Digital Tomosynthesis

Digital Tomosynthesis: Medical Imaging with 3D Precision

Digital tomosynthesis (DT) is an imaging technique that combines X-rays and computer algorithms to create detailed, 3D images from multiple 2D projections. It’s particularly useful in mammography and orthopedic imaging, offering improved lesion visibility and reduced tissue overlap compared to traditional X-rays.

Digital Tomosynthesis

Overview

Digital tomosynthesis (DT) is a cutting-edge imaging technique that has emerged as a powerful tool in the field of medical diagnostics. This article explores the technical intricacies of digital tomosynthesis, exploring its principles, advantages, and applications. From the fundamental concepts to the advanced technologies that drive this imaging modality, in this article by Academic Block we will uncover the inner workings of digital tomosynthesis and its impact on medical imaging, making it a valuable tool in various medical specialties, including radiology, oncology, and orthopedics.

1. Overview of Digital Tomosynthesis

Digital tomosynthesis is an advanced form of tomography, a technique that captures cross-sectional images of the human body. The word “tomosynthesis” is derived from the Greek words “tomos,” meaning section or slice, and “synthesis,” meaning the process of combining. In essence, digital tomosynthesis synthesizes three-dimensional images from a series of two-dimensional X-ray projections, providing a clearer and more detailed view of the internal structures.

2. Principles of Digital Tomosynthesis

2.1 X-ray Source and Detector: At the core of digital tomosynthesis is the use of X-rays to capture images of the human body. An X-ray source emits a controlled dose of ionizing radiation, which passes through the body and is detected by a specialized image receptor. The detector records the intensity of the X-rays that traverse the body, generating a two-dimensional projection image.

2.2 Tube Movement: Unlike traditional X-ray imaging, where the X-ray source and detector remain stationary, digital tomosynthesis introduces controlled movement of the X-ray tube and detector. This movement is typically an arc or linear motion, allowing for the acquisition of multiple projection images from different angles.

2.3 Image Reconstruction: The acquired projection images are then processed through a reconstruction algorithm to generate a three-dimensional image dataset. The reconstruction process involves combining the information from various projections to create sectional images, revealing internal structures with improved clarity and detail.

3. Technical Components of Digital Tomosynthesis

3.1 Detector Technology: Digital tomosynthesis relies on advanced detector technologies to capture high-quality projection images. Flat-panel detectors, which consist of amorphous silicon or amorphous selenium, are commonly used in modern digital tomosynthesis systems. These detectors offer high spatial resolution and sensitivity to X-rays, contributing to the overall image quality.

3.2 X-ray Tube: The X-ray tube is a critical component of digital tomosynthesis systems. It produces a controlled and focused X-ray beam that penetrates the patient’s body. Modern X-ray tubes are designed to deliver consistent and adjustable radiation doses, ensuring optimal image quality while minimizing patient exposure.

3.3 Motion Control System: The controlled movement of the X-ray tube and detector is facilitated by a precision motion control system. This system ensures smooth and accurate motion, allowing the acquisition of projection images from various angles. The synchronization between the X-ray tube and detector movement is crucial for successful image reconstruction.

3.4 Reconstruction Algorithms: Sophisticated algorithms play a key role in the reconstruction of three-dimensional images in digital tomosynthesis. Iterative reconstruction algorithms, such as filtered back projection and algebraic reconstruction technique (ART), are commonly employed to enhance image quality and reduce artifacts. These algorithms optimize the utilization of acquired projection data to reconstruct detailed and accurate sectional images.

4. Advantages of Digital Tomosynthesis

4.1 Improved Image Quality: One of the primary advantages of digital tomosynthesis is the superior image quality it offers compared to traditional two-dimensional X-ray imaging. By capturing images from different angles and reconstructing them into a three-dimensional dataset, digital tomosynthesis provides a more comprehensive and detailed view of anatomical structures.

4.2 Reduced Overlapping Structures: In conventional X-ray imaging, overlapping structures can hinder the interpretation of images, leading to potential diagnostic challenges. Digital tomosynthesis minimizes this issue by selectively focusing on specific planes of interest, reducing the overlap of structures and improving the visibility of abnormalities.

4.3 Lower Radiation Dose: Digital tomosynthesis allows for the optimization of radiation dose delivery to the patient. By tailoring the X-ray beam to the region of interest and utilizing advanced reconstruction algorithms, digital tomosynthesis achieves diagnostic image quality with a lower radiation dose compared to traditional computed tomography (CT) scans.

