{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:25:38Z","timestamp":1792787138887,"version":"4.5.0"},"reference-count":52,"publisher":"SPIE-Intl Soc Optical Eng","issue":"S2","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ScreenPoint Medical"},{"name":"Governmental Funding for Clinical Research"},{"name":"Swedish Cancer Society","id":[{"id":"https:\/\/ror.org\/0527jb766","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Department of Medical Imaging and Physiology, Sk\u00e5ne University Hospital","id":[{"id":"https:\/\/ror.org\/02z31g829","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Region Sk\u00e5ne","id":[{"id":"https:\/\/ror.org\/03sawy356","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"},{"id":"https:\/\/ror.org\/03zttf063","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Allm\u00e4nna Sjukhusets i Malm\u00f6 Stiftelse f\u00f6r Bek\u00e4mpande av Cancer","id":[{"id":"https:\/\/ror.org\/013pz4p34","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Med. Imag."],"published-print":{"date-parts":[[2025,4,30]]},"abstract":"<jats:p>PurposeTo achieve the high sensitivity of digital breast tomosynthesis (DBT), a time-consuming reading is necessary. However, synthetic mammography (SM) images, equivalent to digital mammography (DM), can be generated from DBT images. SM is faster to read and might be sufficient in many cases. We investigate using artificial intelligence (AI) to stratify examinations into reading of either SM or DBT to minimize workload and maximize accuracy.ApproachThis is a retrospective study based on double-read paired DM and one-view DBT from the Malm\u00f6 Breast Tomosynthesis Screening Trial. DBT examinations were analyzed with the cancer detection AI system ScreenPoint Transpara 1.7. For low-risk examinations, SM reading was simulated by assuming equality with DM reading. For high-risk examinations, the DBT reading results were used. Different combinations of single and double reading were studied.ResultsBy double-reading the DBT of 30% (4452\/14,772) of the cases with the highest risk, and single-reading SM for the rest, 122 cancers would be detected with the same reading workload as DM double reading. That is 28% (27\/95) more cancers would be detected than with DM double reading, and in total, 96% (122\/127) of the cancers detectable with full DBT double reading would be found.ConclusionsIn a DBT-based screening program, AI could be used to select high-risk cases where the reading of DBT is valuable, whereas SM is sufficient for low-risk cases. Substantially, more cancers could be detected compared with DM only, with only a limited increase in reading workload. 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