Johns Hopkins Medical Institutions, The Russell H. Morgan Department of Radiology and Radiological Science, 601 N. Wolfe Street, Baltimore, MD 21287, United States of America.
University of Arizona - Banner University Medical Center, 1609 N. Warren Ave, Tucson, AZ 85719, United States of America.
Clin Imaging. 2019 May-Jun;55:188-195. doi: 10.1016/j.clinimag.2018.07.013. Epub 2018 Sep 13.
Digital breast tomosynthesis (DBT) is a new technology that is being used more frequently for both breast cancer screening and diagnostic purposes and its utilization is likely to continue to increase over time. The major benefit of tomosynthesis over 2D-mammography is that it allows radiologists to view breast tissue using a three-dimensional dataset and improves diagnostic accuracy by facilitating differentiation of potentially malignant lesions from overlap of normal tissue. In addition, image processing techniques allow reconstruction of two dimensional synthesized mammograms (SM) from DBT data, which eliminates the need for acquiring two dimensional full field digital mammography (FFDM) in addition to tomosynthesis and thereby reduces the radiation dose. DBT systems incorporate a moveable x-ray tube, which moves in a prescribed way over a limited angular range to obtain three-dimensional data of patients' breasts, and utilize reconstruction algorithms. The limited angular range for DBT leads to incomplete sampling of the object, and a movable x-ray tube prolongs the imaging time, both of which make DBT and SM susceptible to artifacts. Understanding the etiology of these artifacts should help radiologists in reducing the number of artifacts and in differentiating a true finding from one related to an artifact, thus potentially decreasing recall rates and false positive rates. This is becoming especially important with increased incorporation of DBT in practices around the world. The goal of this article is to review the physics principles behind DBT systems and use these principles to explain the origin of artifacts that can limit diagnostic evaluation.
数字乳腺断层合成技术（DBT）是一种新的技术，越来越多地用于乳腺癌筛查和诊断目的，并且随着时间的推移，其应用可能会继续增加。与二维乳腺 X 线摄影相比，断层合成技术的主要优势在于它允许放射科医生使用三维数据集查看乳腺组织，并通过促进潜在恶性病变与正常组织重叠的区分来提高诊断准确性。此外，图像处理技术允许从 DBT 数据重建二维合成乳腺 X 线摄影（SM），从而消除了在断层合成术之外还需要获取二维全视野数字化乳腺 X 线摄影（FFDM）的需求，从而降低了辐射剂量。DBT 系统采用可移动的 X 射线管，以规定的方式在有限的角度范围内移动，以获得患者乳房的三维数据，并利用重建算法。DBT 的有限角度范围导致对物体的不完全采样，并且可移动的 X 射线管延长了成像时间，这两者都使 DBT 和 SM 容易出现伪影。了解这些伪影的病因有助于放射科医生减少伪影的数量，并区分真实发现与与伪影相关的发现，从而潜在地降低召回率和假阳性率。随着 DBT 在全球各地的应用越来越多，这一点变得尤为重要。本文的目的是回顾 DBT 系统背后的物理原理，并利用这些原理来解释可能限制诊断评估的伪影的起源。
