3 key findings from a new survey on synthetic mammography

Synthetic mammography (SM) can be used as a replacement for digital mammography (DM) during digital breast tomosynthesis (DBT), leading to a significant reduction in radiation dose. But are radiologists utilizing SM? What do they think about this fairly new technique?

A new survey published in the Journal of the American College of Radiology asked these questions, among others. The 20-question survey was sent to all active members of the Society of Breast Imaging in June 2018, with 312 members sending in a response. Ninety-six percent of respondents said DBT is available to them at their practice.

“A study performed shortly after FDA approval of SM in May 2013 found that although 59% of breast imagers reported having SM technology, only 24% were using SM instead of DM in DBT screening,” wrote lead author Samantha Zuckerman, MD, University of Pennsylvania in Philadelphia, and colleagues. “The purpose of this survey was to assess changing utilization patterns and attitudes among breast imagers regarding SM more than five years after FDA approval.”

These are three key takeaways from the team’s survey:

1. A majority of radiologists use SM at their practice

Overall, 83% of respondents are able to use SM at their practice, up considerably since that 2013 study following the initial FDA approval. Of the 17% who do not have access to SM, 32% said it was due to the costs associated with upgrading their equipment’s software. Another 32% said concerns about image quality were the main reason their practice had not embraced SM.

“SM technology is rapidly evolving; early iterations of the technology may have been perceived as having decreased quality by radiologists,” the authors wrote. “However, newer versions of SM have improved contrast, resolution, and increased spatial resolution with an appearance more similar to DM. As the technology improves and imaging units are upgraded, concerns over image quality will hopefully be alleviated.”

2. Radiologists are satisfied with SM—some more than others

Respondents reported an average overall satisfaction with SM of 3.4 out of 5. The number of screening examinations per year or practice type were not associated with any difference in satisfaction. However, users with less than one year of satisfaction had “much lower satisfaction” (2.9 out of 5) compared to those with more than one year of experience (3.5 out of 5).

“This indicates that there may be a learning curve in adopting the new technology and that with more experience, satisfaction with synthetic imaging may increase,” Zuckerman and colleagues wrote.

In addition, 31% of respondents report that they have see a decrease in recall rate, 33% said the recall rate has remained stable, 30% were unsure and 6% said there has been an increase. Regarding cancer detection rates, 21% reported that it has increased, 34% said it had remained stable, 44% were unsure and 1% said there has been a decrease.

3. A lower radiation dose the most cited advantage—by far—of SM use

While 85% of respondents cited the decreased radiation dose as an advantage of SM, lesion conspicuity (27%) and increased throughput (19%) were also common answers.

Fault calcification characterization, meanwhile was the top disadvantage, cited by 31% of respondents.