Tomosynthesis in musculoskeletal pathology

Tomosynthesis is an imaging technique that uses standard X-ray equipment with digital flat panel detectors to create tomographic images from very low-dose projections obtained at different angles. These images are parallel to the plane of the detector. Filtered back-projection or iterative reconstruction algorithms can be used to produce them. Iterative reconstruction used with a metal artifact reduction algorithm reduces metal artifacts, and therefore, improve image quality and in-depth spatial resolution. The radiation dose is lower compared to that of computed tomography and is two to three times the dose of a standard radiography. Tomosynthesis is intended for the analysis of high-contrast structures and especially for bones. It is superior to projection radiography when bone superimpositions are important or when metal structures hide regions of interest. The high in-plane resolution and its ability to perform exams in weight-bearing positioning are some of the main advantages of this technique. The impossible production of perpendicular multiplanar reconstruction and a limited contrast resolution are its main limitations. Tomosynthesis must be considered as an extension or an addition to standard radiography, as it can be performed in the same diagnostic step. The purpose of this article was to describe the principles, advantages and limitations, and current and future applications in musculoskeletal pathology of tomosynthesis.