Artificial- intelligence- enhanced synthetic thick slabs versus standard slices in digital breast tomosynthesis

Objectives: Digital breast tomosynthesis (DBT) can provide additional information over mammography, albeit at the cost of prolonged reading time. This study retrospectively investigated the impact of reading enhanced synthetic 6 mm slabs instead of standard 1 mm slices on interpretation time and readers performance in a diagnostic assessment centre.Methods: Three radiologists (R1- 3; 6/4/2 years of breast imaging experience) reviewed 111 diagnostic DBT exam- inations. Two datasets were interpreted independently for each patient, with one set containing artificial- intelligence- enhanced synthetic 6 mm slabs with 3 mm overlap, while the other set comprised standard 1 mm slices. Blinded to histology and follow - up, readers noted individual BIRADS categories and diagnostic confidence while reading time was recorded. Among the 111 exami- nations, 70 findings were histopathologically correlated including 56 malignancies.Results: No significant difference was found between BIRADS categories assigned based on 6 mm vs 1 mm datasets (p >= 0.317). Diagnostic accuracy was compa- rable for 6 mm and 1 mm readings (R1: 87.0% vs 87.0%; R2: 86.1% vs 87.0%; R3: 80.0% vs 84.4%; p >= 0.125) with high interrater agreement (intraclass correlation coeffi- cient 0.848 vs 0.865). One reader reported higher confi- dence with 1 mm slices (R1: p=0.033). Reading time was substantially shorter when interpreting 6 mm slabs compared to 1 mm slices (R1: 33.5 vs 46.2; R2: 49.1 vs 64.8; R3: 39.5 vs 67.2 sec; all p < 0.001).Conclusions: Artificial-intelligence-enhanced synthetic 6 mm slabs allow for substantial interpretation time reduction in diagnostic DBT without a decrease in reader accuracy.Advances in knowledge: A simplified slab - only protocol instead of 1 mm slices may offset the higher reading time without a loss of diagnosis- relevant image information in first and second readings. Further evaluations are required regarding workflow implications, particularly in screening settings.