DBT in Screening: Approaches to Reduce Reading Time
Digital breast tomosynthesis (DBT) is being intensively discussed for use European screening programs, while it’s already being widely adopted in the United States. Within DBT, reading time is of the essence and any effort to reduce it will be particularly important.
What do our clinical experts have to say?
Experts are describing a number of strategies for reducing the number of cases and images that need to be interpreted and are proposing various methods for decreasing the time required to interpret a case. Artificial intelligence is one of the latest developments that can reduce reading time and effort.
DBT in screening: Approaches to reduce reading time – Physicist’s perspective
DBT in screening: Approaches to reduce reading time – Radiologist’s perspective
Approaches to accelerating and standardize DBT reading in screening
DBT in screening: Approaches to reduce reading time
Chantal Van Ongeval; Leuven, Belgium – Radiologist’s view
Ioannis Sechopoulos; Nijmegen, The Netherlands – Medical Physicist’s view
Prospective trials have shown the improvement in detection performance of digital breast tomosynthesis (DBT) compared to mammography at screening. However, these trials have also repeatedly shown that reading a DBT stack takes about twice as long as it does to interpret a 2D mammography image. This is one of the major roadblocks for DBT to be introduced for use in screening programs.
However, many strategies to reduce DBT reading time are being investigated. Some trials have investigated acquiring only the medio-lateral oblique (MLO) view during screening. Other trials have estimated the impact on performance of single-reading DBT cases, as opposed to current standard double reading. The capabilities of artificial intelligence (AI) to identify suspicious cases could be used to avoid the human reading of normal cases. These strategies effectively reduce the number of images to be read. Alternative methods that have been proposed to read an individual case faster include the use of thick slabs instead of thin slices to represent the entire breast, and the use of the synthetic mammogram as a guide to determining which areas of the DBT stack to review. Finally, AI -assisted navigating and reading could also have a substantial impact on reading time.
All these strategies, their technical requirements, and their potential impact on reading efficiency and detection performance will be discussed. The current evidence and availability for incorporating some of them will be presented, while the remaining advances and trials that need to be performed to prove the efficiency and safety of the others will also be reviewed.
1. Describe the proposed strategies to reduce the number of cases and images that need to be interpreted.
2. Describe the methods proposed to decrease the time required to interpret a given case.
3. Discuss the remaining issues and future developments needed to implement these time-saving strategies in the clinic.