Image quality assessment in digital breast tomosynthesis equipment in the cities of Belo Horizonte and Aracaju.

Mammography is the gold standard for breast cancer screening, but it has limitations due to tissue overlap, which can lead to erroneous diagnoses. Digital breast tomosynthesis (DBT) uses low-dose exposures at varying angles to create a pseudo-three-dimensional model of the breast, improving mammography sensitivity, especially in dense breasts. This study evaluated the image quality of four DBT systems (Siemens Mammomat Revelation, Siemens Mammomat Inspiration, FUJI Amulet Innovality, and VMI Digimamo TM 3D) in clinical facilities in Belo Horizonte and Aracaju, Brazil, using the Tomophan phantom and Smári software. Parameters such as global and local uniformity, modulation transfer function (MTF), chest wall tissue loss, and Z-resolution were analyzed. All systems complied with international reference levels for global uniformity (<15%), with values ranging from 4.9% to 11.7%. For local uniformity (<10%), three systems performed within the limit, while one approached the threshold (9.99%). MTF analysis revealed performance variations consistent with detector pixel size and reconstruction algorithms. Two systems exceeded the recommended limit for chest wall tissue loss (<5 mm) but complied with Brazilian standards. Z-resolution assessment identified a methodological limitation: the Tomophan assumes reconstructed planes are parallel to the breast support surface, a condition not met by certain reconstruction algorithms. These findings underscore the urgent need for standardized quality control protocols in Brazil, where specific DBT regulations are currently lacking, and contribute to the foundation for developing national quality standards to support the safe and effective implementation of this technology in Brazilian clinical practice.