Study finds radiologists easily transition to 3D mammography

Radiologists can quickly transition to using three-dimensional mammograms from traditional two-dimensional images, yielding benefits in interpreting studies and in patient care.

A study indicates that radiologists who interpret traditional mammograms require little preparation or training in order to make the transition to reading digital breast tomosynthesis (DBT, which uses 3D mammography) with improved screening accuracy.

Those are among the findings of a study conducted at UC Davis, published in Radiology, a professional journal, which reported on expected transition challenges for radiologists juxtaposed against benefits of the new mammography technology.

UC Davis researchers found that radiologists recalled patients for additional testing at a lower rate on DBT than they did on 2D mammography, without any noticeable decline in cancer detection. A patient may be recalled if a screening examination is interpreted to show a suspicious finding that requires follow-up imaging and possibly biopsy to determine if it is cancer.

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Three-dimensional views taken as part of a DBT screening help the radiologist confirm that some findings on traditional two-dimensional images are not cancer, and as a result, fewer patients have to be recalled. These improvements were seen regardless of the patient’s breast density—patients with high breast density traditionally have been more difficult to screen for breast cancer, particularly at its earliest stages, when treatment is more effective and survival rates are highest.

“We found that patients with or without dense breasts benefit from lower recall rates with 3D mammography, and there is no trade off with cancer detection,” says Diana Miglioretti, dean’s professor of biostatistics in the UC Davis Department of Public Health Sciences, who led the study. “In fact, we were surprised to find that improvements in recall rates were larger in women without dense breasts.”

DBT takes multiple X-ray images of each breast from many angles, which are then computer assembled into a three-dimensional image of the breast that the radiologist can scroll through. The Food and Drug Administration requires only eight hours of additional training for qualified radiologists to be able to interpret DBT studies.

“We found both breast imaging subspecialists and general radiologists improved their screening performance when they switched from 2D to 3D mammography,” Miglioretti says. “These improvements were sustained for at least two years after adoption of the new technology.”

Most women in the U.S. do not have their mammograms interpreted by a breast imaging subspecialist, nor do they have access to academic medical centers. The study evaluated radiologists with a mix of experience at both academic and nonacademic facilities. Both breast imaging subspecialists and general radiologists improved their interpretive performance quickly after adopting DBT, with lower recall rates and similar cancer detection rates as for digital mammography.

The study included data from 104 radiologists from 53 facilities in five states, collected by the Breast Cancer Surveillance Consortium to evaluate whether radiologists experience a learning curve in transitioning to use 3D mammography. The study is the largest of its kind and represented a broad range of radiology centers and providers. It is novel because it tracked radiologists’ performance over time as they transitioned from digital mammography to DBT.