4.4 Dynamic Imaging Capability: Unlike static two-dimensional images, digital tomosynthesis enables dynamic imaging by capturing sequential images over a specific period. This capability is particularly valuable in applications such as musculoskeletal imaging, where the assessment of joint movement and function is essential for accurate diagnosis and treatment planning.

5. Mathematical equations behind the Digital Tomosynthesis

The mathematical equations behind digital tomosynthesis involve principles from computed tomography (CT) and are based on the process of reconstructing three-dimensional images from a series of two-dimensional projections. The most common mathematical technique used for this purpose is filtered back projection. Here, I’ll provide an overview of the mathematical concepts involved:

Projection Equation: The projection equation describes how a two-dimensional projection image (P) is formed from a three-dimensional object (f) by the action of the X-ray system. Mathematically, this can be represented as:

P(θ,s) = −∞ f(x,y) ds ;

Where:

      • P(θ,s) is the projection image at angle θ and distance ss from the rotation axis.
      • f(x,y) is the attenuation coefficient of the object at position (x,y).
      • The integral is taken along the X-ray path.

Filtered Back Projection: The process of back projection involves the reconstruction of the three-dimensional object from its two-dimensional projections. This is done by reversing the projection process, and filtering is applied to improve image quality. Mathematically, the filtered back projection can be expressed as:

f(x,y) = 0π [ (1/s) −∞ P(θ,s) cos⁡(θ − θ0) dθ] ds ;

Where:

      • f(x,y) is the reconstructed image.
      • P(θ,s) is the measured projection image.
      • θ0 is the angle of the X-ray beam.
      • The double integral is performed over all angles θ and distances ss.

Iterative Reconstruction: Iterative reconstruction methods are also used in digital tomosynthesis, where the reconstruction process involves an iterative optimization algorithm. Algebraic Reconstruction Technique (ART) and simultaneous algebraic reconstruction technique (SART) are examples of iterative methods. Mathematically, the iterative reconstruction process can be written as:

Update x(k+1) = x(k) + λ AT{b − A x(k)} ;

Where:

      • x(k) is the reconstructed image at iteration k.
      • A is the system matrix representing the imaging geometry.
      • b is the measured projection data.
      • λ is a relaxation parameter.

Filtered Sinogram: In the case of digital tomosynthesis, the data is often represented in the form of a sinogram, and filtering is applied to this sinogram before back projection. The filtered sinogram (P(θ,s)) can be expressed as:

P′(θ,s) = Filter{P(θ,s)} ;

The choice of filter (e.g., Ram-Lak, Hann) depends on the desired characteristics of the reconstructed image.

These mathematical equations represent the foundational principles behind digital tomosynthesis image reconstruction. The specific implementation may vary depending on the system design and the reconstruction algorithm employed. Advanced techniques, such as statistical iterative reconstruction and model-based iterative reconstruction, are also being explored to further improve image quality and reduce radiation dose.

6. Applications of Digital Tomosynthesis

6.1 Breast Imaging: Digital tomosynthesis has become a game-changer in breast imaging, offering a more detailed and nuanced view of breast tissue compared to traditional mammography. In breast tomosynthesis, the technique enhances the detection of subtle lesions, reduces the impact of overlapping structures, and provides a more accurate assessment of breast abnormalities.

6.2 Orthopedic Imaging: Orthopedic applications of digital tomosynthesis include the evaluation of musculoskeletal conditions, such as fractures, joint disorders, and spinal abnormalities. The ability to visualize anatomical structures in three dimensions aids orthopedic surgeons in treatment planning and ensures a more comprehensive understanding of the patient’s condition.

6.3 Pulmonary Imaging: Digital tomosynthesis is increasingly employed in pulmonary imaging to assess lung conditions and abnormalities. The technique offers improved visualization of lung nodules, better differentiation of pulmonary structures, and reduced interference from overlapping tissues, making it a valuable tool in the diagnosis of respiratory disorders.

6.4 Dentomaxillofacial Imaging: In dentistry and maxillofacial imaging, digital tomosynthesis provides detailed three-dimensional views of the teeth and facial structures. This is particularly beneficial for the assessment of dental fractures, temporomandibular joint disorders, and implant planning, offering dentists and oral surgeons enhanced diagnostic capabilities.

