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Bodewes F, van Asselt A, Dorrius M, Greuter M, de Bock G. Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis. Breast 2022; 66:62-68. [PMID: 36183671 PMCID: PMC9530665 DOI: 10.1016/j.breast.2022.09.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Mammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature. METHODS Medline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I2 statistic, stratified and sensitivity analyses. RESULTS Nine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84-2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52-2.21) increased. Both results were statistically significant and homogenous. CONCLUSIONS Mammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.
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Affiliation(s)
- F.T.H. Bodewes
- Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, HPC: FA40, PO Box 30.001, Groningen, 9700 RB, the Netherlands
| | - A.A. van Asselt
- Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, HPC: FA40, PO Box 30.001, Groningen, 9700 RB, the Netherlands
| | - M.D. Dorrius
- Department of Radiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - M.J.W. Greuter
- Department of Radiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - G.H. de Bock
- Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, HPC: FA40, PO Box 30.001, Groningen, 9700 RB, the Netherlands,Corresponding author.
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Khan SA, Hernandez-Villafuerte KV, Muchadeyi MT, Schlander M. Cost-effectiveness of risk-based breast cancer screening: A systematic review. Int J Cancer 2021; 149:790-810. [PMID: 33844853 DOI: 10.1002/ijc.33593] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 01/01/2023]
Abstract
To analyse published evidence on the economic evaluation of risk-based screening (RBS), a full systematic literature review was conducted. After a quality appraisal, we compared the cost-effectiveness of risk-based strategies (low-risk, medium-risk and high-risk) with no screening and age-based screening. Studies were also analysed for modelling, risk stratification methods, input parameters, data sources and harms and benefits. The 10 modelling papers analysed were based on screening performance of film-based mammography (FBM) (three); digital mammography (DM) and FBM (two); DM alone (three); DM, ultrasound (US) and magnetic resonance imaging (one) and DM and US (one). Seven studies did not include the cost of risk-stratification, and one did not consider the cost of diagnosis. Disutility was incorporated in only six studies (one for screening and five for diagnosis). None of the studies reported disutility of risk-stratification (being considered as high-risk). Risk-stratification methods varied from only breast density (BD) to the combination of familial risk, genetic susceptibility, lifestyle, previous biopsies, Jewish ancestry and reproductive history. Less or no screening in low-risk women and more frequent mammography screening in high-risk women was more cost-effective compared to no screening and age-based screening. High-risk women screened annually yielded a higher mortality rate reduction and more quality-adjusted life years at the expense of higher cost and false positives. RBS can be cost effective compared to the alternatives. However, heterogeneity among risk-stratification methods, input parameters, and weaknesses in the methodologies hinder the derivation of robust conclusions. Therefore, further studies are warranted to assess newer technologies and innovative risk-stratification methods.
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Affiliation(s)
- Shah Alam Khan
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Muchandifunga Trust Muchadeyi
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Goossens M, De Brabander I, De Grève J, Van Ongeval C, Martens P, Van Limbergen E, Kellen E. Flemish breast cancer screening programme: 15 years of key performance indicators (2002-2016). BMC Cancer 2019; 19:1012. [PMID: 31660890 PMCID: PMC6819643 DOI: 10.1186/s12885-019-6230-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Abstract
Background We examined 15 years of key performance indicators (KPIs) of the population-based mammography screening programme (PMSP) in Flanders, Belgium. Methods Individual screening data were linked to the national cancer registry to obtain oncological follow-up. We benchmarked crude KPI results against KPI-targets set by the European guidelines and KPI results of other national screening programmes. Temporal trends were examined by plotting age-standardised KPIs against the year of screening and estimating the Average Annual Percentage Change (AAPC). Results PMSP coverage increased significantly over the period of 15 years (+ 7.5% AAPC), but the increase fell to + 1.6% after invitation coverage was maximised. In 2016, PMSP coverage was at 50.0% and opportunistic coverage was at 14.1%, resulting in a total coverage by screening of 64.2%. The response to the invitations was 49.8% in 2016, without a trend. Recall rate decreased significantly (AAPC -1.5% & -5.0% in initial and subsequent regular screenings respectively) while cancer detection remained stable (AAPC 0.0%). The result was an increased positive predictive value (AAPC + 3.8%). Overall programme sensitivity was stable and was at 65.1% in 2014. In initial screens of 2015, the proportion of DCIS, tumours stage II+, and node negative invasive cancers was 18.2, 31.2, and 61.6% respectively. In subsequent regular screens of 2015, those proportions were 14.0, 24.8, and 65.4% respectively. Trends were not significant. Conclusion Besides a suboptimal attendance rate, most KPIs in the Flemish PMSP meet EU benchmark targets. Nonetheless, there are several priorities for further investigation such as a critical evaluation of strategies to increase screening participation, organising a biennial radiological review of interval cancers, analysing the effect that preceding opportunistic screening has on the KPI for initial screenings, and efforts to estimate the impact on breast cancer mortality.
