1
|
Adhimoolam SK, Kumar S, Manojkumar T, Devanand BL, Elango N, Govindarajan N, Sapra BK. Assessment of local diagnostic reference levels (LDRLS) for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) mammography in Tamil Nadu, India. RADIATION PROTECTION DOSIMETRY 2024:ncae199. [PMID: 39375206 DOI: 10.1093/rpd/ncae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 08/05/2024] [Accepted: 09/16/2024] [Indexed: 10/09/2024]
Abstract
The purpose of this study was to assess local diagnostic reference levels (LDRLs) for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) mammography in India. Data from 1500 women were collected from five different mammography facilities in major cities in Tamil Nadu, India. The mean of mean glandular dose were used to arrive at an LDRL. The noted mean compressed breast thickness was 55.26 ± 3.4. The recorded mean MGDs for the five centres were 3.1 ± 0.1 and 3.8 ± 0.2 mGy for FFDM and DBT, respectively. The 75th percentile value for all five centers is 3.3 and 4.0 mGy for FFDM and DBT, respectively. The LDRLs found in the current study were also compared with those from earlier studies conducted in other nations, such as the United Kingdom, Malaysia, Morocco, and Ghana. The present study is the first of its kind to determine the LDRL for the FFDM and DBT scanners operating in the Tamil Nadu region, India, and is proposed as a starting point that will allow professionals to evaluate and optimize their practice. Furthermore, similar studies in other regions of India are necessary in order to establish National DRLs.
Collapse
Affiliation(s)
- Saravana Kumar Adhimoolam
- Department of Medical Physics, PSG Institute of Medical Sciences Research & Hospitals, Coimbatore 641 004, Tamil Nadu, India
| | - Sudhir Kumar
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre (BARC), CT&CRS, Anushaktinagar, Mumbai 400 094, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai 400 094, India
| | - Thangavel Manojkumar
- Department of Medical Physics, PSG Institute of Medical Sciences Research & Hospitals, Coimbatore 641 004, Tamil Nadu, India
| | - Bala Lakshmoji Devanand
- Department of Radiology & Imaging, PSG Institute of Medical Sciences Research & Hospitals, Coimbatore-641 004, Tamil Nadu, India
| | - Nagappan Elango
- Department of Radiology & Imaging, PSG Institute of Medical Sciences Research & Hospitals, Coimbatore-641 004, Tamil Nadu, India
| | - Nagarajarao Govindarajan
- Department of Medical Physics, PSG Institute of Medical Sciences Research & Hospitals, Coimbatore 641 004, Tamil Nadu, India
| | - Balvinder Kaur Sapra
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre (BARC), CT&CRS, Anushaktinagar, Mumbai 400 094, India
- Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai 400 094, India
| |
Collapse
|
2
|
Dalah EZ, Alkaabi MK, Al-Awadhi HM, Antony NA. Screening Mammography Diagnostic Reference Level System According to Compressed Breast Thickness: Dubai Health. J Imaging 2024; 10:188. [PMID: 39194978 DOI: 10.3390/jimaging10080188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 08/29/2024] Open
Abstract
Screening mammography is considered to be the most effective means for the early detection of breast cancer. However, epidemiological studies suggest that longitudinal exposure to screening mammography may raise breast cancer radiation-induced risk, which begs the need for optimization and internal auditing. The present work aims to establish a comprehensive well-structured Diagnostic Reference Level (DRL) system that can be confidently used to highlight healthcare centers in need of urgent action, as well as cases exceeding the dose notification level. Screening mammographies from a total of 2048 women who underwent screening mammography at seven different healthcare centers were collected and retrospectively analyzed. The typical DRL for each healthcare center was established and defined as per (A) bilateral image view (left craniocaudal (LCC), right craniocaudal (RCC), left mediolateral oblique (LMLO), and right mediolateral oblique (RMLO)) and (B) structured compressed breast thickness (CBT) criteria. Following this, the local DRL value was established per the bilateral image views for each CBT group. Screening mammography data from a total of 8877 images were used to build this comprehensive DRL system (LCC: 2163, RCC: 2206, LMLO: 2288, and RMLO: 2220). CBTs were classified into eight groups of <20 mm, 20-29 mm, 30-39 mm, 40-49 mm, 50-59 mm, 60-69 mm, 70-79 mm, 80-89 mm, and 90-110 mm. Using the Kruskal-Wallis test, significant dose differences were observed between all seven healthcare centers offering screening mammography. The local DRL values defined per bilateral image views for the CBT group 60-69 mm were (1.24 LCC, 1.23 RCC, 1.34 LMLO, and 1.32 RMLO) mGy. The local DRL defined per bilateral image view for a specific CBT highlighted at least one healthcare center in need of optimization. Such comprehensive DRL system is efficient, easy to use, and very clinically effective.
