The impact on lesion detection via a multi-vendor study: A phantom-based comparison of digital mammography, digital breast tomosynthesis, and synthetic mammography.

Purpose: The aim of this study is to perform a test object-based comparison of the imaging performance of digital mammography (DM), digital breast tomosynthesis (DBT), and synthetic mammography (SM).

Methods: Two test objects were used, the CDMAM and the L1-structured phantom. Small-detail detectability was assessed using CDMAM and the microcalcification simulating specks in the L1-structured background. Detection of spiculated and non-spiculated mass-like objects was assessed using the L1 phantom. Six different systems were included: Amulet Innovality (Fujifilm), Senographe Pristina (GEHC), 3Dimensions (Hologic), Giotto Class (IMS), Clarity 2D/3D (Planmed), and Mammomat Revelation (Siemens). Images were acquired under automatic exposure control (AEC) and at adjusted levels of AEC/2 and 2 × AEC level. Threshold gold thickness (T ) was established for the 0.13-mm-diameter CDMAM discs. Threshold diameters for the calcifications (d ), the spiculated masses (d ), and for the non-spiculated masses (d ) were established. The threshold condition was defined as the thickness or diameter for a 62.5% correct score.

Results: T for DM was generally superior to DBT, which in turn was superior to SM, but for most systems, these differences between modes were not significant. For L1, no significant differences in d were found between DM and DBT. The increase in d from DM to SM at AEC dose was 1%, 19%, 11%, 14%, 46%, and 27% for the Fujifilm, GEHC, Hologic, IMS, Planmed, and Siemens, respectively, indicating significantly poorer performance for all vendors except for Fujifilm, Hologic, and IMS. For both mass types, DBT performed better than SM, while SM showed no significant difference with DM (except for Fujifilm spiculated masses). The dose had an impact on small-detail detectability for both phantoms but did not influence the detection of either mass type.

Conclusions: Both phantoms indicated potentially reduced small-detail detectability for SM versus DM and DBT and should therefore not be used in stand-alone mode. The L1 phantom demonstrated no significant difference in microcalcification detection between DM and DBT and also demonstrated the superiority of DBT, compared to DM for mass detection, for all six systems.