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Affiliation(s)
- M Goossens
- Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Centrum voor Kankeropsporing (Centre for Cancer Detection), Ruddershove 4, 8000, Brugge, Belgium.
| | - I De Brabander
- Belgian Cancer Registry, Rue Royale 215, 1210, Brussels, Belgium
| | - J De Grève
- Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - C Van Ongeval
- University Hospital Leuven, Campus St. Rafael, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - P Martens
- Centrum voor Kankeropsporing (Centre for Cancer Detection), Ruddershove 4, 8000, Brugge, Belgium
| | - E Van Limbergen
- Centrum voor Kankeropsporing (Centre for Cancer Detection), Ruddershove 4, 8000, Brugge, Belgium.,University Hospital Leuven, Campus St. Rafael, Kapucijnenvoer 33, 3000, Leuven, Belgium
| | - E Kellen
- Centrum voor Kankeropsporing (Centre for Cancer Detection), Ruddershove 4, 8000, Brugge, Belgium.,University Hospital Leuven, Campus St. Rafael, Kapucijnenvoer 33, 3000, Leuven, Belgium
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Song SY, Park B, Hong S, Kim MJ, Lee EH, Jun JK. Comparison of Digital and Screen-Film Mammography for Breast-Cancer Screening: A Systematic Review and Meta-Analysis. J Breast Cancer 2019; 22:311-325. [PMID: 31281732 PMCID: PMC6597401 DOI: 10.4048/jbc.2019.22.e24] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/19/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Digital mammography (DM) has replaced screen-film mammography (SFM). However, findings of comparisons between the performance indicators of DM and SFM for breast-cancer screening have been inconsistent. Moreover, the summarized results from studies comparing the performance of screening mammography according to device type vary over time. Therefore, this study aimed to compare the performance of DM and SFM using recently published data. Methods The MEDLINE, Embase, and Cochrane Library databases were searched for paired studies, cohorts, and randomized controlled trials published through 2018 that compared the performance of DM and SFM. All studies comparing the diagnostic accuracy of DM and SFM in asymptomatic, average-risk women aged 40 years and older were included. Two reviewers independently assessed the study quality and extracted the data. Results Thirteen studies were included in the meta-analysis. The pooled sensitivity (DM, 0.76 [95% confidence interval {CI}, 0.70–0.81]; SFM, 0.76 [95% CI, 0.70–0.81]), specificity (DM, 0.96 [95% CI, 0.94–0.97]; SFM, 0.97 [95% CI, 0.94–0.98]), and area under the receiver-operating characteristic curve (DM, 0.94 [95% CI, 0.92–0.96]; SFM, 0.92 [95% CI, 0.89–0.94]) were similar for both DM and SFM. The pooled screening performance indicators reinforced superior accuracy of full-field DM, which is a more advanced type of mammography, than SFM. The advantage of DM appeared greater among women aged 50 years or older. There was high heterogeneity among studies in the pooled sensitivity, specificity, and overall diagnostic accuracy estimates. Stratifying by study design (prospective or retrospective) and removing studies with a 2-year or greater follow-up period resulted in homogeneous overall diagnostic accuracy estimates. Conclusion The breast-cancer screening performance of DM is similar to that of SFM. The diagnostic performance of DM depends on the study design, and, in terms of performance, full-field DM is superior to SFM, unlike computed radiography systems.
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Affiliation(s)
- Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Department of Medicine, Hanyang University College of Medicine, Seoul, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Seri Hong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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Timmermans L, Bleyen L, Bacher K, Van Herck K, Lemmens K, Van Ongeval C, Van Steen A, Martens P, De Brabander I, Goossens M, Thierens H. Screen-detected versus interval cancers: Effect of imaging modality and breast density in the Flemish Breast Cancer Screening Programme. Eur Radiol 2017; 27:3810-3819. [PMID: 28289944 DOI: 10.1007/s00330-017-4757-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/22/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate if direct radiography (DR) performs better than screen-film mammography (SF) and computed radiography (CR) in dense breasts in a decentralized organised Breast Cancer Screening Programme. To this end, screen-detected versus interval cancers were studied in different BI-RADS density classes for these imaging modalities. METHODS The study cohort consisted of 351,532 women who participated in the Flemish Breast Cancer Screening Programme in 2009 and 2010. Information on screen-detected and interval cancers, breast density scores of radiologist second readers, and imaging modality was obtained by linkage of the databases of the Centre of Cancer Detection and the Belgian Cancer Registry. RESULTS Overall, 67% of occurring breast cancers are screen detected and 33% are interval cancers, with DR performing better than SF and CR. The interval cancer rate increases gradually with breast density, regardless of modality. In the high-density class, the interval cancer rate exceeds the cancer detection rate for SF and CR, but not for DR. CONCLUSIONS DR is superior to SF and CR with respect to cancer detection rates for high-density breasts. To reduce the high interval cancer rate in dense breasts, use of an additional imaging technique in screening can be taken into consideration. KEY POINTS • Interval cancer rate increases gradually with breast density, regardless of modality. • Cancer detection rate in high-density breasts is superior in DR. • IC rate exceeds CDR for SF and CR in high-density breasts. • DR performs better in high-density breasts for third readings and false-positives.
