Our aim was to evaluate if there is a benefit in diagnostic accuracy and efficiency of viewing breast tomosynthesis (BT)
image volumes presented horizontally oriented, but also to evaluate the use of a systematic search strategy where the
breast is divided, and analyzed consecutively, into two sections. These image presentations were compared to regular
vertical image presentation. All methods were investigated using viewing procedures consisting of free scroll volume
browsing, and a combination of initial cine loops at three different frame rates (9, 14, 25 fps) terminated upon request
followed by free scroll volume browsing if needed. Fifty-five normal BT image volumes in MLO view were collected.
In these, simulated lesions (20 masses and 20 clusters of microcalcifications) were randomly inserted, creating four
unique image sets for each procedure. Four readers interpreted the cases in a random order. Their task was to locate the
lesions, mark and assign a five level confidence scale. The diagnostic accuracy was analyzed using Jackknife Free
Receiver Operating Characteristics (JAFROC). Time efficiency and visual search behavior were also investigated using
eye tracking. Results indicate there was no statistically significant difference in JAFROC FOM between the different
image presentations, although visual search was more time efficient when viewing horizontally oriented image volumes
in medium cine loops.