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  • The VICTRE Trial: Open-Source, In-Silico Clinical Trial For Evaluating Digital Breast Tomosynthesis

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Expensive and lengthy clinical trials delay regulatory evaluation of innovative medical technologies affecting patient access to high-quality medical products. Sophisticated simulation tools are increasingly being used in device development, but are rarely used in regulatory applications. We investigate a new paradigm for evaluating digital breast tomosynthesis (DBT) as a replacement for digital mammography (DM), using exclusively in-silico methods.

A total of 2986 subjects, with breast sizes and radiographic densities representative of a screening population and compressed thicknesses from 3.5 to 6 cm, were simulated and imaged on in-silico versions of DM and DBT systems using fast Monte Carlo x-ray transport. Images were interpreted by a computational reader detecting the presence of lesions. The in-silico trial (VICTRE) was designed to replicate a comparative trial from a previous regulatory submission. The endpoint was the difference in area under the receiver-operating-characteristic curve between modalities (delta-AUC) for lesion detection. Using a fully-crossed design, VICTRE was sized for a standard error (SE) of 0.01 in delta-AUC, half the uncertainty seen in the comparative trial. A 1-hour summary presentation of the project and findings was given at the FDA Grand Rounds on 3/14/2019 and can be found  here .

A systematic exploration of the trial parameters including lesion types and sizes is also possible and greatly facilitated by the availability of open-source, free software tools available at

Localtab Group

titleData Access

Data Access

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titleDetailed Description

Detailed Description

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Image Size (TB)1.03

titleCitations & Data Usage Policy

Citations & Data Usage Policy 

Public collection license

titleDataset Citation

Badano A, Graff CG, Badal A, Sharma D, Zeng R, Samuelson FW, Glick S, Myers KJ. The VICTRE Trial: Open-Source, In-Silico Clinical Trial for Evaluating Digital Breast Tomosynthesis. 2018. DOI:  10.7937/TCIA.2019.ho23nxaw .

titlePublication Citation

Badano A, Graff CG, Badal A, Sharma D , Zeng R, Samuelson FW, Glick SJ, Myers KJ. Evaluation of Digital Breast Tomosynthesis as Replacement of Full-Field Digital Mammography Using an In Silico Imaging Trial. JAMA Netw Open. 2018;1(7):e185474. DOI: 10.1001/jamanetworkopen.2018.5474.

titleTCIA Citation

Clark K, Vendt B, Smith K, Freymann J, Kirby J, Koppel P, Moore S, Phillips S, Maffitt D, Pringle M, Tarbox L, Prior F. The Cancer Imaging Archive (TCIA): Maintaining and Operating a Public Information Repository, Journal of Digital Imaging, Volume 26, Number 6, December, 2013, pp 1045-1057. DOI: 10.1007/s10278-013-9622-7.

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Version 1 (Current): Updated 03/08/2019

Data TypeDownload all or Query/Filter
Images (DICOM, 1.03 TB)