7. Challenges and Future Directions

7.1 Limited Soft Tissue Contrast: While digital tomosynthesis excels in visualizing bony structures, its ability to differentiate soft tissues is somewhat limited compared to other imaging modalities such as magnetic resonance imaging (MRI). Ongoing research aims to enhance soft tissue contrast in digital tomosynthesis through advanced reconstruction techniques and improved detector technologies.

7.2 Integration with Artificial Intelligence: The integration of artificial intelligence (AI) in digital tomosynthesis is an area of active exploration. AI algorithms have the potential to streamline image interpretation, assist in lesion detection, and optimize reconstruction processes. Future developments may see the convergence of digital tomosynthesis with AI, leading to more efficient and accurate diagnostic workflows.

7.3 Continued Technological Advancements: The field of digital tomosynthesis is dynamic, with continuous technological advancements aimed at further improving image quality, reducing radiation dose, and expanding its applications. Innovations in detector technology, motion control systems, and reconstruction algorithms are expected to drive the evolution of digital tomosynthesis in the coming years.

Final Words

Digital tomosynthesis represents a significant advancement in medical imaging, offering three-dimensional insights that enhance diagnostic accuracy across various medical specialties. From its fundamental principles involving X-ray sources and detectors to the technical components of motion control systems and reconstruction algorithms, digital tomosynthesis has revolutionized the way healthcare professionals visualize and interpret medical images.

In this article we have seen that as the ongoing research and technological developments continue to shape the landscape of digital tomosynthesis, the potential for further improvements in image quality, diagnostic applications, and integration with artificial intelligence remains promising. The journey from two-dimensional to three-dimensional imaging has opened new horizons in medical diagnostics, and digital tomosynthesis stands at the forefront of this transformative evolution. Please provide your comments below, it will help us in improving this article. Thanks for reading!

This Article will answer your questions like:

+ What is Digital Tomosynthesis and how does it produce three-dimensional images? >

Digital Tomosynthesis is a technique that produces three-dimensional images by acquiring multiple X-ray projections of an object from different angles. Unlike traditional X-ray imaging, which produces a single two-dimensional image, Digital Tomosynthesis reconstructs slices or sections of the object, providing depth information and enhancing visualization of structures that may overlap in conventional X-ray images. This method uses digital processing to reconstruct the images, allowing radiologists to scroll through the slices and focus on specific planes of interest, improving diagnostic accuracy and reducing the need for additional imaging studies.

+ How does Digital Tomosynthesis differ from conventional X-ray imaging and CT? >

Digital Tomosynthesis differs from conventional X-ray imaging by capturing multiple images from different angles and reconstructing them into slices or sections, providing three-dimensional information. In contrast, conventional X-ray produces a single two-dimensional image of overlapping structures. Digital Tomosynthesis offers advantages similar to CT (Computed Tomography) in visualizing cross-sectional anatomy but with lower radiation exposure and cost. Unlike CT, it does not fully surround the patient, making it less suitable for comprehensive imaging of complex anatomical regions or detailed soft tissue characterization.

+ What are the key principles behind the acquisition and reconstruction in Digital Tomosynthesis? >

Digital Tomosynthesis acquires X-ray projections from multiple angles around the patient. These projections are digitally processed to reconstruct cross-sectional slices or sections of the imaged anatomy. The acquisition involves moving the X-ray tube and detector in synchronization, capturing images at different angles along an arc or linear path. Reconstruction algorithms then combine these projections to create a series of tomographic slices that can be viewed individually or as a sequence. This method enhances visualization of anatomical structures and improves diagnostic accuracy by reducing overlapping structures compared to traditional X-ray imaging.

+ How is Digital Tomosynthesis used in medical imaging for diagnostic purposes? >

Digital Tomosynthesis is used in medical imaging to diagnose various conditions by providing detailed three-dimensional views of anatomical structures. It is particularly valuable in orthopedics for visualizing fractures and joint abnormalities with improved clarity and reduced artifacts compared to traditional X-rays. In pulmonary imaging, it aids in detecting and characterizing lung nodules and abnormalities by enhancing the visibility of overlapping structures. Digital Tomosynthesis also supports diagnostic evaluations in dental imaging and mammography, offering enhanced visualization of complex anatomical features and reducing the need for additional imaging studies.

