By Dr. Michael Yuz

Medical imaging is an ever-evolving discipline. And it isn’t uncommon that, with innovation and technical advances, what’s old is new again. Keep your eye on the ball!

A case in point is tomosynthesis. Long after its introduction, the modality gained prominence as digital breast tomosythesis (DBTS) in breast cancer screening in 2011. Today, with continued evolution, its use is growing significantly for a wide range of additional clinical applications. Many believe that DTS may just be poised to replace X-ray as the most commonly used imaging modality worldwide for many of these new use cases.
What is so notable about DTS? While DTS relies on an X-ray tube and image receptor, unlike conventional 2D X-ray, DTS is a volumetric modality. It yields far greater information than conventional X-ray, without the cost, mechanical and operational complexities as well as radiation exposure of 3D CT. Helping it along is a recent effort to broaden the modality’s accessibility with delivery through a medical scanning as a service (MSaaS) model. This pay-per-scan fee structure eliminates capital equipment expenditures, which is greater than for X-ray, addressing one of the barriers that prevent some practices from adopting the imaging technique.

The DTS MSaaS offering also includes an optional cloud-based teleradiology service using experts in the modality. This eliminates learning curves and allows specialists of every stripe to offer this advanced imaging in-house when needed to boost patient care.

Tomosynthesis: Historical overview
A refresher course: The roots of tomosynthesis date back to the 1930s and geometric tomography. Early tomography devices were an effort to compensate for a major shortcoming of conventional X-ray: projecting a 3D volume on a 2D plane, which superimposes underlying and overlying structures on the region-of-interest and potentially obscures clinically important information. To compensate, early tomography relied on the simultaneous movement of the X-ray tube and detector around a designated point in the patient being imaged. The result was a slice image that sharpened the details of structures closest to the detector, while blurring those further away.

During the years that followed, the advent of the digital detector enabled faster and more sophisticated image capture. New, powerful computers also supported reconstruction of multiple image slices that could be used to synthesize any coronal plane in the body, providing physicians with far greater clinical information.

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