalcifications detection in digital breast tomosynthesis images

Breast cancer is a global leading cause of female mortality. Digital breast tomosynthesis (DBT) is pivotal for early breast cancer detection, with microcalcifications serving as crucial indicators. However, the movement of the DBT machine introduces blurry artefacts, potentially impacting accurate diagnosis. This study addresses this challenge by proposing an adaptive fuzzy weighted median filter (AFWMF) to enhance DBT images and aid microcalcification diagnosis. AFWMF automatically determines optimal parameters based on input images, outperforming conventional methods with a threshold range (C) from peak to end of switching. Quantitative assessment reveals peak signal to noise ratio (PSNR), and mean absolute error (MAE) values of 96.2267 and 0.0000636, respectively, demonstrating a significant improvement in microcalcification detection. This study contributes an effective and adaptive enhancement technique for DBT images, promising better breast cancer diagnosis, particularly in microcalcification scenarios.

SAH-NET: Structure-Aware Hierarchical Network for Clustered Microcalcification Classification in Digital Breast Tomosynthesis.

Benign and malignant classification of clustered microcalcifications (MCs) in digital breast tomosynthesis (DBT) is an essential task in computer-aided diagnosis. However, due to the anisotropic resolution of DBT, three-dimensional (3-D) convolutional neural network (CNN)-based methods cannot extract hierarchical features efficiently. Moreover, the sparse distribution of MC points in the cluster makes it difficult for the CNN to extract discriminative structural information for classification. To comprehensively address these challenges, we propose a novel structure-aware hierarchical network (SAH-Net) for benign and malignant classification of clustered MC in a DBT volume. Specifically, the two-dimensional (2-D) group convolution is used to extract intraslice features. The one-to-one correspondence between group convolutions and slices ensures the independence of hierarchical feature extraction. Then, a partial deformable Transformer-based 3-D structural feature learning module is proposed to capture the long-range dependency between MC points in the cluster. We evaluate the proposed method on an in-house dataset with 495 clustered MCs collected from 462 DBT images. Experimental results confirm the validity of our proposed modules. The results also show that the proposed SAH-Net outperforms several other representative methods on this topic, and achieves the best classification result, with an area under the receiver operation curve (AUC) of 86.87%. The implementation of the proposed model is available at https://github.com/sunhaotian130911/SAHNet.

Comparative analysis of cone‐beam breast computed tomography and digital breast tomosynthesis for breast cancer diagnosis: A comprehensive study on reconstruction algorithms

AbstractBreast cancer (BC) is the most commonly diagnosed non‐skin cancer in women. To achieve early and accurate diagnosis, three‐dimensional (3D) cone‐beam breast computed tomography (CBBCT) and digital breast tomosynthesis (DBT) modalities are used. Importantly, the comparison of reconstruction accuracy of both CBBCT and DBT has rarely been investigated, thus constituting a research gap. This study systematically investigated the performances of the CBBCT and DBT for different reconstruction algorithms using both BR3D breast phantom and breast images. We acquired clinical breast images and scanned the BR3D phantom for additional breast images. These acquired images were used to simulate projection data using predefined CBBCT and DBT geometries. The simulated projections were reconstructed using five different reconstruction algorithms. To evaluate the reconstruction accuracy, we calculated average image quality assessment (IQA) indices, including peak signal‐to‐noise ratio (PSNR), structural similarity index (SSIM), root mean square error (RMSE), and others, across different algorithms and modalities. The pooled PSNR, SSIM, and RMSE for DBT and CBBCT images are (31.6265 ± 0.8725), (0.9353 ± 0.0077), and (0.0270 ± 0.0025) and (29.7007 ± 0.9249), (0.9136 ± 0.0130), and (0.0342 ± 0.0040), which implies that the overall IQA indices of DBT are superior to CBBCT; therefore, DBT tends to reveal more BC detectability as the diagnosis outcome would largely depend on good quality images. The results show that DBT gives an improved result for all algorithms compared to CBBCT, although further experimental trials may be needed to establish the findings fully. The findings suggest that using DBT may enhance the accuracy of BC diagnosis compared to CBBCT due to its superior image quality in clinical practice, emphasizing the importance of selecting optimal reconstruction algorithms for improved diagnostic outcomes.

Optimized signal of calcifications in wide-angle digital breast tomosynthesis: a virtual imaging trial.

