DOI: 10.1148/rg.27si075511
Breast Tomosynthesis: Present Considerations and Future Applications1
Jeong Mi Park, MD,
Edmund A. Franken, Jr, MD,
Megha Garg, MD,
Laurie L. Fajardo, MD, and
Loren T. Niklason, PhD
1 From the Division of Breast Imaging and Intervention, Department of Radiology, University of Iowa Hospitals and Clinics, Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242-1082 (J.M.P., E.A.F., M.G., L.L.F.); and Hologic, Danbury, Conn (L.T.N.). Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received March 5, 2007; revision requested March 29 and received May 10; accepted May 15. Supported in part by Hologic. J.M.P. is a researcher with Hologic, and L.L.F. is a member of the board of directors of Hologic; all remaining authors have no financial relationships to disclose.
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Figure 1a. Basic technologic principles of breast tomosynthesis. (a, b) Schemas show how image data are acquired from various angles as the x-ray tube moves in an arc. Either the step-and-shoot method (a) or the continuous exposure method (b) may be used, and the detector may be moving or stationary during image acquisition. The 3D image data are subsequently reconstructed as conventional mammographic projections (craniocaudal, mediolateral oblique, and mediolateral views). (c, d) Diagrams show how different 3D image data acquired from different angles (c) are reconstructed to provide separate depiction of two overlapping structures located in different planes (d).
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Figure 1b. Basic technologic principles of breast tomosynthesis. (a, b) Schemas show how image data are acquired from various angles as the x-ray tube moves in an arc. Either the step-and-shoot method (a) or the continuous exposure method (b) may be used, and the detector may be moving or stationary during image acquisition. The 3D image data are subsequently reconstructed as conventional mammographic projections (craniocaudal, mediolateral oblique, and mediolateral views). (c, d) Diagrams show how different 3D image data acquired from different angles (c) are reconstructed to provide separate depiction of two overlapping structures located in different planes (d).
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Figure 1c. Basic technologic principles of breast tomosynthesis. (a, b) Schemas show how image data are acquired from various angles as the x-ray tube moves in an arc. Either the step-and-shoot method (a) or the continuous exposure method (b) may be used, and the detector may be moving or stationary during image acquisition. The 3D image data are subsequently reconstructed as conventional mammographic projections (craniocaudal, mediolateral oblique, and mediolateral views). (c, d) Diagrams show how different 3D image data acquired from different angles (c) are reconstructed to provide separate depiction of two overlapping structures located in different planes (d).
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Figure 1d. Basic technologic principles of breast tomosynthesis. (a, b) Schemas show how image data are acquired from various angles as the x-ray tube moves in an arc. Either the step-and-shoot method (a) or the continuous exposure method (b) may be used, and the detector may be moving or stationary during image acquisition. The 3D image data are subsequently reconstructed as conventional mammographic projections (craniocaudal, mediolateral oblique, and mediolateral views). (c, d) Diagrams show how different 3D image data acquired from different angles (c) are reconstructed to provide separate depiction of two overlapping structures located in different planes (d).
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Figure 2a. Photographs of the experimental breast tomosynthesis unit at the authors’ institution show the x-ray tube positioned at angles of –7.5° (a) and +7.5° (b), the angular range used during image data acquisition.
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Figure 2b. Photographs of the experimental breast tomosynthesis unit at the authors’ institution show the x-ray tube positioned at angles of –7.5° (a) and +7.5° (b), the angular range used during image data acquisition.
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Figure 3a. Comparison of screening mammography with breast tomosynthesis in a 57-year-old woman. (a) Digital mammogram shows a mass (arrows) in the lower outer part of the left breast. The mass is not clearly visible because of surrounding dense tissue. (b) Breast tomosynthesis image provides clearer depiction of the mass (arrows), which is well circumscribed. Because its US appearance remained stable for 2 years, the mass was considered benign. (See also Movie 1 at
radiographics.rsnajnls.org/cgi/content/full/27/S231/DC1.)
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Figure 3b. Comparison of screening mammography with breast tomosynthesis in a 57-year-old woman. (a) Digital mammogram shows a mass (arrows) in the lower outer part of the left breast. The mass is not clearly visible because of surrounding dense tissue. (b) Breast tomosynthesis image provides clearer depiction of the mass (arrows), which is well circumscribed. Because its US appearance remained stable for 2 years, the mass was considered benign. (See also Movie 1 at
radiographics.rsnajnls.org/cgi/content/full/27/S231/DC1.)
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Figure 4a. Fibrocystic changes and ductal hyperplasia without atypia in a 45-year-old woman with a palpable abnormality in the left breast. (a) Digital mammogram shows a barely visible mass, marked by a BB, in the lower outer part of the left breast. The mass is poorly depicted because of surrounding dense tissue. (b) Breast tomosynthesis image clearly shows the mass (arrows). (See also Movie 2 at
radiographics.rsnajnls.org/cgi/content/full/27/S231/DC1.) (c) US image shows a circumscribed hypoechoic mass. The diagnosis was established at US-guided core-needle biopsy.
