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Screening Mammography with Tomosynthesis (DBT)

MammoNo contrastBreast

Indications

Asymptomatic screening, particularly dense breasts where overlapping tissue lowers 2D sensitivity
Reduces recall rate and increases cancer detection vs 2D alone
Routine screening at centers offering tomosynthesis

Patient prep

Same as 2D screening: no deodorant/powder/lotion
Obtain priors for comparison
Counsel that compression and positioning are similar to 2D

Contrast

None / non-contrast

Technique

At least two DBT acquisitions per breast (CC and MLO) — multiple low-dose projections over an arc reconstructed into thin slices
Paired with a correlative 2D image: either acquired standard 2D (DM) or synthesized 2D (SM/C-View) reconstructed from the tomo dataset
Synthesized 2D reduces total radiation dose compared to combined DM + DBT
Same compression and positioning standards as conventional mammography

Series / Sequences

#	Series / Sequence	Plane	Notes
1	CC bilateral DBT	Craniocaudal	Tomosynthesis slices + 2D (acquired or synthesized)
2	MLO bilateral DBT	Mediolateral oblique	Tomosynthesis slices + 2D (acquired or synthesized)

Key points

Scroll through slices to resolve summation artifact and detect architectural distortion
Synthesized 2D (C-View/Intelligent 2D) replaces acquired 2D to limit dose while retaining microcalcification display
Same BI-RADS assessment and density reporting as 2D
Especially valuable in heterogeneously/extremely dense breasts; lowers false-positive recalls

References

• ACR Practice Parameter for the Performance of Digital Breast Tomosynthesis (DBT)
• FDA MQSA (DBT systems accreditation)
• ACR BI-RADS Atlas, 5th ed.
• Radiopaedia: Digital breast tomosynthesis ( link

Source: Researched — verify against your institution

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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.