Evaluate microcalcification detectability in digital breast tomosynthesis (DBT) and synthetic 2D mammography (SM) for different acquisition setups using a virtual imaging trial (VIT) approach. Medio-lateral oblique (MLO) DBT acquisitions on eight patients were performed at twice the automatic exposure controlled (AEC) dose. The noise was added to the projections to simulate a given dose trajectory. Virtual microcalcification models were added to a given projection set using an in-house VIT framework. Three setups were evaluated: (1) standard acquisition with 25 projections at AEC dose, (2) 25 projections with a convex dose distribution, and (3) sparse setup with 13 projections, every second one over the angular range. The total scan dose and angular range remained constant. DBT volume reconstruction and synthetic mammography image generation were performed using a Siemens prototype algorithm. Lesion detectability was assessed through a Jackknife-alternative free-response receiver operating characteristic (JAFROC) study with six observers. For DBT, the area under the curve (AUC) was 0.97 ± 0.01 for the standard, 0.95 ± 0.02 for the convex, and 0.89 ± 0.03 for the sparse setup. There was no significant difference between standard and convex dose distributions (p = 0.309). Sparse projections significantly reduced detectability (p = 0.001). Synthetic images had a higher AUC with the convex setup, though not significantly (p = 0.435). DBT required four times more reading time than synthetic mammography. A convex setup did not significantly improve detectability in DBT compared to the standard setup. Synthetic images exhibited a non-significant increase in detectability with the convex setup. Sparse setup significantly reduced detectability in both DBT and synthetic mammography. This virtual imaging trial study allowed the design and efficient testing of different dose distribution trajectories with real mammography images, using a dose-neutral protocol. • In DBT, a convex dose distribution did not increase the detectability of microcalcifications compared to the current standard setup but increased detectability for the SM images. • A sparse setup decreased microcalcification detectability in both DBT and SM images compared to the convex and current clinical setups. • Optimal microcalcification cluster detection in the system studied was achieved using either the standard or convex dose setting, with the default number of projections.

Image Quality Enhancement for Digital Breast Tomosynthesis: High-Density Object Artifact Reduction.

Breast cancer has a high incidence and mortality rate among women, early diagnosis is essential as it gives insight regarding the most appropriate therapeutic strategy for each case. Among all imaging diagnostic methods, digital breast tomosynthesis (DBT) is effective for early breast cancer detection. In DBT images, high-density object artifacts are generated when imaging objects with high X-ray absorptivity, which include metal artifacts, ripple artifacts, and deformation artifacts. In this study, we analyze the causes of these artifacts and propose a set of high-density object reconstruction methods based on iterative algorithms. Our method includes a reprojection-based high-density object projection data segmentation algorithm and an iterative reconstruction algorithm based on volume expansion. The experiments on simulation data and the human breast data with artificial surgical needles prove the effectiveness of our method. By using our algorithm, the problem of distorting the shape, size, and position of high-density objects during DBT reconstruction is raised, the influence of these artifacts is reduced, and the quality of the DBT reconstructed image is improved. We hope that our algorithm might contribute to promoting the usage of DBT.

Can artificial intelligence detect type 2 diabetes in women by evaluating the pectoral muscle on tomosynthesis: diagnostic study

ObjectivesThis retrospective single-center analysis aimed to evaluate whether artificial intelligence can detect type 2 diabetes mellitus by evaluating the pectoral muscle on digital breast tomosynthesis (DBT).Material methodAn analysis of 11,594 DBT images of 287 consecutive female patients (mean age 60, range 40–77 years) was conducted using convolutional neural networks (EfficientNetB5). The inclusion criterion was left-sided screening images with unsuspicious interpretation who also had a current glycosylated hemoglobin A1c (HBA1c) % value. The exclusion criteria were inadequate imaging, history of breast cancer, and/or diabetes mellitus. HbA1c values between 5.6 and 6.4% were categorized as prediabetic, and those with values ≥ 6.5% were categorized as diabetic. A recorded HbA1c ≤ 5.5% served as the control group. Each group was divided into 3 subgroups according to age. Images were subjected to pattern analysis parameters then cropped and resized in a format to contain only pectoral muscle. The dataset was split into 85% for training and 15% for testing the model’s performance. The accuracy rate and F1-score were selected as performance indicators.ResultsThe training process was concluded in the 15th epoch, each comprising 1000 steps, with an accuracy rate of 92% and a loss of only 0.22. The average specificity and sensitivity for all 3 groups were 95%. The F1-score was 0.95. AUC-ROC was 0.995. PPV was 94%, and NPV was 98%.ConclusionOur study presented a pioneering approach, applying deep learning for the detection of diabetes mellitus status in women using pectoral muscle images and was found to function with an accuracy rate of 92%.Critical relevance statementAI can differentiate pathological changes within pectoral muscle tissue by assessing radiological images and maybe a potential diagnostic tool for detecting diabetes mellitus and other diseases that affect muscle tissues.Key points• AI may have an opportunistic use as a screening exam for diabetes during digital breast tomosynthesis.• This technique allows for early and non-invasive detection of diabetes mellitus by AI.• AI may have broad applications in detecting pathological changes within muscle tissue.Graphical

Adaptive Machine Learning Approach for Importance Evaluation of Multimodal Breast Cancer Radiomic Features.

