Implementation of Digital Breast Tomosynthesis Into Clinical Practice

Introduction

The limitations of conventional digital mammography have been well established. Conventional mammography creates a two-dimensional (2D) image of a three-dimensional (3D) structure, which may result in superimposition of normal tissue and obscuration of lesions. This influences cancer detection and leads to high screening recall rates and false-positive findings. Conventional 2D mammography is particularly limited in dense breast tissue, and cancer detection is as low as 48% in women with extremely dense breast tissue.

Digital breast tomosynthesis is being increasingly adopted in breast imaging centers around the world, largely due to early clinical studies demonstrating this technology’s ability to address many of the limitations of conventional mammography. Due to improved diagnostic performance, it is expected that tomosynthesis will eventually become the standard of care in breast imaging facilities, and thus every facility will ultimately be faced with the task of incorporating the technology into practice. This presents a challenge, as to date there is limited guidance regarding how to best implement the technology, nor are there standard guidelines for the clinical use of tomosynthesis. In this chapter, we will discuss experience with the adoption and implementation of the tomosynthesis technology into the clinical practice setting, with perspectives from both a large private practice and a tertiary academic hospital setting.