+ What types of anatomical areas and conditions benefit from Digital Tomosynthesis? >

Digital Tomosynthesis benefits anatomical areas and conditions that require detailed visualization of complex structures and precise localization of abnormalities. It is particularly effective in orthopedics for imaging joints and bones, allowing for accurate assessment of fractures, alignment issues, and joint disorders. In pulmonary imaging, Digital Tomosynthesis aids in detecting lung nodules and assessing pulmonary conditions with improved sensitivity compared to conventional X-rays. Dental and breast imaging also benefit from Digital Tomosynthesis by providing enhanced views of dental structures and breast tissue, supporting early detection of lesions and improving diagnostic confidence.

+ How does the imaging geometry and detector movement enhance image quality? >

The imaging geometry in Digital Tomosynthesis involves moving the X-ray tube and detector in synchronization around the patient. This movement captures images from different angles, reducing overlapping structures and improving spatial resolution. By acquiring multiple projections along an arc or linear path, Digital Tomosynthesis reconstructs cross-sectional slices with enhanced clarity and detail. Detector movement ensures that each projection covers a specific angle, optimizing image acquisition for different anatomical regions and conditions. This dynamic approach minimizes artifacts and enhances image quality, allowing radiologists to visualize subtle anatomical features and pathological changes more accurately.

+ What role does iterative reconstruction play in improving Digital Tomosynthesis images? >

Iterative reconstruction in Digital Tomosynthesis improves image quality by reducing noise and artifacts, enhancing diagnostic accuracy and visualization of anatomical structures. Unlike traditional filtered back projection, iterative reconstruction algorithms iteratively refine image reconstruction by incorporating statistical models and prior knowledge of tissue characteristics. This approach compensates for incomplete data and improves spatial resolution, especially in low-dose imaging scenarios. Iterative reconstruction enhances image sharpness and detail, enabling radiologists to interpret subtle anatomical features and abnormalities with greater confidence, thereby optimizing diagnostic outcomes and patient care in clinical settings.

+ How is Digital Tomosynthesis applied in orthopedics and pulmonary imaging? >

Digital Tomosynthesis is applied in orthopedics to visualize joints and bones with enhanced clarity, facilitating accurate diagnosis of fractures, arthritis, and musculoskeletal conditions. By reconstructing cross-sectional images, it provides orthopedic surgeons and radiologists with detailed views of bone structures and joint alignments, aiding in treatment planning and monitoring. In pulmonary imaging, Digital Tomosynthesis improves the detection and characterization of lung nodules, consolidations, and other pulmonary abnormalities. It enhances sensitivity compared to conventional X-rays by reducing overlapping structures and offering multiple views of the lungs, supporting early diagnosis and management of pulmonary diseases.

+ What are the advantages of using Digital Tomosynthesis for reducing artifacts and improving spatial resolution? >

Digital Tomosynthesis reduces artifacts and improves spatial resolution by acquiring multiple X-ray projections from different angles and reconstructing them into cross-sectional slices. This dynamic approach minimizes superimposition of structures seen in conventional X-rays, enhancing visibility of subtle anatomical details and pathology. By reducing artifacts such as bone overlap or tissue shadowing, Digital Tomosynthesis provides clearer images with improved spatial resolution, enabling radiologists to detect small lesions, assess bone fractures, and evaluate soft tissue abnormalities more accurately. This advanced imaging technique enhances diagnostic confidence and patient care, particularly in orthopedics, pulmonary medicine, and other clinical specialties.

+ How does Digital Tomosynthesis compare to MRI and PET in clinical applications? >

Digital Tomosynthesis offers advantages over MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography) in certain clinical applications due to its lower cost, faster imaging time, and reduced complexity. While MRI and PET provide detailed soft tissue contrast and functional information, Digital Tomosynthesis excels in imaging skeletal structures, pulmonary nodules, and other dense anatomical areas with enhanced spatial resolution. It is particularly valuable in orthopedics for visualizing bone fractures and joint conditions, and in pulmonary medicine for detecting and characterizing lung abnormalities. However, MRI and PET remain superior for soft tissue evaluation and functional imaging tasks where detailed anatomical and metabolic information is critical.

+ What are the limitations and radiation exposure considerations in Digital Tomosynthesis? >

One limitation of Digital Tomosynthesis is its relatively higher radiation dose compared to traditional X-ray imaging, though it is lower than CT scans. Radiologists must balance the diagnostic benefits with potential radiation risks, particularly in pediatric and sensitive patient populations. Another consideration is the limited field of view and inability to capture comprehensive images of large anatomical regions, unlike CT. Moreover, artifacts such as motion blur or incomplete projections can affect image quality, requiring careful patient positioning and technique optimization. Continuous advancements in dose reduction strategies and imaging technology aim to minimize these limitations, improving safety and diagnostic efficacy in clinical practice.