Breast cancer holds the highest diagnosis rate among female tumors and is the leading cause of death among women. Quantitative analysis of radiological images shows the potential to address several medical challenges, including the early detection and classification of breast tumors. In the P.I.N.K study, 66 women were enrolled. Their paired Automated Breast Volume Scanner (ABVS) and Digital Breast Tomosynthesis (DBT) images, annotated with cancerous lesions, populated the first ABVS+DBT dataset. This enabled not only a radiomic analysis for the malignant vs. benign breast cancer classification, but also the comparison of the two modalities. For this purpose, the models were trained using a leave-one-out nested cross-validation strategy combined with a proper threshold selection approach. This approach provides statistically significant results even with medium-sized data sets. Additionally it provides distributional variables of importance, thus identifying the most informative radiomic features. The analysis proved the predictive capacity of radiomic models even using a reduced number of features. Indeed, from tomography we achieved AUC-ROC using 19 features and using 7 of them; while from ABVS we attained an AUC-ROC of using 22 features and using only 3 features. Although the predictive power of DBT outperforms ABVS, when comparing the predictions at the patient level, only 8.7% of lesions are misclassified by both methods, suggesting a partial complementarity. Notably, promising results (AUC-ROC ABVS-DBT - ) were achieved using non-geometric features, thus opening the way to the integration of virtual biopsy in medical routine.

Classifying Breast Tumors in Digital Tomosynthesis by Combining Image Quality-Aware Features and Tumor Texture Descriptors

Digital breast tomosynthesis (DBT) is a 3D breast cancer screening technique that can overcome the limitations of standard 2D digital mammography. However, DBT images often suffer from artifacts stemming from acquisition conditions, a limited angular range, and low radiation doses. These artifacts have the potential to degrade the performance of automated breast tumor classification tools. Notably, most existing automated breast tumor classification methods do not consider the effect of DBT image quality when designing the classification models. In contrast, this paper introduces a novel deep learning-based framework for classifying breast tumors in DBT images. This framework combines global image quality-aware features with tumor texture descriptors. The proposed approach employs a two-branch model: in the top branch, a deep convolutional neural network (CNN) model is trained to extract robust features from the region of interest that includes the tumor. In the bottom branch, a deep learning model named TomoQA is trained to extract global image quality-aware features from input DBT images. The quality-aware features and the tumor descriptors are then combined and fed into a fully-connected layer to classify breast tumors as benign or malignant. The unique advantage of this model is the combination of DBT image quality-aware features with tumor texture descriptors, which helps accurately classify breast tumors as benign or malignant. Experimental results on a publicly available DBT image dataset demonstrate that the proposed framework achieves superior breast tumor classification results, outperforming all existing deep learning-based methods.

Deep learning model to predict Ki-67 expression of breast cancer using digital breast tomosynthesis.

Developing a deep learning (DL) model for digital breast tomosynthesis (DBT) images to predict Ki-67 expression. The institutional review board approved this retrospective study and waived the requirement for informed consent from the patients. Initially, 499 patients (mean age: 50.5years, range: 29-90years) referred to our hospital for breast cancer were participated, 126 patients with pathologically confirmed breast cancer were selected and their Ki-67 expression measured. The Xception architecture was used in the DL model to predict Ki-67 expression levels. The high Ki-67 vs low Ki-67 expression diagnostic performance of our DL model was assessed by accuracy, sensitivity, specificity, areas under the receiver operating characteristic curve (AUC), and by using sub-datasets divided by the radiological characteristics of breast cancer. The average accuracy, sensitivity, specificity, and AUC were 0.912, 0.629, 0.985, and 0.883, respectively. The AUC of the four subgroups separated by radiological findings for the mass, calcification, distortion, and focal asymmetric density sub-datasets were 0.890, 0.750, 0.870, and 0.660, respectively. Our results suggest the potential application of our DL model to predict the expression of Ki-67 using DBT, which may be useful for preoperatively determining the treatment strategy for breast cancer.