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Affiliation(s)
- Lore Timmermans
- Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium.
| | - Luc Bleyen
- Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium
| | - Klaus Bacher
- Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium
| | - Koen Van Herck
- Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium
| | - Kim Lemmens
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Andre Van Steen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Hubert Thierens
- Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium
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Ślusarczyk-Kacprzyk W, Skrzyński W, Fabiszewska E. Evaluation of Doses and Image Quality in Mammography with Screen-Film, CR, and DR Detectors - Application of the ACR Phantom. Pol J Radiol 2016; 81:386-91. [PMID: 27617048 PMCID: PMC4993217 DOI: 10.12659/pjr.897304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 01/14/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Different methods of image quality evaluation are routinely used for analogue and digital mammography systems in Poland. In the present study, image quality for several screen-film (SF), computed radiography (CR), and fully digital (DR) mammography systems was compared directly with the use of the ACR mammography accreditation phantom. MATERIAL/METHODS Image quality and mean glandular doses were measured and compared for 47 mammography systems in the Mazovia Voivodeship in Poland, including 26 SF systems, 12 CR systems, and 9 DR systems. The mean glandular dose for the breast simulated by 4.5 cm of PMMA was calculated with methods described in the "European guidelines for quality assurance in breast cancer screening and diagnosis". Visibility of the structures in the image (fibers, microcalcifications, and masses) was evaluated with the mammographic accreditation ACR phantom. RESULTS Image quality for DR systems was significantly higher than for SF and CR systems. Several SF systems failed to pass the image quality tests because of artifacts. The doses were within acceptable limits for all of the systems, but the doses for the CR systems were significantly higher than for the SF and DR systems. CONCLUSIONS The best image quality, at a reasonably low dose, was observed for the DR systems. The CR systems are capable of obtaining the same image quality as the SF systems, but only at a significantly higher dose. The ACR phantom can be routinely used to evaluate image quality for all types of mammographic systems.
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Affiliation(s)
| | - Witold Skrzyński
- Author’s address: Witold Skrzyński, Department of Medical Physics, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 Str., 02-781, Warsaw, Poland, e-mail:
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Théberge I, Vandal N, Langlois A, Pelletier É, Brisson J. Detection Rate, Recall Rate, and Positive Predictive Value of Digital Compared to Screen-Film Mammography in the Quebec Population-Based Breast Cancer Screening Program. Can Assoc Radiol J 2016; 67:330-338. [PMID: 27451910 DOI: 10.1016/j.carj.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/21/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The study sought to compare performance indicators of computed radiography (CR) using different plate readers, digital direct radiography (DR), and screen-film mammography (SFM) in a population-based screening program. METHODS This analysis involved women 50-69 years of age who participated in the breast screening program of Quebec (Canada) and who had screening mammogram between January 1, 2007, and September 30, 2012. The detection rate, recall rate, and positive predictive value of CR (n = 672,125 mammograms) and DR (n = 60,023) were compared to SFM (n = 782,894) using mixed-effect logistic regression, adjusting for potential confounders. No institutional review board approval was required. RESULTS CR was not associated with change in cancer detection rate (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.88-1.03), but with a small increase in recall rate (OR: 1.03; 95% CI: 1.01-1.06) compared to SFM. The association of CR with recall rate varies with the CR plate reader manufacturer (P < .0001). DR was not associated with change in detection rate (OR: 1.06; 95% CI: 0.89-1.25), but with an increase in the recall rate (OR: 1.25; 95% CI: 1.19-1.30) compared to SFM. CONCLUSIONS In our screening program, digital mammograms gave detection rates equivalent to those of SFM, but with an increase of recall rate, particularly for DR. If this situation persists, the adoption of DR may increase the adverse effects of screening with little or no benefit for women.
