Digital Breast Tomosynthesis: Considerations for Adoption

By reading this study, members will learn:

  • The potential market for digital breast tomosynthesis (DBT)
  • How to deploy DBT to the appropriate population
  • Reimbursement options for tomosynthesis
  • DBT's impact on care pathways and radiologist workflow


Executive Summary

Digital breast tomosynthesis is a 3-D mammogram that detects breast cancer by capturing multiple images of the breast in a single data set.
What is tomosynthesis?

Digital breast tomosynthesis, or DBT, is a three-dimensional (3-D) mammogram used to detect breast cancer by capturing multiple images of the breast in a single data set. As of 2013, Hologic has the only Food and Drug Administration (FDA)-approved system, though GE submitted a device for approval in November 2011, which is still pending as of August 2013.

How is it used?

Although there is an emerging consensus that DBT detects breast cancer more accurately than two-dimensional (2-D) mammography, there has not been enough research for the American College of Radiology or the Society of Breast Imaging to definitively define the role of DBT in clinical practice, or recommend the technology as a screening or diagnostic tool.

Each provider needs to assess their resources and patient population to determine whether an investment in DBT is advantageous and how they should best use the technology.
As of August 2013, there is no CPT code for DBT, although that may soon change.
As of August 2013, there is no CPT code for DBT, although that may soon change For now, payers generally reimburse the scan as a 2-D mammogram. Some centers use an unspecified code or ask patients to pay an additional $30-$70 up front to defray costs.

Impact on other modalities

Generally, using DBT as a screening tool reduces the number of callbacks for additional views and increases breast cancer detection versus traditional mammography. 

Fewer callbacks for additional views are beneficial to patients, but may also result in less diagnostic imaging and therefore less revenue. However, increased detection of cancer may be an effective way to attract new patients to an institution, which should offset revenue losses from fewer diagnostic scans.

How to implement tomosynthesis

  • Training: All technologists and radiologists are required by the FDA to take an eight-hour training course. Technologists seem to have little difficulty learning how to administer the new technology, while radiologists report taking around 30 days to adapt to reading exams.

    Generally, read times double from the average mammography read of 45 seconds to 90 seconds with DBT, yet some programs have reported that dedicated radiologists who read mostly 3-D exams have decreased read times.

  • Infrastructure: Image transfer and picture archiving and communication system (PACS) compatibility can be difficult due to the fact that Hologic images cannot be read on other hardware without a software add-on. Also, image storage costs increase exponentially: 2-D exams use around 22MB of space, while 3-D exams use around 380MB.

  • Marketing: Successful DBT programs require a two-pronged approach to marketing. Providers must first educate referring physicians and then advertise to the public.

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Your Next Step

Want to learn more about tomosynthesis and the breast imaging market? Register now for our new webconference on October 24. We'll tell you about the most important market trends, mammography volume forecasts, and the breast imaging technology that’s on everyone’s mind.