Recent advances in digital breast tomosynthesis (DBT) technology were focused on the reconstruction of 2D "Synthesized Mammograms" (SMs) from DBT dataset. The introduction of SMs could avoid an additional digital mammography (DM) which is often required in complement to DBT examinations. Therefore, breast absorbed dose and compression time can be significantly reduced in DBT+SM procedures with respect to DBT+DM modality. However, to date, a limited number of studies have objectively characterised the image quality of SMs with respect to DM images. Therefore, the aim of this phantom study was to comprehensively compare SMs and DM images in terms of several image quality parameters. A Selenia Dimensions system (Hologic, Bedford, Mass, USA) was employed in this work. Five different phantoms were adopted to study noise, contrast and spatial resolution properties of the images. Specifically, noise power spectrum (NPS), maps of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), modulation transfer function (MTF) and contrast-detail (CD) thresholds were evaluated both for SM and DM modalities. SMs were characterised by different texture, noise and SNR spatial distribution properties with respect to DM images. Additionally, while in some conditions SM provides higher CNR than DM, lower overall performances in terms spatial resolution and CD curves were found in comparison to DM images. Therefore, given the great benefits of SMs in terms of dose and compression time saving, further clinical investigations on SMs image quality properties could be of practical interest to integrate our findings.
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