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• This is a general information tool for medical professionals and is not a
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protocol is appropriate. At all times, clinicians remain responsible for
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any kind resulting from your use of the information presented.
1
Introduction to 3D Mammography
(Breast Tomosynthesis)
Nomenclature
Shorthand
Definition
2D
Conventional digital mammography
3D
Tomosynthesis
2D plus 3D
A protocol where both digital mammograms
and tomosynthesis images are acquired (CC &
MLO for both modalities)
2D plus 3D MLO
A protocol where the two-view digital
mammogram (CC & MLO) and the
tomosynthesis MLO images are acquired
Talk Outline
• What is breast tomosynthesis?
• Why do breast tomosynthesis?
• How does breast tomosynthesis work?
• How do we use it clinically?
• Clinical examples
• What is its clinical performance?
• Summary of advantages
What is Breast Tomosynthesis?
• A method of imaging the breast in three dimensions
(3D)
• Image slices are 1 mm thick
• Image slices high resolution: like mammograms
Intended Use Statement
The Hologic Selenia Dimensions Digital Breast Tomosynthesis
System generates digital mammographic images that can be
used for screening and diagnosis of breast cancer. The Selenia
Dimensions system is intended for use in the same clinical
applications as Full Field Digital Mammography systems for
screening mammograms. Specifically, the Selenia Dimensions
system can be used to acquire two-dimensional full field digital
mammograms and three-dimensional tomosynthesis
mammograms. The screening examination will consist of a twodimensional image set or a two dimensional and
tomosynthesis image set. The Selenia Dimensions system may
also be used for additional diagnostic workup of the breast.
Mammography Limitations
• Prompt annual mammography has shown the ability to
reduce the mortality rate from breast cancer in a population
by 15% to 50%.1-3
• As many as 20% of breast cancers will be missed by
mammography.
• Approximately 10% of women are recalled for additional
workup and a significant portion prove to have no
abnormality, resulting in unnecessary anxiety and cost.
1.
2.
3.
Smith RA, Duffy SW, Gabe R et al. The randomized trials of breast cancer screening: what have we
learned? Radiol Clin N Am 42 (2004) 793 – 806
Hendrick RE, Smith RA, Rutledge JH, Smart CR. Benefit of screening mammography in women ages 4049: a new meta-analysis of randomized controlled trials. Monogr Natl Cancer Inst 1997;22:87-92.
Tabar L, Vitak B, Tony HH, Yen MF, Duffy SW, Smith RA. Beyond randomized controlled trials: organized
mammographic screening substantially reduces breast carcinoma mortality. Cancer 2001;91:1724-31
• A major factor contributing to the limited
performance of mammography is the tissue
superimposition that is created by the overlap of
normal breast structures in a two-dimensional
mammographic projection.
• These overlapping structures can obscure a lesion
making it more difficult to perceive or rendering it
completely mammographically occult.
Why Breast Tomosynthesis
(3D mammography)?
• Tissue superimposition hides
pathologies in 2D
• Tissue superimposition mimics
pathologies in 2D
3D Improves Visibility by Reducing Tissue
Superimposition
2D Mammogram
Tomosynthesis
Better Sensitivity
2D Mammogram
Tomosynthesis
Fewer Recalls
How Does Tomosynthesis Work?
13
14
3D Principle of Operation
Arc of motion of x-ray tube, showing
individual exposures
• X-ray tube moves in an
arc across the breast
• A series of low dose
images are acquired
from different angles
• Total dose
approximately the
same as one 2D
mammogram
• Projection images are
reconstructed into
1 mm slices
Reconstructed
Slices
{
Compression
Paddle
Compressed
Breast
Detector Housing
How is Tomosynthesis Used Clinically?
A collection of publications and presentations
documenting the uses and value of breast
tomosynthesis is available
Clinical Performance
1.
Andersson I, Ikeda DM, Zackrisson S, et al.
Breast Tomosynthesis and Digital
Mammography: A Comparison of Breast
Cancer Visibility and BIRADS Classification
in a Population of Cancers with Subtle
Mammographic Findings. Eur Radiology
18 (12): 2817-25
4
Michell M, et al. Digital Breast
Tomosynthesis: A Comparison of the
Accuracy of Digital Breast Tomosynthesis,
Two-Dimensional Digital Mammography and
Two-Dimensional Screening Mammography
(Film-Screen). Breast Cancer Research 2009,
11 (Suppl 2):01
2.