Collapse
Affiliation(s)
- Entesar Z Dalah
- HQ Diagnostic Imaging Department, Dubai Health, Dubai 2727, United Arab Emirates
- College of Medicine, Mohammed Bin Rashid University, Dubai Health, Dubai 2727, United Arab Emirates
| | - Maryam K Alkaabi
- Medical Imaging Department, Dubai Hospital, Dubai Health, Dubai 2727, United Arab Emirates
| | - Hashim M Al-Awadhi
- Medical Imaging Department, Dubai Hospital, Dubai Health, Dubai 2727, United Arab Emirates
| | - Nisha A Antony
- Medical Imaging Department, Dubai Hospital, Dubai Health, Dubai 2727, United Arab Emirates
| |
Collapse
|
3
|
Kanda R, Akahane M, Koba Y, Chang W, Akahane K, Okuda Y, Hosono M. Developing diagnostic reference levels in Japan. Jpn J Radiol 2021; 39:307-314. [PMID: 33211263 PMCID: PMC8019674 DOI: 10.1007/s11604-020-01066-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Reiko Kanda
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan.
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan.
| | - Masaaki Akahane
- Department of Radiology, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Yusuke Koba
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Weishan Chang
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Keiichi Akahane
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Yasuo Okuda
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
- Japan Network for Research and Information On Medical Exposures (J-RIME), 4-9-1, Anagawa, Inage-ku, Chiba, 263-8555, Japan
| |
Collapse
|
4
|
Niroshani HS, Jeyasugiththan J, Senanayake G, Negishi T. Establishment of regional diagnostic reference levels for digital mammography in Western Province of Sri Lanka. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:79-96. [PMID: 33271512 DOI: 10.1088/1361-6498/abd075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
The radiation dose to the breasts should be kept to a minimum as breast tissues are highly sensitive to radiation. In mammography, the mean glandular dose (MGD) is used to specify the patient dose. In this study, data on the MGD during diagnostic mammographic examinations was collected using the database from six digital mammography facilities available in the Western Province in Sri Lanka. Examinations involving breast pathology, breast implants, or compressed breast thicknesses (CBT) outside the range of 20-110 mm were excluded in this study. The mean MGD per breast was 3.50 mGy, with a mean CBT of 57 mm. The mean MGD per facility varies from 1.58 to 2.27 mGy, with overall 75th and 95th percentiles of 2.15 and 2.82 mGy, respectively. The 75th and 95th percentile MGD per image, for the average CBT of 57 ± 12 mm, were 2.00 and 2.65 mGy respectively. The 75th percentile value of the MGD is suggested for the Western Province and it depends on the specific CBT.
