ArticleRadiology2019
Digital Breast Tomosynthesis: Radiologist Learning Curve.
Abstract readEvaluation StudyMulticenter Study
In one paragraph
Article in Radiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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13citing papers in PubMed
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Who cites it
13 citing papers in PubMed.
- Variability Among Radiologists in Interpreting Low-Dose CT Lung Cancer Screens.Journal of the American College of Radiology : JACR · 2026Article
- Diagnostic Management Pathways for Workup of Abnormal Screening With Digital Mammography Versus Digital Breast Tomosynthesis.Journal of the American College of Radiology : JACR · 2025Article
- Article
- National Performance Benchmarks for Screening Digital Breast Tomosynthesis: Update from the Breast Cancer Surveillance Consortium.Radiology · 2023Article
- Article
- Cumulative Probability of False-Positive Results After 10 Years of Screening With Digital Breast Tomosynthesis vs Digital Mammography.JAMA network open · 2022Observational
- Comparative Effectiveness of Digital Breast Tomosynthesis for Breast Cancer Screening Among Women 40-64 Years Old.Journal of the National Cancer Institute · 2021Observational
- Trade-Offs Between Harms and Benefits of Different Breast Cancer Screening Intervals Among Low-Risk Women.Journal of the National Cancer Institute · 2021Article
- Diagnostic accuracy of contrast-enhanced digital mammography in breast cancer detection in comparison to tomosynthesis, synthetic 2D mammography and tomosynthesis combined with ultrasound in women with dense breast.The British journal of radiology · 2021Article
- Comparative Access to and Use of Digital Breast Tomosynthesis Screening by Women's Race/Ethnicity and Socioeconomic Status.JAMA network open · 2021Article
- Multicenter Evaluation of Breast Cancer Screening with Digital Breast Tomosynthesis in Combination with Synthetic versus Digital Mammography.Radiology · 2020Article
- Screening Performance of Digital Breast Tomosynthesis vs Digital Mammography in Community Practice by Patient Age, Screening Round, and Breast Density.JAMA network open · 2020Article
- Digital Breast Tomosynthesis: Update on Technology, Evidence, and Clinical Practice.Radiographics : a review publication of the Radiological Society of North America, IncArticle
Corrections and comments
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Authors and funding
10 authors.
Diana L MigliorettiFrom the Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, One Shields Ave, Med Sci 1C, Room 144, Davis, CA 95616 (D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., L.A., D.S.M.B.); Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Department of Radiology (S.D.H.) and Department of Surgery, Office of Health Promotion Research (B.L.S.), Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vt; Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (A.N.A.T.); and Departments of Medicine andEpidemiology and Biostatistics and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, Calif (K.K.).ORCID 0000-0002-5547-1833
Linn AbrahamFrom the Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, One Shields Ave, Med Sci 1C, Room 144, Davis, CA 95616 (D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., L.A., D.S.M.B.); Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Department of Radiology (S.D.H.) and Department of Surgery, Office of Health Promotion Research (B.L.S.), Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vt; Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (A.N.A.T.); and Departments of Medicine andEpidemiology and Biostatistics and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, Calif (K.K.).ORCID 0000-0002-0840-1947
Christoph I LeeFrom the Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, One Shields Ave, Med Sci 1C, Room 144, Davis, CA 95616 (D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., L.A., D.S.M.B.); Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Department of Radiology (S.D.H.) and Department of Surgery, Office of Health Promotion Research (B.L.S.), Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vt; Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (A.N.A.T.); and Departments of Medicine andEpidemiology and Biostatistics and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, Calif (K.K.).ORCID 0000-0002-8185-7721
Diana S M BuistFrom the Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, One Shields Ave, Med Sci 1C, Room 144, Davis, CA 95616 (D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., L.A., D.S.M.B.); Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Department of Radiology (S.D.H.) and Department of Surgery, Office of Health Promotion Research (B.L.S.), Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vt; Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (A.N.A.T.); and Departments of Medicine andEpidemiology and Biostatistics and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, Calif (K.K.).ORCID 0000-0001-5408-2804
Sally D HerschornFrom the Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, One Shields Ave, Med Sci 1C, Room 144, Davis, CA 95616 (D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., L.A., D.S.M.B.); Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Department of Radiology (S.D.H.) and Department of Surgery, Office of Health Promotion Research (B.L.S.), Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vt; Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (A.N.A.T.); and Departments of Medicine andEpidemiology and Biostatistics and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, Calif (K.K.).ORCID 0000-0002-9193-6490
Brian L SpragueFrom the Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, One Shields Ave, Med Sci 1C, Room 144, Davis, CA 95616 (D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., L.A., D.S.M.B.); Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Department of Radiology (S.D.H.) and Department of Surgery, Office of Health Promotion Research (B.L.S.), Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vt; Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (A.N.A.T.); and Departments of Medicine andEpidemiology and Biostatistics and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, Calif (K.K.).ORCID 0000-0001-7948-8317
Louise M HendersonFrom the Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, One Shields Ave, Med Sci 1C, Room 144, Davis, CA 95616 (D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., L.A., D.S.M.B.); Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Department of Radiology (S.D.H.) and Department of Surgery, Office of Health Promotion Research (B.L.S.), Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vt; Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (A.N.A.T.); and Departments of Medicine andEpidemiology and Biostatistics and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, Calif (K.K.).ORCID 0000-0001-8356-9267
Anna N A TostesonFrom the Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, One Shields Ave, Med Sci 1C, Room 144, Davis, CA 95616 (D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., L.A., D.S.M.B.); Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Department of Radiology (S.D.H.) and Department of Surgery, Office of Health Promotion Research (B.L.S.), Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vt; Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (A.N.A.T.); and Departments of Medicine andEpidemiology and Biostatistics and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, Calif (K.K.).