Gur D, Abrams GS, Chough DM, et al.
Digital Breast Tomosynthesis: Observer
Performance Study: AJR 2009; 193(2):
586-591.
3.
Kopans D, Moore R, Gavenonis S,
Calcification in Digital Breast
Tomosynthesis. Presented at RSNA 2008,
Session SSJ01-02 Breast Imaging
(digital/tomosynthesis)
5. Niklason L, Rafferty E, Smith A. Inter-Reader
Variability for the Decision to Recall and
BIRADS Characterization: Comparing Breast
Tomosynthesis Plus FFDM to FFDM Alone.
Presented at Duke Tomosynthesis Imaging
Symposium May 2009.
6. Poplack SP, Tosteson TD, Kogel CH, Nagy HM.
Digital Breast Tomosynthesis: Initial
Experience in 98 Women with Abnormal
Digital Screening Mammography. AJR 2007;
189(3): 616-623
Clinical Performance
7. Rafferty E, Niklason L., Comparison of FFDM
with Breast Tomosynthesis to FFDM Alone:
Performance in Fatty and Dense Breasts.
Presented at Duke Tomosynthesis Imaging
Symposium May 2009.
10. Teertstra HJ, Loo CE, van den Bosch MAAJ.
Breast Tomosynthesis in Clinical Practice:
Initial Results. Eur Radiology 2009 Aug 6.
{Epub ahead of print}
11. Zuley ML, et al. Time to Diagnosis and
8. EA, Niklason L, Halpern E et al. Assessing
Performance Levels During Repeat
Radiologist Performance Using Combined FullInterpretations of Digital Breast
Field Digital Mammography and Breast
Tomosynthesis. Acad Radiol 2010, Apr, 01:
Tomosynthesis Versus Full-Field Digital
17(4): 450-5
Mammography Alone: Results of a MultiCenter, Multi-Reader Trial. Presented at RSNA 12. Svahn T, Adersson I, et al. The Diagnostic
Accuracy of Dual-view Digital
2007, Session SSE26-02 Late Breaking
Mammography, Single-View Breast
Multicenter Clinical Trials
Tomosynthesis and a Dual-view
9. Rafferty EA, Niklason L, Jameson-Meehan L.,
Combination of Breast Tomosynthesis and
Breast Tomosynthesis: One View or Two?
Digital Mammography in a Free Response
Presented at RSNA 2006, Session SSG01-04
Observe Performance Study. Radiat Prot
Breast Imaging (digital/tomosynthesis.)
Dosimetry 2010, Apr, 01: 139(1-3): 113-7
2D Mammogram
Tomosynthesis
Better Sensitivity
2D Mammogram
Tomosynthesis
Fewer Recalls
Clinical Examples
Collected from six sites:
– MGH Boston MA USA
– Dartmouth Hitchcock Medical Center, Lebanon
NH USA
– University of Iowa, Iowa City, IA USA
– Magee Women’s Hospital, Pittsburgh PA USA
– AVL Cancer Hospital, Amsterdam Holland
Selenia Mammogram
Biopsy proven cancer
Selenia Tomosynthesis
Selenia Mammogram
Selenia Tomosynthesis
Mammographically occult biopsy proven
Selenia Mammogram
Selenia Tomosynthesis
Mammographically occult biopsy proven
Selenia Mammogram
Selenia Tomosynthesis
Benign. Superimposed parenchyma
Selenia Mammogram
Selenia Tomosynthesis
Benign. Superimposed parenchyma
Selenia Mammogram
Lesion not seen on mammogram
Selenia Tomosynthesis
Selenia Mammogram
Lesion not seen on mammogram
Selenia Tomosynthesis
Pooled ROC Curves
Thank You.
Images and data courtesy of:
Netherlands Cancer Institute – Antoni Van Leeuwenhoek Hospital, Amsterdam Holland
Massachusetts General Hospital, Boston MA USA
Centre de Radiologie et d’Echographie du Docteur Joussier, Paris France
Dartmouth Hitchcock Medical Center, Lebanon NH USA
Magee Women’s Hospital, Pittsburgh PA USA
University of Iowa Health Care, Iowa City IA USA
Yale University School of Medicine, New Haven CT USA