Digital Breast Tomosynthesis—Imaging and Biopsy of Calcifications

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: 2.25
Image Production: 0.75
Image Acquisition and Quality Assurance: 0.75
Procedures: 1.50
Anatomy, Physiology, and Pathology: 0.75
Mammographic Positioning, Special Needs, and Imaging Procedures: 0.75

Registered Radiologist Assistant: 0.75
Procedures: 0.75
Thoracic Section: 0.75

Outline

1. Introduction
2. DBT and Synthesized Mammography
3. DBT for Screening
   1. Screening Protocols
4. Diagnostic Performance of DBT in the Detection of Breast Cancer
5. Calcifications and Breast Cancer
6. Types of Breast Calcifications
   1. Benign Calcifications
   2. Probably Benign Calcifications
   3. Suspicious Calcifications
   4. Distribution
7. Calcification Artifacts at DBT
8. Clinical Performance of DBT in the Detection of Breast Calcifications
   1. DBT versus FFDM
   2. DBT Plus FFDM versus FFDM Alone
   3. SM versus FFDM
   4. Calcification Conspicuity
9. DBT-guided Biopsy
10. Future Directions for DBT
11. Conclusion

Objectives

Upon completion of this course, students will:

1. state the cancer mortality reduction percentage achieved with screening mammography
2. list the patients best served by FFDM
3. explain the advantages of DBT over FFDM
4. describe how the x-ray tube moves in DBT
5. compare radiation dose protocols between DBT and FFDM
6. recall the factors that affect the range of breast radiation dose at DBT
7. state what synthesized mammograms are created from
8. compare the approximate reduction in radiation does that is observed with DBT plus synthesized mammography as compared to DBT plus FFDM
9. describe how DBT for breast cancer screening improves sensitivity and specificity over the use of FFDM
10. compare screening protocols for DBT plus FFDM versus DBT alone
11. discuss the combined techniques for increasing sensitivity and specificity of breast cancer screening
12. list the screening trials that compare the use of DBT combined with FFDM to the use of FFDM alone
13. list how invasive and in situ breast cancers can manifest
14. describe how calcification morphology is classified
15. describe how benign calcifications are seen at mammography
16. know the BI-RADS category for benign calcifications
17. describe the appearance of skin calcifications
18. recognize typically benign versus suspicious morphology related to breast calcifications
19. describe the appearance of vascular calcifications
20. describe rim calcifications
21. recall how lesions with a less than 2 percent likelihood of malignancy are classified
22. state the interval follow-up for calcifications detected at baseline screening mammography that have a probably benign appearance
23. list the morphologic descriptions for suspicious calcifications
24. list how calcification distribution can be described
25. describe artifacts most frequently related to calcifications
26. recall how shadow artifacts appear on synthesized mammograms
27. choose the study that included 99 cases of malignant calcifications in order to compare their detection between DBT and FFDM
28. state which trial had similar sensitivities when comparing digital breast imaging plus FFDM with FFDM alone in the detection of malignant calcifications
29. give the performance percentage of DBT plus synthesized mammography in the detection of malignant calcifications as seen in the TOMMY trial
30. list the factors that may cause lower spatial resolution at DBT
31. compare the pros and cons of the use of DBT for diagnosing breast calcifications
32. list the challenges of stereotactic biopsy
33. discuss why conventional stereotactic breast biopsy is still needed
34. describe patient position for DBT-guided breast biopsy
35. choose which trial will compare DBT and FFDM screening protocols with the objective of determining which is the best screening modality