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Figure 4b. Fibrocystic changes and ductal hyperplasia without atypia in a 45-year-old woman with a palpable abnormality in the left breast. (a) Digital mammogram shows a barely visible mass, marked by a BB, in the lower outer part of the left breast. The mass is poorly depicted because of surrounding dense tissue. (b) Breast tomosynthesis image clearly shows the mass (arrows).
(See also Movie 2 at radiographics.rsnajnls.org/cgi/content/full/27/S231/DC1.) (c) US image shows a circumscribed hypoechoic mass. The diagnosis was established at US-guided core-needle biopsy.
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Figure 4c. Fibrocystic changes and ductal hyperplasia without atypia in a 45-year-old woman with a palpable abnormality in the left breast. (a) Digital mammogram shows a barely visible mass, marked by a BB, in the lower outer part of the left breast. The mass is poorly depicted because of surrounding dense tissue. (b) Breast tomosynthesis image clearly shows the mass (arrows). (See also Movie 2 at
radiographics.rsnajnls.org/cgi/content/full/27/S231/DC1.) (c) US image shows a circumscribed hypoechoic mass. The diagnosis was established at US-guided core-needle biopsy.
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Figure 7a. Infiltrating ductal carcinoma and ductal carcinoma in situ in a 51-year-old woman with a lump in the right breast for 1 month. (a) Digital mammogram shows an irregularly shaped primary mass and accompanying microcalcifications (arrows). (b) Breast tomosynthesis image provides better depiction of accompanying architectural distortion and of the direction and extent of the microcalcifications (arrows). (See also Movie 5 at
radiographics.rsnajnls.org/cgi/content/full/27/S231/DC1.)
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Figure 7b. Infiltrating ductal carcinoma and ductal carcinoma in situ in a 51-year-old woman with a lump in the right breast for 1 month. (a) Digital mammogram shows an irregularly shaped primary mass and accompanying microcalcifications (arrows). (b) Breast tomosynthesis image provides better depiction of accompanying architectural distortion and of the direction and extent of the microcalcifications (arrows). (See also Movie 5 at
radiographics.rsnajnls.org/cgi/content/full/27/S231/DC1.)
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Figure 10a. Appearance of glandular tissue in the breast of a 45-year-old woman. Normal glandular tissues are more clearly depicted on the breast tomosynthesis image (arrows in a) than on the digital mammogram (b).
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Figure 10b. Appearance of glandular tissue in the breast of a 45-year-old woman. Normal glandular tissues are more clearly depicted on the breast tomosynthesis image (arrows in a) than on the digital mammogram (b).
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Figure 11a. Appearance of lactiferous ducts at screening mammography in a 53-year-old woman. Normal ducts are more prominently depicted on the breast tomosynthesis image (arrows in a) than on the digital mammogram (b).
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Figure 11b. Appearance of lactiferous ducts at screening mammography in a 53-year-old woman. Normal ducts are more prominently depicted on the breast tomosynthesis image (arrows in a) than on the digital mammogram (b).
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Figure 12a. Appearance of the breast parenchyma in a 40-year-old woman. (a) Single-section breast tomosynthesis image shows a parenchymal pattern of scattered fibroglandular tissue. (b) Digital mammogram shows heterogeneously dense parenchyma.
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Figure 12b. Appearance of the breast parenchyma in a 40-year-old woman. (a) Single-section breast tomosynthesis image shows a parenchymal pattern of scattered fibroglandular tissue. (b) Digital mammogram shows heterogeneously dense parenchyma.
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Figure 13a. Benign lesion in a 56-year-old woman. (a) Breast tomosynthesis image shows prominent architectural distortion, an apparent mass, and loosely grouped microcalcifications (arrows), features suggestive of malignancy. Although the 2D mammographic appearance (b) had been stable for many years, a core-needle biopsy was recommended on the basis of findings at tomosynthesis. The diagnosis established at pathologic analysis was ductal epithelial hyperplasia without atypia, fibrocystic change, ductal rupture with chronic inflammation, and microcalcifications.
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Figure 13b. Benign lesion in a 56-year-old woman. (a) Breast tomosynthesis image shows prominent architectural distortion, an apparent mass, and loosely grouped microcalcifications (arrows), features suggestive of malignancy. Although the 2D mammographic appearance (b) had been stable for many years, a core-needle biopsy was recommended on the basis of findings at tomosynthesis. The diagnosis established at pathologic analysis was ductal epithelial hyperplasia without atypia, fibrocystic change, ductal rupture with chronic inflammation, and microcalcifications.
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Copyright © 2007 by the Radiological Society of North America.
Breast tomosynthesis image shows a more exaggerated calcification-related artifact (arrow).