Collapse
Affiliation(s)
- H S Niroshani
- Department of Nuclear Science, University of Colombo, Colombo, Sri Lanka
- Department of Radiography & Radiotherapy, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
- Department of Radiological Sciences, Graduate school of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | | | - G Senanayake
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
| | - Toru Negishi
- Department of Radiological Sciences, Graduate school of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| |
Collapse
|
5
|
Parmaksız A, Ataç GK, Bulur E, İnal T, Alhan A. AVERAGE GLANDULAR DOSES AND NATIONAL DIAGNOSTIC REFERENCE LEVELS IN MAMMOGRAPHY EXAMINATIONS IN TURKEY. RADIATION PROTECTION DOSIMETRY 2020; 190:100-107. [PMID: 32556186 DOI: 10.1093/rpd/ncaa080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
In order to establish national diagnostic reference levels for mammography examinations, entrance skin air kerma, entrance skin dose and average glandular doses (AGDs) were calculated for a total of 25 624 cranio-caudal (CC) and mediolateral oblique (MLO) projections of 6309 patients for 40-49 and 50-64 age groups. The average entrance skin air kerma and entrance skin dose values for both age groups were found to be higher in MLO projections compared with CC projections. The minimum and maximum values of AGDs were determined as 0.4 and 7.9 mGy for both projections. The maximum numbers of AGDs for CC and MLO projections were calculated in the range of 1.1-1.5 and 1.6-2.0 mGy, respectively. The third quartile values of AGDs were calculated for each compressed breast thickness between 20 and 99 mm. The first national diagnostic reference levels of the country were established for each 10-mm compressed breast thickness in mammography examinations.
Collapse
Affiliation(s)
- Aydın Parmaksız
- Radiation and Accelerator Technologies Department, Turkish Atomic Energy Authority, Atom Street, 06983 Kahramankazan, Ankara, Turkey
| | - Gökçe K Ataç
- Medicine Faculty, Ufuk University, Mevlana Boulevard (Konya Road), Balgat, Ankara, Turkey
| | - Emine Bulur
- Radiation and Accelerator Technologies Department, Turkish Atomic Energy Authority, Atom Street, 06983 Kahramankazan, Ankara, Turkey
| | - Tolga İnal
- Department of Electrical and Electronics Engineering, Ankara University, Dögol Street, Ankara, Turkey
| | - Aslıhan Alhan
- Statistics Department, Art and Science Faculty., Ufuk University, İncek Şehit Savcı Mehmet Selim Kiraz Boulevard, Gölbaşı, Ankara, Turkey
| |
Collapse
|
6
|
Lekatou A, Metaxas V, Messaris G, Antzele P, Tzavellas G, Panayiotakis G. INSTITUTIONAL BREAST DOSES IN DIGITAL MAMMOGRAPHY. RADIATION PROTECTION DOSIMETRY 2019; 185:239-251. [PMID: 30753684 DOI: 10.1093/rpd/ncz005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
The objective of this study was to survey breast dose in screening mammography, establish institutional doses and compare them with the corresponding dose values. Three hundred women between the ages of 40 and 80 years old participated in the study. All mammographic examinations were performed with a digital mammography system. The women characteristics (age, weight, height, BMI), technical and exposure parameters (anode/filter material, projection, compressed breast thickness (CBT), compression force, tube voltage, tube load), the entrance surface dose (ESD) and the average glandular dose (AGD) were recorded. The mean, median, 75th and 95th percentiles of the AGD and ESD distributions were estimated for all examinations, for right and left breast, as well as for CBT within 55-65 mm, for Cranio-Caudal (CC) and Medio-Lateral Oblique (MLO) projections. A statistical analysis was also performed, to investigate the impact of the recorded parameters on the ESD and AGD. The mean/median values of the ESD and AGD for all examinations, for CC and MLO projections were 4.60/4.29 and 5.42/5.25 mGy and 1.18/1.13 and 1.32/1.30 mGy, respectively. The mean/median values of the ESD and AGD for CC and MLO projections at CBT range 55-65 mm were 5.29/5.08 and 5.56/5.42 mGy and 1.30/1.24 and 1.36/1.32 mGy, respectively. The 75th percentile for CC and MLO projections were estimated 5.79 and 6.17 mGy, as well as 1.41 and 1.48 mGy in terms of ESD and AGD values, respectively. The 95th percentile of the ESD and AGD for CC and MLO projections were also 7.40 and 7.53 mGy and 1.76 and 1.78 mGy, respectively. The tube voltage, tube load, age and CBT had a significant influence on the dose values. The estimated values were found to be comparable, or in most cases lower, than the corresponding 75th and 95th percentile values from previous studies.