Task-based detectability in anatomical background in digital mammography, digital breast tomosynthesis and synthetic mammography

Objective. Determining the detectability of targets for the different imaging modalities in mammography in the presence of anatomical background noise is challenging. This work proposes a method to compare the image quality and detectability of targets in digital mammography (DM), digital breast tomosynthesis (DBT) and synthetic mammography. Approach. The low-frequency structured noise produced by a water phantom with acrylic spheres was used to simulate anatomical background noise for the different types of images. A method was developed to apply the non-prewhitening observer model with eye filter (NPWE) in these conditions. A homogeneous poly(methyl) methacrylate phantom with a 0.2 mm thick aluminium disc was used to calculate 2D in-plane modulation transfer function (MTF), noise power spectrum (NPS), noise equivalent quanta, and system detective quantum efficiency for 30, 50 and 70 mm thicknesses. The in-depth MTFs of DBT volumes were determined using a thin tungsten wire. The MTF, system NPS and anatomical NPS were used in the NPWE model to calculate the threshold gold thickness of the gold discs contained in the CDMAM phantom, which was taken as reference. Main results. The correspondence between the NPWE model and the CDMAM phantom (linear Pearson correlation 0.980) yielded a threshold detectability index that was used to determine the threshold diameter of spherical microcalcifications and masses. DBT imaging improved the detection of masses, which depended mostly on the reduction of anatomical background noise. Conversely, DM images yielded the best detection of microcalcification s. Significance. The method presented in this study was able to quantify image quality and object detectability for the different imaging modalities and levels of anatomical background noise.

Model-based deep CNN-regularized reconstruction for digital breast tomosynthesis with a task-based CNN image assessment approach

Objective. Digital breast tomosynthesis (DBT) is a quasi-three-dimensional breast imaging modality that improves breast cancer screening and diagnosis because it reduces fibroglandular tissue overlap compared with 2D mammography. However, DBT suffers from noise and blur problems that can lower the detectability of subtle signs of cancers such as microcalcifications (MCs). Our goal is to improve the image quality of DBT in terms of image noise and MC conspicuity. Approach. We proposed a model-based deep convolutional neural network (deep CNN or DCNN) regularized reconstruction (MDR) for DBT. It combined a model-based iterative reconstruction (MBIR) method that models the detector blur and correlated noise of the DBT system and the learning-based DCNN denoiser using the regularization-by-denoising framework. To facilitate the task-based image quality assessment, we also proposed two DCNN tools for image evaluation: a noise estimator (CNN-NE) trained to estimate the root-mean-square (RMS) noise of the images, and an MC classifier (CNN-MC) as a DCNN model observer to evaluate the detectability of clustered MCs in human subject DBTs. Main results. We demonstrated the efficacies of CNN-NE and CNN-MC on a set of physical phantom DBTs. The MDR method achieved low RMS noise and the highest detection area under the receiver operating characteristic curve (AUC) rankings evaluated by CNN-NE and CNN-MC among the reconstruction methods studied on an independent test set of human subject DBTs. Significance. The CNN-NE and CNN-MC may serve as a cost-effective surrogate for human observers to provide task-specific metrics for image quality comparisons. The proposed reconstruction method shows the promise of combining physics-based MBIR and learning-based DCNNs for DBT image reconstruction, which may potentially lead to lower dose and higher sensitivity and specificity for MC detection in breast cancer screening and diagnosis.

Development of an Intratumoral and Peritumoral Radiomics Nomogram Using Digital Breast Tomosynthesis for Preoperative Assessment of Lymphovascular Invasion in Invasive Breast Cancer

This study aimed to create a nomogram model that combines clinical factors with radiomics analysis of both intra- and peritumoral regions extracted from preoperative digital breast tomosynthesis (DBT) images, in order to develop a reliable method for predicting the lymphovascular invasion (LVI) status in invasive breast cancer (IBC) patients. A total of 178 patients were randomly split into a training dataset (N=124) and a validation dataset (N=54). Comprehensive clinical data, encompassing DBT features, were gathered for all cases. Radiomics features were extracted and selected from intra- and peritumoral region to establish radiomics signature (Radscore). To construct the clinical model and nomogram model, univariate and multivariate logistic regression analyses were utilized to identify independent risk factors. To assess and validate these models, various analytical methods were employed, including receiver operating characteristic (ROC) curve analysis, calibration curve analysis, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discriminatory improvement (IDI). The clinical model is constructed based on two independent risk factors: tumor margin and the DBT-reported lymph node metastasis (DBT_reported_LNM). Incorporating Radscore_Combine(utilizing both intra- and peritumoral radiomics features), tumor margin, and DBT_reported_LNM into the nomogram achieved a reliable predictive performance, with area under the curve (AUC) values of 0.906 and 0.905 in both datasets, respectively. The significant improvement demonstrated by the NRI and IDI indicates that the Radscore_Combine could be a valuable biomarker for effectively predicting the status of LVI. The nomogram demonstrated a reliable ability to predict LVI in IBC patients.

