Digital tomosynthesis of the chest is a promising technology which overcomes significant limitations associated with plain chest X-ray and brings some advantages by permitting the reconstruction of various image slices from multiple low-dose acquisitions of image data.

Compared to standard radiography, DTS of the chest has several advantages including improved lesion detection. Recent reports have shown that the use of digital tomosynthesis, as an alternative to conventional chest radiography, leads to considerable improvement in diagnostic content¹.

In terms of radiation exposure, posterior-anterior and lateral chest radiographs would result in a radiation dose of 0.01 mSv and 0.15 mSv, respectively². DTS related dose would be approximately 0.1–0.2 mSv^{3, 4}. When compared to CT, the advantage of digital tomosynthesis is a pronounced reduced radiation dose to patients [4–8 mSv in chest CT⁵ and 15 mSv in low-dose CT^{3, 4, 6}]. As mentioned, DTS is emerging as a promising technology for the diagnosis of equivocal or suspected pulmonary lesions⁷.

It has been suggested that chest digital tomosynthesis can be used as a case solving technique in the workup of equivocal or suspected pulmonary lesions on chest radiography. Chest DTS can contribute additional information on the suspected lesion, and rather than sending patients directly to CT, digital tomosynthesis can eliminate false positive cases in which the lesion can be characterized as extrapulmonary or benign⁸. Chest DTS highlights the potential to follow up known nodules⁹. It also has applications in cystic fibrosis¹⁰ tuberculosis¹¹ and asbestos-related diseases¹².

COVID-19

COVID-19 has already infected more than 200M and killed many millions worldwide. Despite global vaccination efforts, the 4th surge is at its peak in extensive geographical areas and new variants are worrisome. Studies have shown that although CT scanning is more sensitive than conventional X-ray and is a valuable tool in severe COVID, practically, it is used only in a minority of COVID patients. While more studies are required, it is proposed that digital tomosynthesis can serve as a replacement for some indications where CT would otherwise be required^{13, 14}.

1 Machida H, Yuhara T, Tamura M, et al. Whole-Body Clinical Applications of Digital Tomosynthesis. Radiographics 2016;36:735-50.

_{2 Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med 2007;357:2277-84.}

_{3 Bath M, Svalkvist A, von Wrangel A, et al. Effective dose to patients from chest examinations with tomosynthesis. Radiat Prot Dosimetry 2010;139:153-8.}

_{4 Yamada Y, Jinzaki M, Hasegawa I, et al. Fast scanning tomosynthesis for the detection of pulmonary nodules: diagnostic performance compared with chest radiography, using multidetector-row computed tomography as the reference. Invest Radiol 2011;46:471-7.14 Silva AC, Lawder HJ, Hara A, et al. Innovations in CT dose reduction strategy: application of the adaptive statistical iterative reconstruction algorithm. AJR Am J Roentgenol 2010;194:191-9.}

5 Silva AC, Lawder HJ, Hara A, et al. Innovations in CT dose reduction strategy: application of the adaptive statistical iterative reconstruction algorithm. AJR Am J Roentgenol 2010;194:191-9.

_{6 National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409.}

_{7 Grosso M, Priotto R, Ghirardo D, et al. Comparison of digital tomosynthesis and computed tomography for lung nodule detection in SOS screening program. Radiol Med 2017;122:568-74.}

_{8 Bertolaccini L, Viti A, Terzi A. Digital tomosynthesis in lung cancer: state of the art. Ann Transl Med 2015;3:139.}

_{9 Ferrari A, Bertolaccini L, Solli P, Di Salvia PO, Scaradozzi D. Digital chest tomosynthesis: the 2017 updated review of an emerging application. Ann Transl Med. 2018; 6(5): 91.}

_{10 Meltzer C, Båth M, Kheddache S, Ásgeirsdóttir H, Gilljam M, Johnsson ÅA. Visibility of structures of relevance for patients with cystic fibrosis in chest tomosynthesis: Influence of anatomical location and observer experience. Radiat Prot Dosimetry. 2016; 169(1-4): 177-187.}

_{11 Sharma M, Sandhu MS, Gorsi U, Gupta D, Khandelwal N. Role of digital tomosynthesis and dual energy subtraction digital radiography in etection of parenchymal lesions in active pulmonary tuberculosis. Eur J Radiol. 2015; 84(9): 1820-1827. 21 Lee G, Jeong YJ, Kim KI, et al. Comparison of chest digital tomosynthesis and chest radiography for detection n of parenchymal lesions in active pulmonary tuberculosis. Eur J Radiol. 2015; 84(9): 1820-1827.}

_{12 Lee G, Jeong YJ, Kim KI, et al. Comparison of chest digital tomosynthesis and chest radiography for detection of asbestosrelated pleuropulmonary disease. Clin Radiol. 2013; 68(4): 376-382.}

_{13 Inmaculada Calvo et al 2020. Digital Tomosynthesis and covid 19: An improvement in the assessment of pulmomary opacities Arch Bronconeumol 56(11): 761–763 12}

_{14 E. Martínez Chamorro et al 2021. Radiologic diagnosis of patients with COVID-19 Radiologica 63, 56-73.}