Genesis of breast tomosynthesis goes back decades to hand-controlled tubes

Regarding "Breast tomosynthesis trials show promise" (May, page 42), I thought you might be interested in a brief history of the development of digital breast tomosynthesis.

The first I heard of the tomosynthesis technique was an article I read in 1978 (Radiology 1971;98:249-255). I thought it was very clever. When I saw how clear cancers were on specimen radiography (after they had been removed from the breast), I thought how much easier it would be to detect breast cancers if we could see them without the rest of the breast getting in the way. I was frustrated that we could not use the tomosynthesis technique to accomplish this. Unfortunately, there was no way at the time of recording the images and processing them to do tomosynthesis of the breast.

As digital detectors started to be built for mammography, I began to plan for doing tomosynthesis of the breast. In 1992, we were joined by Loren Niklason, Ph.D., who became our physicist. I showed him the article and told him that I wanted to do tomosynthesis of the breast. When Niklason, Richard Moore, my head of research, and I met with GE, Fischer, radiologists from North Carolina and Thomas Jefferson, and physicists from Sunnybrook in Canada to develop and promote digital mammography, we recognized that the detector that GE was building would be ideally suited for tomosynthesis. As a result, MGH partnered with GE, while Dr. Stephen Feig at Thomas Jefferson partnered with Fischer. Loren, his wife, and another physicist worked out the physics, and we asked GE if they would help us motorize the x-ray tube so that we could do tomo.

GE was highly skeptical, so MGH got the patent on the system. We proved the concept by moving the tube by hand. With GE we received a grant from the Army that paid GE over $1 million to build us a prototype, which we used in our pilot studies of 450 women.

We were also responsible for pushing Lorad to do tomosynthesis. We also spoke to Siemens and most of the other mammography companies about the importance of digital breast tomosynthesis.

I have never been interested in accolades, but I do feel strongly about facts. DBT for screening the entire breast was first conceived at the MGH, designed, put to practice, and proven here. History should reflect the facts.

-Daniel B. Kopans, M.D.

Professor of radiology, Harvard Boston, MA