This study evaluates digital breast tomosynthesis (DBT) as a potential replacement for digital mammography (DM) using an in silico imaging trial. The Virtual Imaging Clinical Trial for Regulatory Evaluation (VICTRE) compared DBT and DM performance in detecting breast lesions. Results showed DBT outperformed DM across various breast densities, aligning with real-patient trials. The research suggests in silico trials could streamline regulatory processes for new imaging technologies.