+ How are Digital Tomosynthesis images interpreted and reported by radiologists? >

Digital Tomosynthesis images are interpreted and reported by radiologists using specialized viewing software that allows them to scroll through reconstructed slices or sections. Radiologists analyze the images for anatomical abnormalities, fractures, and other pathologies by assessing the clarity, contrast, and spatial relationships of structures within each slice. They compare findings with previous imaging studies and clinical data to formulate diagnostic impressions and recommendations for patient management. Reporting involves documenting findings in detailed radiology reports, providing referring physicians with actionable information for treatment planning and follow-up care, ensuring comprehensive and accurate communication of diagnostic results.

Hardware and software required for Digital Tomosynthesis

Hardware Components:
  1. X-ray Source: A high-quality X-ray tube capable of producing controlled and focused X-ray beams is a fundamental component.
  2. Detector: Flat-panel detectors, typically based on amorphous silicon or amorphous selenium technology, are commonly used in modern digital tomosynthesis systems. These detectors capture the transmitted X-rays to create projection images.
  3. Tube and Detector Motion Control System: Precision motion control systems are essential for controlled movement of the X-ray tube and detector during image acquisition. This motion is typically an arc or linear motion, allowing the acquisition of multiple projection images from different angles.
  4. Patient Support System: A platform or table on which the patient is positioned for imaging. The support system may allow controlled movement to optimize the imaging process.
  5. Image Reconstruction Hardware: High-performance computational hardware is required to execute the complex reconstruction algorithms. This can include dedicated processors or GPUs (Graphics Processing Units) capable of handling the computational load efficiently.
  6. Display System: High-resolution medical-grade displays are used by radiologists to interpret and analyze the reconstructed digital tomosynthesis images.
  7. Power Supply and Cooling Systems: The X-ray source and other components generate heat and require appropriate cooling systems. Additionally, a stable power supply is crucial for consistent performance.
Software Components:
  1. Acquisition Software: Software that controls the X-ray source, detector, and motion control system during the image acquisition process. It may also include features for adjusting imaging parameters.
  2. Reconstruction Software: Algorithms for processing and reconstructing two-dimensional projection images into three-dimensional datasets. Common techniques include filtered back projection and iterative reconstruction.
  3. Image Processing Software: Tools for enhancing and optimizing the quality of reconstructed images. This may include noise reduction, contrast adjustment, and other image enhancement techniques.
  4. Viewer Software: Software for viewing and interpreting digital tomosynthesis images. It should allow radiologists to navigate through the reconstructed datasets and analyze them in detail.
  5. Integration with PACS (Picture Archiving and Communication System): Integration with PACS allows for the storage, retrieval, and distribution of digital tomosynthesis images within the healthcare enterprise.

Key Figures behind Digital Tomosynthesis

The origins of tomosynthesis can be traced to the work of Dr. G.N. Hounsfield, who is often regarded as one of the pioneers of computed tomography (CT) imaging. In the early 1970s, Hounsfield and his colleague Dr. A.M. Cormack developed the mathematical principles that laid the foundation for CT scanning, a technique that produces detailed cross-sectional images of the body.

While Hounsfield’s work focused on CT, tomosynthesis, in various forms, began to emerge in subsequent years. Digital tomosynthesis, as it is known today, has evolved with advancements in digital imaging technology and computational techniques.

In the context of digital breast tomosynthesis (DBT), which is a specific application of digital tomosynthesis used in breast imaging, Dr. Per Skaane, a Norwegian radiologist, and Dr. László Tabár, a Swedish radiologist, made significant contributions to its development. Their work in the 1990s and early 2000s helped establish the feasibility and benefits of using tomosynthesis in breast imaging.

Facts on Digital Tomosynthesis

Principle of Operation: Digital tomosynthesis involves capturing a series of X-ray projections from different angles as the X-ray tube and detector move in controlled motion. These projections are then reconstructed into a series of cross-sectional images, providing a three-dimensional view of the imaged anatomy.