Collapse
Affiliation(s)
- Aristea Lekatou
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Vasileios Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Gerasimos Messaris
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - Penelope Antzele
- Department of Radiology, University Hospital of Patras, Patras, Greece
| | - George Tzavellas
- Department of Radiology, University Hospital of Patras, Patras, Greece
| | - George Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| |
Collapse
|
7
|
Suleiman ME, McEntee MF, Cartwright L, Diffey J, Brennan PC. Diagnostic reference levels for digital mammography in New South Wales. J Med Imaging Radiat Oncol 2016; 61:48-57. [DOI: 10.1111/1754-9485.12540] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Moayyad E Suleiman
- Faculty of Health Sciences; The University of Sydney; Lidcombe New South Wales Australia
| | - Mark F McEntee
- Faculty of Health Sciences; The University of Sydney; Lidcombe New South Wales Australia
| | | | - Jennifer Diffey
- Hunter New England Imaging; John Hunter Hospital; New Lambton Heights New South Wales Australia
| | - Patrick C Brennan
- Faculty of Health Sciences; The University of Sydney; Lidcombe New South Wales Australia
| |
Collapse
|
8
|
Asada Y, Suzuki S, Minami K, Shirakawa S, Kobayashi M. Survey of patient exposure from general radiography and mammography in Japan in 2014. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:N8-N18. [PMID: 26975874 DOI: 10.1088/0952-4746/36/2/n8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
With the objective of reducing patient exposure to radiation, we conducted a questionnaire survey regarding radiographic conditions in 2014. Here we report estimates of dose exposure in general radiography and mammography through an investigation and comparison of present patient exposure conditions. Questionnaires were sent to 3000 facilities nationwide in Japan. Surveys asked questions on a total of 16 items related to general radiography, including the chest, abdomen, and breast. Output data from x-ray tubes measured in the Chubu area of Japan were used as the mean in these estimates. The index of patient exposure was adopted as the entrance skin dose (ESD) for general radiography and as the mean glandular dose (MGD) for mammography. The response rate for this survey was 21.9%. Our results showed that doses received through the use of flat-panel detector (FPD) devices were lower than those received through computed radiography devices, except for the ankle joint (e.g. in chest examination, the dose from FPD and CR was 0.24 mGy, 0.31 mGy on the average, respectively). These results suggest that more widespread use of FPD devices could lead to decreases in the ESD and MGD, thereby reducing patient exposure.
Collapse
Affiliation(s)
- Y Asada
- Faculty of Radiological Technology, Fujita Health University, School of Health Science, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | | | | | | | | |
Collapse
|
9
|
Suleiman ME, Brennan PC, McEntee MF. Diagnostic reference levels in digital mammography: a systematic review. RADIATION PROTECTION DOSIMETRY 2015; 167:608-619. [PMID: 25543130 DOI: 10.1093/rpd/ncu365] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/03/2014] [Indexed: 06/04/2023]
Abstract
This study aims to review the literature on existing diagnostic reference levels (DRLs) in digital mammography and methodologies for establishing them. To this end, a systematic search through Medline, Cinahl, Web of Science, Scopus and Google scholar was conducted using search terms extracted from three terms: DRLs, digital mammography and breast screen. The search resulted in 1539 articles of which 22 were included after a screening process. Relevant data from the included studies were summarised and analysed. Differences were found in the methods utilised to establish DRLs including test subjects types, protocols followed, conversion factors employed, breast compressed thicknesses and percentile values adopted. These differences complicate comparison of DRLs among countries; hence, an internationally accepted protocol would be valuable so that international comparisons can be made.
Collapse
Affiliation(s)
- Moayyad E Suleiman
- Faculty of Health Sciences, The University of Sydney, M205, Cumberland Campus, 75 East St, Lidcombe, Sydney, NSW 2141, Australia
| | - Patrick C Brennan
- Faculty of Health Sciences, The University of Sydney, M205, Cumberland Campus, 75 East St, Lidcombe, Sydney, NSW 2141, Australia
| | - Mark F McEntee
- Faculty of Health Sciences, The University of Sydney, M205, Cumberland Campus, 75 East St, Lidcombe, Sydney, NSW 2141, Australia
| |
Collapse
|