Karla KerlikowskeFrom the Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, One Shields Ave, Med Sci 1C, Room 144, Davis, CA 95616 (D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., L.A., D.S.M.B.); Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Department of Radiology (S.D.H.) and Department of Surgery, Office of Health Promotion Research (B.L.S.), Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vt; Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (A.N.A.T.); and Departments of Medicine andEpidemiology and Biostatistics and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, Calif (K.K.).
Breast Cancer Surveillance ConsortiumFrom the Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, One Shields Ave, Med Sci 1C, Room 144, Davis, CA 95616 (D.L.M.); Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M., L.A., D.S.M.B.); Department of Radiology, University of Washington School of Medicine; Department of Health Services, University of Washington School of Public Health; Hutchinson Institute for Cancer Outcomes Research, Seattle, Wash (C.I.L.); Department of Radiology (S.D.H.) and Department of Surgery, Office of Health Promotion Research (B.L.S.), Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vt; Department of Radiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (A.N.A.T.); and Departments of Medicine andEpidemiology and Biostatistics and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, Calif (K.K.).
Funding
Staff InvestigatorsP30CA093373 · NCI · UNIVERSITY OF CALIFORNIA DAVIS · PI Gina M Dayton · 2002 to 2026
$84.9MRisk-based Imaging Strategies to Improve Breast Cancer Surveillance OutcomesP01CA154292 · NCI · UNIVERSITY OF CALIFORNIA AT DAVIS · PI KARLA M KERLIKOWSKE · 2011 to 2026
$52.9MVermont Screening Process Documentation UnitU54CA163303 · NCI · UNIVERSITY OF VERMONT & ST AGRIC COLLEGE · PI SPRAGUE, BRIAN L · 2011 to 2017
$6.4MComparative effectiveness of breast imaging modalities: a natural experimentR01HS018366 · AHRQ · UNIVERSITY OF ILLINOIS AT CHICAGO · PI RAUSCHER, GARTH H · 2010 to 2014
$1.8MAHRQ HHS R01 HS018366NCI NIH HHS P01 CA154292NCI NIH HHS P30 CA093373NCI NIH HHS U54 CA163303
Abstract
Background There is growing evidence that digital breast tomosynthesis (DBT) results in lower recall rates and higher cancer detection rates when compared with digital mammography. However, whether DBT interpretative performance changes with experience (learning curve effect) is unknown. Purpose To evaluate screening DBT performance by cumulative DBT volume within 2 years after adoption relative to digital mammography (DM) performance 1 year before DBT adoption. Materials and Methods This prospective study included 106 126 DBT and 221 248 DM examinations in 271 362 women (mean age, 57.5 years) from 2010 to 2017 that were interpreted by 104 radiologists from 53 facilities in the Breast Cancer Surveillance Consortium. Conditional logistic regression was used to estimate within-radiologist effects of increasing cumulative DBT volume on recall and cancer detection rates relative to DM and was adjusted for examination-level characteristics. Changes were also evaluated by subspecialty and breast density. Results Before DBT adoption, DM recall rate was 10.4% (95% confidence interval [CI]: 9.5%, 11.4%) and cancer detection rate was 4.0 per 1000 screenings (95% CI: 3.6 per 1000 screenings, 4.5 per 1000 screenings); after DBT adoption, DBT recall rate was lower (9.4%; 95% CI: 8.2%, 10.6%; P = .02) and cancer detection rate was similar (4.6 per 1000 screenings; 95% CI: 4.0 per 1000 screenings, 5.2 per 1000 screenings; P = .12). Relative to DM, DBT recall rate decreased for a cumulative DBT volume of fewer than 400 studies (odds ratio [OR] = 0.83; 95% CI: 0.78, 0.89) and remained lower as volume increased (400-799 studies, OR = 0.8 [95% CI: 0.75, 0.85]; 800-1199 studies, OR = 0.81 [95% CI: 0.76, 0.87]; 1200-1599 studies, OR = 0.78 [95% CI: 0.73, 0.84]; 1600-2000 studies, OR = 0.81 [95% CI: 0.75, 0.88]; P < .001). Improvements were sustained for breast imaging subspecialists (OR range, 0.67-0.85; P < .02) and readers who were not breast imaging specialists (OR range, 0.80-0.85; P < .001). Recall rates decreased more in women with nondense breasts (OR range, 0.68-0.76; P < .001) than in those with dense breasts (OR range, 0.86-0.90; P ≤ .05; P interaction < .001). Cancer detection rates for DM and DBT were similar, regardless of DBT volume (P ≥ .10). Conclusion Early performance improvements after digital breast tomosynthesis (DBT) adoption were sustained regardless of DBT volume, radiologist subspecialty, or breast density. © RSNA, 2019 See also the editorial by Hooley in this issue.
Indexed as
Learning CurveAdultAgedBreast DensityBreast NeoplasmsFemaleHumansMammographyMiddle AgedProspective StudiesRadiologistsRisk Factors
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