Digital breast tomosynthesis

About DBT , do check out note section also some of the slide contents are in the note section of slides this slide is made just as in intro of DBT

1. Digital Breast Tomosynthesis Presenter :- Yashawant ku . Yadav NAMS (Bir Hospital) Kathmandu , Nepal

2. Outlines Introduction to DBT Principle of dbt Equipment advancement Why dbt over ffdm / digital mammo Dose comparisons among mammography modalities Advancement with dbt in mammo screening Summary References

3. Introduction Digital Breast Tomosynthesis (DBT) is a   refine breast imaging technique that aims to remove the problem of overlapping fibroglandular tissue, improve lesion detection and characterization and help exclude the presence of a breast lesion when none is there.

4. Contd.. When screening mammograms demonstrate a questionable finding, the results of follow-up diagnostic mammography and ultrasonography (US), magnetic resonance (MR) imaging, or biopsy ultimately determine whether the finding is significant. The process causes anxiety for patients and incurs additional healthcare costs for findings that frequently are proved benign.

5. Contd.. Breast tomosynthesis is a new tool that can be expected to ameliorate(uplift) this problem by reducing or eliminating tissue overlap. Breast tomosynthesis technology is essentially a modification of a digital mammography unit to enable the acquisition of a three-dimensional (3D) volume of thin-section data. Images are reconstructed in conventional orientations by using reconstruction algorithms similar to those used in computed tomography (CT).

6. Principle DBT is based on decades old mathematical theory and combines FFDM, tomographic principles and reconstruction algorithms to produce multiple thin section images through the breast. This novel technique may reduce the number of women recalled and have improved sensitivity compared with FFDM

7. How to achieve = advancement Since the advent of DBT, multiple systems have been designed that vary in parameters such as geometry, gantry motion, scan angle, angular sampling and number of projections . The geometry of DBT systems is related to the path and relationship of the x-ray tube to the detector full isometric geometry Partial isometric geometry

8. Ganatry motion The x-ray tube can move in several ways, including in an arc, circular or linear sweep direction. Most DBT systems utilize an arc motion for the x-ray tube. Images may be acquired by different methods. These techniques include a step and shoot or continuous motion acquisition

9. Contd.. As a result, the overall radiation dose is maintained at an acceptable level similar to FFDM and well below the Mammography Quality and Standards Act The scan angle It is defined as the angular range between the first and last exposure that is acquired. It is typically from 15 to 50 degrees depending on the DBT device and manufacturer

10. Contd.. Furthermore, the scan angle angular sampling number of projections; i.e. number of projections=(scan angle/angular sampling)+1.

11. Why dbt over ffdm / digital mammo Increased sensitivity ? with DBT (compared to DM) indicates that DBT correctly identifies more breast cancers compared to other imaging modalities. ( 90%) Increased specificity? would indicate that DBT results in the correct dismissal of more women with normal or benign findings without the need for further work-up (i.e., a reduction in false positive recalls for further assessment). 79%

12. Contd.. DBT provides clear x, y, z coordinates from first imaging and improves localisation which contributes to faster biopsy time . Evaluation of a dense breast and lesion contour tomosynthesis is 15% more sensitive than MG in dense breasts. Reduces recall rates: this in turn decreases patient distress and screening program costs . Tomosynthesis lowers recall rates in 10%-30% when contrasted with digital MG. some studies report recall rate drops of up to 50%

13. Contd.. Findings suggest that tomosynthesis may decrease overdiagnosis. Disadvantages Cost of equipment Time investment: Microcalcification visualization:

14. Radiation dose in dbt Radiation dosage is a major concern for the International Commission on Radiological Protection (ICRP) due to potential risks of ionizing radiation in unauthorized doses. For a breast with a thickness of around 5 cm and 50% glandular fraction, tomosynthesis imaging only requires 8% more radiation than digital MG or analog MG (1.3 mGy and 1.2 mGy , respectively). Tomosynthesis is considered a safe procedure as radiation doses it requires are within parameters established by the Mammography Quality Standard Act

15. AI with dbt Artificial intelligent can be possible with the digital breast tomosynthesis. AI and deep learning are now being used to speed DBT interpretation time and improve reading workflow. These solutions become smarter and more adept at identifying cancer as they are trained on breast imaging data, automatically highlighting suspicious areas and enabling radiologists to focus on areas they should review more closely.

16. References https://www.itnonline.com/content/icad-receives-fda-clearance-powerlook-density-assessment-digital-breast-tomosynthesis https://www.icadmed.com/home.html

17. Thank you