X-ray tomosynthesis: a review of its use for breast and chest imaging

Tomosynthesis is a three-dimensional imaging technique based on the reconstruction of several planar radiographs. During the image acquisition in tomosynthesis, the X-ray tube moves around the detector which is often stationary, and a number of projection images are taken from different angles. Individual slices from the reconstructed volume can be studied. With the effective reduction of the visibility of the overlapping normal tissue, the detection of pathological lesions is improved when compared with projection radiography. Up to now, tomosynthesis has mainly been used for breast and chest examinations and, to some extent, also for orthopaedic, angiographic and dental investigations. For chest, tomosynthesis is used as an alternative to computed tomography with significantly lower cost and radiation dose to the patient. Breast tomosynthesis has, in several studies, proved to be an effective tool for improving detection of breast lesions. As tomosynthesis has many properties that make it suitable as a modality for screening, including good diagnostic performance, short examination time and low radiation dose, it is a strong competitor to the current gold standard breast screening modality, i.e. mammography. In this paper, the principles of tomosynthesis will be presented as well as a few clinical studies showing the potential role of tomosynthesis in clinical routine examinations.