Impact of AI-based Slab Reconstruction Technology on the Diagnostic Accuracy of Screening Digital Breast...

Background Digital breast tomosynthesis (DBT) uses 1-mm slices, resulting in a larger number of images and longer interpretation times than conventional digital two-dimensional mammography. Slab reconstruction technologies address this challenge by generating thicker slices, thereby reducing the number of images requiring review, improving efficiency, and lowering storage demand. Purpose To compare the diagnostic accuracy of screening DBT before and after the implementation of artificial intelligence (AI)-based slab reconstruction technology. Materials and Methods Consecutive screening DBT examinations obtained before and after the implementation of a slab reconstruction technology at an academic medical center were retrospectively reviewed. The slab reconstruction technology uses AI to generate 6-mm synthetic slices with 3-mm overlap and 70-μm pixel resolution. The preimplementation period was between January 2018 and December 2019, and the postimplementation period was between October 2021 and September 2022. Multivariable logistic regression models were used to compare screening performance metrics in both periods, and a noninferiority analysis was performed. Results A total of 119 662 screening DBT examinations in 64 949 women were analyzed: 77 577 (52 649 women; mean age, 60 years ± 11 [SD]) during the preimplementation period and 42 085 (42 059 women; mean age, 60 years ± 11) during the postimplementation period. The cancer detection rate (CDR) (5.8 vs 6.5 per 1000 examinations; adjusted odds ratio [OR], 1.1; P = .49), sensitivity (82.3% vs 85.9%; adjusted OR, 1.3; P = .27), and false-negative rate (1.2 vs 1.1 per 1000 examinations; adjusted OR, 0.8; P = .39) did not differ between periods, and all three metrics met the noninferiority criteria. The abnormal interpretation rate (AIR) was lower (6.2% vs 5.8%; adjusted OR, 0.9; P < .001) and the specificity was higher (94.4% vs 94.9%; adjusted OR, 1.1; P < .001) during the postimplementation period. Conclusion The implementation of AI-based slab reconstruction technology was associated with noninferior CDR and sensitivity, improved specificity, and reduced AIR. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Grimm in this issue.