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Affiliation(s)
- Isabelle Théberge
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada.
| | - Nathalie Vandal
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - André Langlois
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - Éric Pelletier
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - Jacques Brisson
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec City, Québec, Canada
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Marshall NW, van Ongeval C, Bosmans H. Performance evaluation of a retrofit digital detector-based mammography system. Phys Med 2016; 32:312-22. [PMID: 26803225 DOI: 10.1016/j.ejmp.2016.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/07/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022] Open
Abstract
A retrofit flat panel detector was integrated with a GE DMR+ analog mammography system and characterized using detective quantum efficiency (DQE). Technical system performance was evaluated using the European Guidelines protocol, followed by a limited evaluation of clinical image quality for 20 cases using image quality criteria in the European Guidelines. Optimal anode/filter selections were established using signal difference-to-noise ratio measurements. Only small differences in peak DQE were seen between the three anode/filter settings, with an average value of 0.53. For poly(methyl methacrylate) (PMMA) thicknesses above 60 mm, the Rh/Rh setting was the optimal anode/filter setting. The system required a mean glandular dose of 0.54 mGy at 30 kV Rh/Rh to reach the Acceptable gold thickness limit for 0.1 mm details. Imaging performance of the retrofit unit with the GE DMR+ is notably better than of powder based computed radiography systems and is comparable to current flat panel FFDM systems.
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Affiliation(s)
- Nicholas W Marshall
- Department of Radiology, UZ Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
| | - Chantal van Ongeval
- Department of Radiology, UZ Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
| | - Hilde Bosmans
- Department of Radiology, UZ Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
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Young KC, Oduko JM. Radiation doses received in the United Kingdom breast screening programme in 2010 to 2012. Br J Radiol 2015; 89:20150831. [PMID: 26654386 DOI: 10.1259/bjr.20150831] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To review the radiation doses received by women attending the UK breast-screening programme between 2010 and 2012. To compare doses with previous years and to quantify the impact on dose of changing from analogue to digital imaging and to analyse doses by type of imaging system. METHODS Measurements of doses to samples of about 50-100 women attending for screening were collected across the whole of the UK breast-screening programme. RESULTS Data were collected for 87,122 exposures, using 449 X-ray sets, for 25,408 women. The average mean glandular dose (MGD) was 1.79 mGy for mediolateral oblique images and 1.58 mGy for craniocaudal images. The average MGD per two-view examination was 4.01 mGy for film-screen imaging and 3.03 mGy for direct digital radiography (DR) and 4.69 mGy for computed radiography. CONCLUSION The MGD to women attending breast screening has been reduced on average by about 25% where DR systems have replaced film-screen systems. The dose reduction was greatest for breasts with the largest compressed thickness. There are large variations in dose between the different models of DR system provided by different manufacturers. There should be further work to ensure that all DR systems are operated at the optimal dose level to ensure the best cancer detection while balancing the detriment caused by using radiation. ADVANCES IN KNOWLEDGE Changes in the radiation dose in breast screening over time have been determined. Specifically, the impact on radiation dose of introducing different types of DR and computed radiography system into breast screening has been quantified.
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Affiliation(s)
- Kenneth C Young
- 1 National Co-ordinating Centre for the Physics of Mammography, Medical Physics Department, Royal Surrey County Hospital, Guildford, UK.,2 Physics Department, University of Surrey, Guildford, UK
| | - Jennifer M Oduko
- 1 National Co-ordinating Centre for the Physics of Mammography, Medical Physics Department, Royal Surrey County Hospital, Guildford, UK
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Organ Doses and Radiation Risk of Computed Tomographic Coronary Angiography in a Clinical Patient Population: How Do Low-Dose Acquisition Modes Compare? J Comput Assist Tomogr 2015; 39:591-7. [PMID: 26182227 DOI: 10.1097/rct.0000000000000253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the organ doses and lifetime-attributable risk of cancer for electrocardiogram-triggered sequential and high-pitch helical scanning in a clinical patient population. METHODS Phantom thermoluminiscence dosimeter measurements were used as a model for the organ dose assessment of 314 individual patients who underwent coronary computed tomographic angiography. Patient-specific lifetime-attributable cancer risks were calculated. RESULTS Phantom measurements showed that heart rate had a significant influence on the delivered radiation exposure in sequential mode, and calcium scoring and contrast bolus tracking scans make a nonnegligible contribution to patients' dose. Therefore, they should be taken into account for patients' organ dose estimations. Median cancer induction risks are low, with 0.008% (0.0016%) and 0.022% (0.056%) for high-pitch and sequential scanning for men (women), respectively. CONCLUSIONS The use of high-pitch helical scanning leads to 65% and 72% lower lifetime-attributable risk values for men and women, respectively, compared with sequential scanning.
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