Intravenous pyelogram artefacts unique to digital tomosynthesis reconstruction

Recent advances in technology have led to the realisation of digital tomosynthesis (DT) imaging in routine investigations such as intravenous pyelogram (IVP). The major advantage this technology has over other technologies is its ability to perform a retrospective reconstruction of an arbitrary number of coronal image planes from a single data set consisting of a series of low dose discrete projections acquired over a limited angular range using a stationary detector. It is well documented that because DT relies on an angular limited acquisition, the data set is incomplete. This, in combination with the image reconstruction algorithm, results in reconstructed images containing non-focused information from outside the immediate focal plane. This article describes and suggests the cause of two artefacts unique to DT that cannot be explained by blurring alone. We believe the two artefacts are caused by breathing during data acquisition together with a combination of other factors, including the anatomy of the renal system, the method of data acquisition and the reconstructive algorithm used. This could lead to the unaware reporting radiologist falsely diagnosing a duplex collecting system. To avoid these artefacts, we recommend DT IVP should only be used in patients who can adequately perform a breath-hold for the duration of the data acquisition. In addition, we suggest that the study should be performed with breath-held following expiration.