Digital tomosynthesis in lung cancer: state of the art

Chest digital tomosynthesis (CDT) is a limited angle image tomography, which improves the visibility of anatomy compared with radiographic imaging. Due to the limited acquisition angle of CDT, it has the potential to significantly increase the temporal resolution of patient surveillance at the cost of reduced resolution in one direction. CDT is 3 times more effective in identifying pulmonary nodules compared to conventional radiography and at lower doses and cost compared with routine chest computed tomography (CT) examinations. There is only one report in which CDT was used in a single-arm observational study for lung cancer detection in at-risk population while a few studies suggested that CDT sensitivity is superior to radiography but inferior to CT in detecting lung nodules, other studies on the accuracy of CDT suggest that the specificity is much closer to CT than radiography. Therefore, large-scale randomized controlled trial would be needed to confirm benefits of CDT and identify where it is best used in the clinical setting. CDT seems to be a cost-effectiveness first-line lung cancer screening tool to detect potential lung cancer nodule.