Atypical architectural distortion detection in digital breast tomosynthesis: a multi-view computer-aided detection model with ipsilateral learning

Objective. Breast architectural distortion (AD), a common imaging symptom of breast cancer, is associated with a particularly high rate of missed clinical detection. In clinical practice, atypical ADs that lack an obvious radiating appearance constitute most cases, and detection models based on single-view images often exhibit poor performance in detecting such ADs. Existing multi-view deep learning methods have overlooked the correspondence between anatomical structures across different views. Approach. To develop a computer-aided detection (CADe) model for AD detection that effectively utilizes the craniocaudal (CC) and mediolateral oblique (MLO) views of digital breast tomosynthesis (DBT) images, we proposed an anatomic-structure-based multi-view information fusion approach by leveraging the related anatomical structure information between these ipsilateral views. To obtain a representation that can effectively capture the similarity between ADs in images from ipsilateral views, our approach utilizes a Siamese network architecture to extract and compare information from both views. Additionally, we employed a triplet module that utilizes the anatomical structural relationship between the ipsilateral views as supervision information. Main results. Our method achieved a mean true positive fraction (MTPF) of 0.05–2.0, false positives (FPs) per volume of 64.40%, and a number of FPs at 80% sensitivity (FPs@0.8) of 3.5754; this indicates a 6% improvement in MPTF and 16% reduction in FPs@0.8 compared to the state-of-the-art baseline model. Significance. From our experimental results, it can be observed that the anatomic-structure-based fusion of ipsilateral view information contributes significantly to the improvement of CADe model performance for atypical AD detection based on DBT. The proposed approach has the potential to lead to earlier diagnosis and better patient outcomes.

Multiloss strategy for breast cancer subtype classification using digital breast tomosynthesis

AbstractBreast cancer is the most common cancer for women, and it also is the leading cause of cancer‐related deaths. As a highly heterogeneous disease, it is crucial to identify the molecular subtypes of breast cancer before individualized therapy. Therefore, we proposed a multiloss network framework to classify the breast cancer subtype based on digital breast tomosynthesis (DBT) images. We employed the multiloss strategy to learn the low‐level features more efficiently and effectively, which would provide a better basis for extracting the high‐level features. Additionally, we also proposed a decomposed attention block (DA), which not only captured the interdependencies between all channels but also the precise positional information at the x‐ and y‐dimensions. The multiloss strategy enables the network to learn useful feature representations of breast cancer subtypes, and the DA block further improves the classification performance by capturing the information between channels and positions.

Deep learning, radiomics and radiogenomics applications in the digital breast tomosynthesis: a systematic review

BackgroundRecent advancements in computing power and state-of-the-art algorithms have helped in more accessible and accurate diagnosis of numerous diseases. In addition, the development of de novo areas in imaging science, such as radiomics and radiogenomics, have been adding more to personalize healthcare to stratify patients better. These techniques associate imaging phenotypes with the related disease genes. Various imaging modalities have been used for years to diagnose breast cancer. Nonetheless, digital breast tomosynthesis (DBT), a state-of-the-art technique, has produced promising results comparatively. DBT, a 3D mammography, is replacing conventional 2D mammography rapidly. This technological advancement is key to AI algorithms for accurately interpreting medical images.Objective and methodsThis paper presents a comprehensive review of deep learning (DL), radiomics and radiogenomics in breast image analysis. This review focuses on DBT, its extracted synthetic mammography (SM), and full-field digital mammography (FFDM). Furthermore, this survey provides systematic knowledge about DL, radiomics, and radiogenomics for beginners and advanced-level researchers.ResultsA total of 500 articles were identified, with 30 studies included as the set criteria. Parallel benchmarking of radiomics, radiogenomics, and DL models applied to the DBT images could allow clinicians and researchers alike to have greater awareness as they consider clinical deployment or development of new models. This review provides a comprehensive guide to understanding the current state of early breast cancer detection using DBT images.ConclusionUsing this survey, investigators with various backgrounds can easily seek interdisciplinary science and new DL, radiomics, and radiogenomics directions towards DBT.

