Quantitative analysis of radiation dosage and image quality between digital breast tomosynthesis (DBT) with two-dimensional synthetic mammography and full-field digital mammography (FFDM)


      • Digital breast tomosynthesis (DBT) is used adjunctively with conventional mammography.
      • DBT with 2D reconstructed image benefits in image quality and radiation exposure.
      • DBT may have potential as an alternative to conventional mammography.



      Currently in diagnostic setting for breast cancer, FFDM and DBT are performed conjunctively. However, performing two imaging modalities may increase radiation exposure by double. Two-dimensional reconstructed images created from DBT with 2DSM, has a potential to replace conventional FFDM in concerning both radiation dosage and image quality. With increasing concerns for individual radiation exposure, studies analyzing radiation dosage in breast imaging modalities are needed. This study compared radiation dosage and image quality between DBT + 2DSM versus FFDM.

      Methods and materials

      374 patients (mean age 52 years) who underwent both DBT and FFDM were retrospectively reviewed. Radiation dosage data were obtained by radiation dosage scoring and monitoring program Radimetrics (Bayer HealthCare, Whippany, NJ). Entrance dose and mean glandular doses in each breast were obtained for both modalities. To compare image quality of DBT + 2DSM and FFDM, a 5-point scoring system for lesion clarity was assessed. The parameters of radiation dosage (entrance dose, mean glandular dose) and image quality (lesion clarity scoring) were compared.


      For entrance dose, DBT had lower mean dosage (14.8 mGy) compared with FFDM (21.8 mGy, p-value < 0.0001). Mean glandular doses for both breasts were lower in DBT (Left 1.74, Right 2.1) compared with FFDM (Left 2.85, Right 2.74, p-value < 0.0001). Lesion clarity score was higher in DBT with 2DSM (mean score 4.03) compared with FFDM (3.82, p-value < 0.0001).


      DBT showed lower radiation entrance dose and mean glandular doses to both breasts compared with FFDM. DBT + 2DSM had better image quality than FFDM, suggesting that DBT with 2DSM has potential as an alternative to FFDM.


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        • Zuley
        • et al.
        Comparison of two-dimensional synthesized mammograms versus original digital mammograms alone and in combination with tomosynthesis images.
        Radiology. 2014; 271: 664-671
        • Peppard
        • et al.
        Digital breast tomosynthesis in the diagnostic setting: indications and clinical applications.
        Radiographics. 2015; 35: 975-990
        • Korhonen
        • et al.
        Strategies to increase cancer detection: review of true-positive and false-negative results at digital breast tomosynthesis screening.
        Radiographics. 2016; 36: 1954-1965
        • Roth
        • et al.
        Digital breast tomosynthesis: lessons earned from early clinical implementation.
        Radiographics. 2014; 34: E89-102
        • Helvie Mark A.
        Digital mammography imaging: breast tomosynthesis and advanced applications.
        Radiol Clin North Am. 2010; 48: 917-929
        • Rafferty
        • et al.
        Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial.
        Radiology. 2013; 266: 104-113
        • U.S. Food and Drug Administration
        Meeting of the Radiological Devices Advisory Panel. P080003/S001 Hologic Selenia Dimensions 3D system FDA Executive Summary.
        (Published October 24, 2012)
        • Paulis
        • et al.
        Radiation exposure of digital breast tomosynthesis using an antiscatter grid compared with full-field digital mammography.
        Invest Radiol. 2015; 50: 679-685
        • Dance
        • et al.
        Estimation of mean glandular dose for breast tomosynthesis: factors for use with the UK, European and IAEA breast dosimetry protocols.
        Phys Med Biol. 2011; 56: 453-471
        • Good
        • et al.
        Digital breast tomosynthesis: a pilot observer study.
        Am J Roentgenol. 2008; 190: 865-869
        • Svahn
        • et al.
        Review of radiation dose estimates in digital breast tomosynthesis relative to those in two-view full-field digital mammography.
        Breast. 2015; 24: 93-99
      1. Mammography Quality Standards Act of 1992. Public Law 102–539. As amended by the Mammography Quality Standards Reauthorization Act of 1998, Pub. L. No. 105248, Title 42, Subchapter II, Part F, Subpart 3, § 354 (42 USC 263b), Certification of Mammography Facilities n.d.

        • Bouwman
        • et al.
        Average glandular dose in digital mammography and digital breast tomosynthesis: comparison of phantom and patient data.
        Phys Med Biol. 2015; 60: 7893-7907
        • Zuckerman
        • et al.
        Implementation of synthesized two-dimensional mammography in a population-based digital breast tomosynthesis screening program.
        Radiology. 2016; 281: 730-736
        • Bernardi
        • et al.
        Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study.
        Lancet Oncol. 2016; 17: 1105-1113
        • Mariscotti
        • et al.
        Comparison of synthetic mammography, reconstructed from digital breast tomosynthesis, and digital mammography: evaluation of lesion conspicuity and BI-RADS assessment categories.
        Breast Cancer Res Treat. 2017; 166: 765-773