With flat panel detector radiography or x-ray TV systems, digital tomosynthesis (DT) has been recently introduced as limited-angle CT, which can remove overlying structures, enhance local tissue separation, and provide depth information about structures of interest by providing tomographic images of high quality. DT is advantageous in various clinical applications, including chest, head and neck, orthopedic, fluoroscopic, and mammographic studies. Specifically, compared to conventional radiography or fluoroscopy, DT can improve the detection of pulmonary nodules, the diagnosis of paranasal sinusitis, and the delineation of subtle fractures, particularly in complex anatomic structures, and gastrointestinal and breast tumors by less tissue overlap. Compared to CT, DT can reduce radiation exposure by limited sweep angle and improve the assessment of fine bony changes by better in-plane resolution and the postoperative evaluation in patients with metallic prostheses and osteosynthesis materials by less metallic artifact. DT is also useful for functional, weight-bearing and stress tests by more arbitrary patient positioning. To accomplish adequate patient management, a comprehensive understanding of the clinical utilities and limitations of those DT applications is important for the improvement of diagnostic quality, workflow, and cost-effectiveness.