Evolution from Analog Tomosynthesis: Tomosynthesis has its roots in analog tomosynthesis, which used conventional film-based imaging. The transition to digital tomosynthesis brought significant improvements in image quality, accessibility, and the ability to manipulate and store digital images.

Applications in Breast Imaging: Digital tomosynthesis is widely used in breast imaging, particularly in mammography. It helps overcome limitations of traditional mammography by reducing overlapping breast tissue, improving lesion visibility, and providing better characterization of suspicious findings.

Reduced Radiation Dose: Compared to traditional computed tomography (CT), digital tomosynthesis typically involves a lower radiation dose. This makes it a preferred option for certain imaging applications where repeated scans may be necessary.

Orthopedic Applications: Digital tomosynthesis is utilized in orthopedic imaging for evaluating musculoskeletal conditions, such as fractures, joint disorders, and spinal abnormalities. Its ability to provide detailed views of bony structures aids in diagnosis and treatment planning.

Dynamic Imaging Capability: Digital tomosynthesis allows for dynamic imaging by capturing sequential images over time. This capability is valuable in applications where the assessment of movement, such as joint dynamics, is critical for diagnosis.

Improved Lesion Detection: In breast imaging, digital tomosynthesis has demonstrated improved detection of lesions, especially in dense breast tissue. The technique enhances the visualization of subtle abnormalities that might be challenging to identify in traditional mammography.

Integration with 3D Printing: The three-dimensional datasets generated by digital tomosynthesis can be integrated with 3D printing technology. This integration facilitates the creation of physical models for surgical planning and education.

Ongoing Research and Development: The field of digital tomosynthesis is dynamic, with ongoing research focused on improving image quality, developing advanced reconstruction algorithms, and expanding its applications. Researchers are also exploring the integration of artificial intelligence for image analysis.

Combination with Other Modalities: Digital tomosynthesis is sometimes used in combination with other imaging modalities, such as ultrasound or magnetic resonance imaging (MRI), to provide a more comprehensive assessment of certain conditions.

Digital Tomosynthesis in Lung Imaging: Digital tomosynthesis is finding applications in pulmonary imaging for assessing lung conditions. It offers advantages in visualizing lung nodules, improving differentiation of pulmonary structures, and reducing interference from overlapping tissues.

Academic References on Digital Tomosynthesis

  1. Niklason, L. T., Christian, B. T., Niklason, L. E., Kopans, D. B., Castleberry, D. E., Opsahl-Ong, B. H., … & Wirth, R. F. (1997). Digital tomosynthesis in breast imaging. Radiology, 205(2), 399-406.
  2. Yaffe, M. J., & Mainprize, J. G. (2014). Digital tomosynthesis: technique. Radiologic Clinics, 52(3), 489-497.
  3. Dobbins III, J. T., McAdams, H. P., Godfrey, D. J., & Li, C. M. (2008). Digital tomosynthesis of the chest. Journal of thoracic Imaging, 23(2), 86-92.
  4. Alakhras, M., Bourne, R., Rickard, M., Ng, K. H., Pietrzyk, M., & Brennan, P. C. (2013). Digital tomosynthesis: a new future for breast imaging?. Clinical radiology, 68(5), e225-e236.
  5. Vedantham, S., Karellas, A., Vijayaraghavan, G. R., & Kopans, D. B. (2015). Digital breast tomosynthesis: state of the art. Radiology, 277(3), 663-684.
  6. Friedewald, S. M., Rafferty, E. A., Rose, S. L., Durand, M. A., Plecha, D. M., Greenberg, J. S., … & Conant, E. F. (2014). Breast cancer screening using tomosynthesis in combination with digital mammography. Jama, 311(24), 2499-2507.
  7. Dobbins III, J. T., & Godfrey, D. J. (2003). Digital x-ray tomosynthesis: current state of the art and clinical potential. Physics in medicine & biology, 48(19), R65.
  8. Skaane, P., Bandos, A. I., Eben, E. B., Jebsen, I. N., Krager, M., Haakenaasen, U., … & Gullien, R. (2014). Two-view digital breast tomosynthesis screening with synthetically reconstructed projection images: comparison with digital breast tomosynthesis with full-field digital mammographic images. Radiology, 271(3), 655-663.
  9. Godfrey, D. J., Yin, F. F., Oldham, M., Yoo, S., & Willett, C. (2006). Digital tomosynthesis with an on-board kilovoltage imaging device. International Journal of Radiation Oncology* Biology* Physics, 65(1), 8-15.
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