Digital chest tomosynthesis: the 2017 updated review of an emerging application

Lung cancer is the leading cause of cancer death and second most common cancer among both men and women, but most of them are detected when patients become symptomatic and in late-stage. Chest radiography (CR) is a basic technique for the investigation of lung cancer and has the benefit of convenience and low radiation dose, but detection of malignancy is often difficult. The introduction of computed tomography (CT) for screening has increased the proportion of lung cancer detected but with higher exposure dose and higher costs. Digital chest tomosynthesis (DCT), a tomographic technique, may offer an alternative to CT. DCT uses a conventional radiograph tube, a flat-panel detector, a computer-controlled tube mover and reconstruction algorithms to produce section images. It shows promise in the detection of potentially malignant lung nodules, with higher sensibility than CR, and is emerging as a low-dose and low-cost alternative to CT to improve treatment decisions. In fact, an increasing number of researchers are showing that tomosynthesis could have a role in the detection of lung cancer, in addition to its present role in breast screening. However, DCT offers some limitations, such as limited depth resolution, which may explain the difficulty in detecting pathologies in the subpleural region and the occurrence of artefacts from medical devices. Once solved these limitations and once more studies supporting its use will be available, DCT could become the first-line lung cancer screening tool among patients at considerable risk of lung cancer.