Diagnostic value of digital breast tomosynthesis and synthetic images in patients with breast cancer.

Different imaging techniques are used in the diagnosis of breast cancer. The low sensitivity of mammography to detect cancer in the dense breast parenchyma and the lack of standard application of digital breast tomosynthesis (DBT) are some of the problems. Therefore, breast cancer imaging techniques should be compared in terms of conspicuity and characterization of lesions. Full-field digital mammography (DM) and synthetic mammography (SM) which are obtained from the slices of digital breast tomosynthesis (DBT) give similar results in terms of conspicuity and characterization of the lesions in detecting breast cancer. In this retrospective study, 47 women diagnosed with breast cancer were included in the study. DM, SM, and DBT images were evaluated by scoring the conspicuity of the index lesion in the parenchyma and its characterization in terms of contour and shape with a 4-point scale. In addition, the conspicuity of the lesions in relation to lesion size and breast density was examined with these three techniques. There is no significant difference between DM and SM techniques for index lesion conspicuity and characterization; however, the imaging score of DBT is significantly higher than other techniques for the conspicuity and characterization of the lesions. In terms of the conspicuity of the lesions in relation to lesion size, DM and SM techniques show significant difference according to the size of the lesion, whereas the DBT technique did not show significant difference. While mammography type is a determinant of lesion conspicuity in only DM and SM techniques, conspicuity findings do not differ significantly in the DBT technique. In conclusion, it was shown that standard images and SM images obtained from DBT did not differ significantly in terms of conspicuity and characterization of lesions. Thus, DBT is significantly superior to the DM and SM images. While the DM and SM images are more successful in showing large lesions and lesion detection in nondense breasts, DBT images were not affected by lesion size and breast density.

Synthetic Mammography: Benefits, Drawbacks, and Pitfalls.

Digital breast tomosynthesis (DBT) allows three-dimensional assessment of breast tissue; however, DBT requires a two-dimensional (2D) image for comparison with prior mammograms and accurate interpretation of calcifications. Traditionally, full-field digital mammography (FFDM) has been performed after the DBT image acquisition. Synthetic mammography (SM), the 2D reconstruction of the tomosynthesis slice dataset, has been designed to replace FFDM. Advantages of SM include decreased image acquisition time and decreased radiation exposure, with maintained or improved screening performance metrics. Because SM algorithms give extra weight to lesion-like characteristics (eg, calcifications and architectural distortions), they may enable increased visibility of these characteristics relative to that at FFDM. Although SM algorithms were designed to improve lesion identification, they have led to varied outcomes in studies reported in the literature. Compared with FFDM, SM has been reported to be associated with a higher false-positive rate for calcifications, decreased conspicuity of asymmetries, lower breast density assessments, and imaging artifacts (eg, metallic artifact, bright-band artifact, blurring of the axilla, and truncation artifact). The authors review the literature on SM, including its implementation, benefits, and artifacts. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.

A new projection correction based voting strategy for breast calcification artifact reduction

Objective. Digital Breast Tomosynthesis (DBT) is an imaging technique that combines traditional tomography with image processing and reconstruction techniques. In screening for breast cancer, high attenuation lesion will cause calcification hardening artifacts, which reduces the reconstructed image quality and limits diagnostic accuracy. We focus on the reconstruction artifacts that are caused by high-attenuation features in DBT, and aim to propose an efficient and accurate method to remove calcification artifacts and retain calcification information. Approach. The proposed method first introduces a new segmentation method, which can segment breast calcification accurately and effectively. Then an interpolation method is used to eliminate both the calcified area and artifact area in the projection images which are then used to reconstruct the image without artifacts and calcifications. Finally, the interpolated reconstructed image and the unprocessed reconstructed image are fused under the proposed voting strategy to obtain the DBT image with calcification artifacts removal. Main results. 18 groups of simulated projection data and 10 groups of real projection data collected by us are used to evaluate the proposed method. Experimental results show that our algorithm can effectively reduce the calcification artifact and preserve the effective information in the image as well. Significance. The proposed method utilizes a novel projection correction based voting fusion strategy for image fusion, and is advanced in reducing breast calcification artifacts compared with other state-of-the-art methods. Our work paves the way for more efficient and precise DBT breast cancer screening.