Digital Breast Tomosynthesis—Concepts and Clinical Practice

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 27, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Mammography: 2.00
Image Production: 1.00
Image Acquisition and Quality Assurance: 1.00
Procedures: 1.00
Anatomy, Physiology, and Pathology: 0.50
Mammographic Positioning, Special Needs, and Imaging Procedures: 0.50

Outline

1. Introduction
2. Screening Outcomes
   1. Cancer Detection Rate
   2. Recall Rate
   3. False-Negative and Interval Cancer Rates
3. Advantage of DBT in Lesion Evaluation
   1. Lesion Localization
   2. Lesion Conspicuity
   3. Calcifications
   4. Architectural Distortion
   5. Asymmetries
   6. Masses
   7. Cancer Conspicuity according to View
4. Practice Considerations
   1. Decreased Mammographic Workup
   2. SM Examination
   3. Use of the Breast Imaging Reporting and Data System with DBT
   4. Tomosynthesis-guided Biopsy
   5. Biopsy Rates and PPV3
   6. Reimbursement and Cost Considerations
5. Dense Breast and Supplemental Screening
6. Future of DBT Imaging
7. Conclusion

Objectives

Upon completion of this course, students will:

1. recall the x-ray tube arc range for DBT image acquisition
2. describe the benefits of a larger angular range of the x-ray tube during DBT
3. describe the length of acquisition and interpretation time associated with DBT
4. state the standard of care for both screening and diagnostic breast imaging
5. give the cancer detection range when digital breast tomosynthesis plus FFDM is utilized as a screening tool
6. list the findings from the Kim et al study
7. describe how prospective and retrospective DBT studies have demonstrated lower recall rates
8. interpret data regarding retrospective U.S. study comparisons
9. define false-negative as it pertains to mammographic screening
10. give the alternative name for reconstructed image stacks associated with DBT
11. recall the first step when locating the nipple in DBT reconstructed images
12. state whether a narrow or wide arc of the x-ray tube in DBT gives the thinnest reconstructed section
13. list the factors that may compromise the resolution of each individual calcification in DBT
14. recall the study that evaluated calcification conspicuity and found no significant difference between synthesized mammography and FFDM alone or with DBT
15. describe why it is important to assess for motion during DBT acquisition if imaging with DBT plus synthetic mammography is performed without FFDM
16. state the most commonly missed abnormality in interval cancers
17. recall the study that found a positive predictive value for biopsies performed of 26% for architectural distortions that were otherwise occult at FFDM and ultrasound
18. state when additional breast imaging should be performed when architectural distortion is seen only with DBT imaging
19. tell which modality should be considered the next step if there is a suspicion of distortion even if visualized on only one view at DBT
20. list types of benign fatty breast masses
21. list the assessment factors for malignant fat containing lesions seen at DBT
22. state the type of breast cancer that is more commonly seen only on one view due to field of view limitation
23. describe the DBT view in which studies have shown cancers to be more conspicuous
24. describe the study in which cancers were significantly more conspicuous on the craniocaudal view than on the mediolateral oblique view with both FFDM and DBT
25. list the two views needed for a complete breast screening evaluation
26. discuss the study that found FFDM spot compression views to provide no more diagnostic value over those with DBT imaging
27. give the number of women involved in the Tomosynthesis Assessment Clinic Trial
28. discuss the efficiency of DBT
29. list the limitations of DBT plus FFDM
30. list the pitfalls and artifacts associated with synthetic mammography
31. provide an alternate name for bright-band artifact
32. state what BI-RADS stands for
33. list the outcomes of the Raghu et al study
34. state the recommendations for BI-RADS category 3 follow-up
35. recall the outcome of the Schrading et al study
36. state the year in which the Ambinder et al study took place
37. list the advantages of DBT guidance for biopsy
38. state the year when the Centers for Medicare and Medicaid Services approved DBT without copayment for screening indications
39. list the main drivers of economic value in implementing DBT at the population level
40. list potential indirect cost savings for patients receiving DBT