Digital Breast Tomosynthesis Update

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

Breast Sonography: 0.25
Patient Care: 0.25
Patient Interactions and Management: 0.25

Mammography: 2.25
Image Production: 1.00
Image Acquisition and Quality Assurance: 1.00
Procedures: 1.25
Mammographic Positioning, Special Needs, and Imaging Procedures: 1.25

Magnetic Resonance Imaging: 0.25
Procedures: 0.25
Body: 0.25

Registered Radiologist Assistant: 1.00
Procedures: 1.00
Thoracic Section: 1.00

Sonography: 0.25
Procedures: 0.25
Superficial Structures and Other Sonographic Procedures: 0.25

Radiation Therapy: 0.25
Patient Care: 0.25
Patient and Medical Record Management: 0.25

Outline

1. Introduction
2. Current Scope
3. Screening Outcomes and Guidelines
   1. Cancer Detection Rates
   2. Mortality Benefit
   3. Multimodality Screening
   4. Screening Environment
   5. DBT Screening Guidelines
4. Diagnostic Outcomes and Guidelines
   1. Reducing Additional Views
   2. Positive Predictive Value of Biopsy
   3. Architectural Distortion
   4. Workflow Efficiency
   5. DBT Diagnostic Guidelines
5. Technical Considerations
   1. Synthetic Mammography
   2. Vendor Diversification
   3. Technical Innovations
6. DBT Lexicon
7. Conclusion

Objectives

Upon completion of this course, students will:

1. recall the year that DBT was initially approved by the U.S. Food and Drug Administration
2. list ongoing efforts to make improvements in DBT
3. explain the efforts made by DBT vendors to improve breast imaging systems
4. state the percentage of all accredited mammography units in the United States that had DBT capabilities by August 2020
5. recall the year that dedicated Current Procedural Terminology codes for DBT became available
6. interpret reference tables within the article to determine specific recall rates for digital mammography throughout different studies
7. state the ultimate goal of breast cancer screening
8. list the ways DBT helps detect different types of breast cancers
9. describe outcomes of early data regarding DBT
10. describe how tumors detected by DBT present
11. list the characteristics of true interval cancers
12. interpret data tables to determine the number of interval screening rounds performed in a given number of screening studies
13. list potential outcomes of the Tomosynthesis Mammographic Screening Trial
14. choose the imaging modality that is the most common supplemental modality used in women with dense breast tissue because of its wide availability
15. state the risk factor of developing breast cancer in women with extremely dense breasts as compared to women with fatty breasts
16. state how ultrasound screening after digital mammography can increase the cancer detection rate
17. differentiate between multiple breast cancer clinical trials and their outcomes
18. list the challenges associated with automated breast ultrasound
19. state what percent of cancers are not detected with ultrasound or mammography despite increased cancer detection with supplemental ultrasound in addition to mammography
20. state the sensitivity of magnetic resonance imaging in addition to digital mammography and ultrasound in the ACRIN 6666 trial
21. describe imaging developments that will help expand the role of magnetic resonance imaging in breast cancer screening
22. describe the cancer detection rates between Europe, Scandinavia, and the United States
23. be familiar with the National Comprehensive Cancer Network screening mammography recommendations
24. discuss how DBT has affected the need for additional views
25. describe how the use of DBT in the diagnostic setting has reduced the need for additional imaging and interventions
26. list the benefits of diagnostic examinations with DBT as compared with digital mammography
27. explain the likelihood of malignancy in lesions recommended for biopsy
28. state what imaging modality is best at demonstrating architectural distortions of the breast
29. compare study outcomes related to breast architectural distortion
30. discuss breast architectural distortion malignancy rates
31. explain the difference in interpretation time between DBT and digital mammography
32. discuss the current ACR appropriateness criteria in the United States for specific modality use in specific patient types
33. explain the purpose of synthetic mammography
34. list the FDA-approved DBT systems available in the United States
35. state the year that the DBT supplement to the 2013 ACR BI-RADS manual on mammography was published