Strengths and Weaknesses of Synthetic Mammography in Screening

Abstract

Synthetic mammography (SM) consists of two-dimensional images reconstructed from digital breast tomosynthesis (DBT) data. Unlike standard full-field digital mammography (FFDM), SM does not require additional radiation exposure. SM is being introduced in breast imaging centers because early clinical data demonstrate that synthetic images are comparable to FFDM in cancer detection, positive predictive values, and recall rates. SM has completely replaced FFDM in some practices. Thus, an understanding of SM and its strengths and weaknesses compared with those of FFDM is essential. The artifacts of SM include blurring subcutaneous tissue, loss of resolution in the axilla on mediolateral oblique views, pseudocalcifications, and decreased resolution near foreign bodies (eg, biopsy markers). SM's strengths include a reduced radiation dose, shorter acquisition time compared with a combined FFDM/ DBT screening examination (with potentially less motion artifact), and increased conspicuity of calcifications, spiculated margins, and architectural distortion. The weaknesses of SM include the potential for false positives due to pseudocalcifications and the difficulty in assessing for motion artifact. This article reviews SM and its role in screening and presents clinical cases to highlight SM's strengths, weaknesses, and artifacts. © RSNA, 2017 • Abbreviations: CC = craniocaudal, DBT = digital breast tomosynthesis, FDA = Food and Drug Administration, FFDM = full-field digital mammography, MLO = mediolateral oblique, SM = synthetic mammography, 2D = two-dimensional

The threshold detectable mass diameter for 2D-mammography and digital breast tomosynthesis

“…A potential solution may lie in the use of synthetic imaging, which provides the generation of a synthesised 2D image from DBT data (and thus eliminating the use of 2Dmammography), and is available from some manufacturers. There are on-going studies on the use of synthetic imaging in screening [40][41][42][43] and the identification of its strengths and weaknesses [44].…”

Synthesized Mammography: Clinical Evidence, Appearance, and Implementation

“…If motion is present, the artifact seen with metal clips or calcifications will not be completely vertical, but instead will have a “zig-zag” appearance. Movement of the inframammary fold on the tomosynthesis projection images can also be a clue to patient motion [ 37 , 40 ].…”

Calcifications at Digital Breast Tomosynthesis: Imaging Features and Biopsy Techniques

“…A reduction of approximately 40%-50% in radiation dose is observed with DBT plus SM compared with that of the DBT plus FFDM screening protocol (12,17). Examination time is also reduced at DBT plus SM, as the FFDM acquisition time is no longer necessary (10).…”

“…First, portions of the DBT image acquisition are selected and combined. Second, computational algorithms generate a 2D image that simulates an FFDM view (10). A reduction of approximately 40%-50% in radiation dose is observed with DBT plus SM compared with that of the DBT plus FFDM screening protocol (12,17).…”