Digital Breast Tomosynthesis Indications and Applications

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Mammography: 2.50
Image Production: 1.00
Image Acquisition and Quality Assurance: 1.00
Procedures: 1.50
Anatomy, Physiology, and Pathology: 0.75
Mammographic Positioning, Special Needs, and Imaging Procedures: 0.75

Outline

1. Introduction
2. DBT Technology
3. Indications for DBT
   1. Lesion Visibility
   2. Reader Performance and Preferences
   3. Replacement for Traditional Supplemental Imaging
4. Contraindications for DBT
5. Practical Use of DBT in Diagnostic Workup
   1. Assessment of Noncalcified Cancers
      1. Architectural Distortion
      2. Focal Asymetry
      3. Masses
   2. Localization of Single-View Findings
   3. Breast Cancer Staging
      1. Tumor Size
      2. Number of Tumor Lesions or Satellite Lesions
      3. Evaluation of the Contralateral Breast
6. Potential Limitations and Drawbacks
7. Conclusion

Objectives

Upon completion of this course, students will:

1. list the reasons for performing diagnostic mammography
2. relate alternate terminology for pseudolesions
3. describe the x-ray tube movement during digital breast tomosynthesis
4. state what DBTCANNOT be used for
5. recall the thickness of reconstructed DBT post-acquisition images
6. define combination acquisition mode
7. list the advantages of combination acquisition mode imaging
8. compare outcomes for the Dang et al. study
9. state recommended number of views for diagnostic DBT
10. describe how infiltrating invasive lobular carcinoma presents at mammogram
11. compare DBT vs. conventional diagnostic mammography in reader studies
12. discuss study findings relative to the potential of DBT to replace other imaging modalities
13. determine which study examined diagnostic workflow
14. list the outcomes of the Philpotts et al. study
15. state workflow improvements as readers become more familiar with DBT technology
16. describe the relative bell curve for DBT accuracy
17. state the effect of DBT in regard to number of lesions classified at BI-RADS category 3
18. explain the compression time needed for combination-mode DBT
19. compare the imaging features of breast cancer for DBT versus conventional mammography
20. relate the importance of identifying architectural distortion at diagnostic mammography
21. describe architectural distortion as it presents at mammography
22. list factors associated with the appearance of architectural distortion
23. state the types of scars that manifest as architectural distortion
24. describe focal asymmetry
25. define asymmetry
26. list how DBT can be utilized for the evaluation of focal asymmetry
27. list how breast masses are characterized
28. compare mass margins, shape, and density between DBT and FFDM
29. name the tissue that comprises the majority of the breast
30. state how breast masses should be evaluated
31. describe the angle used for MLO views of the breast
32. describe how image sets are arranged for DBT
33. state how known or suspected lesions are examined at mammogram
34. note the prevalence of contralateral breast disease for women with newly diagnosed breast cancer
35. state the desired compression breast thickness for DBT