Results of a European dose survey for mammography

Estimating Local Diagnostic Reference Levels for Mammography in Dubai

As the total volume of mammograms in Dubai is increasing consistently, it is crucial to focus on the process of dose optimization by determining dose reference levels for such sensitive radiographic examinations as mammography. This work aimed to determine local diagnostic reference levels (DRLs) for mammography procedures in Dubai at different ranges of breast thickness. A total of 2599 anonymized mammograms were randomly retrieved from a central dose survey database. Mammographic cases for screening women aged from 40 to 69 years were included, while cases of breast implants and breast thickness outside the range of 20-100 mm were excluded. Mean, median, and 75 percentiles were obtained for the mean glandular dose (MGD) distribution of each mammography projection for all compressed breast thickness (CBT) ranges. The local DRLs for mammography in Dubai were found to be between 0.80 mGy and 0.82 mGy for the craniocaudal (CC) projection and between 0.89 mGy and 0.971.8 mGy for the mediolateral oblique (MLO) projection. Local DRLs were proposed according to different breast thicknesses, starting from 20 to 100 mm. All groups of CBT showed a slight difference in MGD values, with higher values in MLO views rather than CC views. The local DRLs in this study were lower than some other Middle Eastern countries and lower than the standard reference levels reported by the International Atomic Energy Agency (IAEA) at 3 mGy/view.

Establishment of regional diagnostic reference levels for digital mammography in Western Province of Sri Lanka

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.

INSTITUTIONAL BREAST DOSES IN DIGITAL MAMMOGRAPHY

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.

Diagnostic reference levels in digital mammography: a systematic review

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.

[Construction and usefulness of the dose management system using DICOM radiation dose structured report (Dose SR) in angiography]

The International Commission on Radiological Protection recommends diagnostic reference levels (DRL) in each radiological examination for justification and optimization of patients' dose in medicine. The aim of our study was to propose the dose management system by utilizing dose information in diagnostic X-ray radiation dose structured report (Dose SR) in The Digital Imaging and Communications in Medicine to optimize radiation dose in institutions. Our dose management system is able to organize dose information obtained from various angiography systems and CTs. It is possible to provide this information to operators for justification and optimization of patient dose. Our system would be useful for the estimation of organ dose and could be used for the determination of local DRL (LDRL) for each radiological practice. In addition, the optimization became possible to compare LDRL with national DRL.

New diagnostic reference level for full-field digital mammography units

The diagnostic reference level (DRL) has generally been defined as the 75th percentile of the distributions of mean doses observed on a sample of standard-sized patients, but for mammography, the 95th percentile has been used. In this study, the 75th and 95th percentiles are estimated for 26 full-field digital mammography units, representing six models from four manufacturers. Systematic differences between categories of manufacture/models are investigated with respect to mean glandular dose (MGD) and figure of merit (FOM), defined as signal difference to noise ratio squared divided by the MGD. The MGDs per unit range from 0.7 to 2.1 mGy, with overall 75th and 95th percentiles of 1.4 and 2.0 mGy, respectively. The different manufacture/models show differences in both dose distributions and FOMs. As national DRL, the 95th percentile is proposed to determine which units can be accepted for use. To identify the need for optimisation, it is proposed to use the 75th percentile for the different manufacture/models, along with the FOM.

Mammography equipment performance, image quality and mean glandular dose in Malta

In this first Maltese national mammography survey, the effectiveness of direct digital (DR) mammography in breast cancer screening has been confirmed. Patient data were made available from three clinics out of the participating nine. A dose survey of mean glandular dose (MGD) calculated for 759 patients examined in the state-owned mammography facilities was performed. An MGD national diagnostic reference level was set at 1.87 mGy for patients with breast compression thicknesses (BCT) between 5.0 and 7.0 cm. This range was selected since patient data were retrieved from three clinics only and the results showed that other international BCT reference levels may be unsuitable for the Maltese population. In fact, the overall average BCT was 5.75 ± 1.4 cm. The survey results have shown that the technical standard of mammographic equipment in the Malta National Breast Screening Programme is on a par with other countries, including its Western European counterparts.

Comprehensive dose survey of breast screening in Ireland

The primary purpose of this study was to evaluate the impact of digital mammography screening on breast dose by analysing the results of a patient dose survey of the Irish breast screening programme. Results from the survey were used to determine a dose reference level for the screening programme. Approximately, 100 examinations were acquired for each of the digital mammography systems operational in the screening programme. Each examination consisted of two standard views of each breast. The mean glandular dose for each acquired image was calculated. The dose reference level was established by calculating the 95th percentile of the average mean glandular dose for the average compressed breast thickness of the mediolateral oblique views. The overall average mean glandular dose per examination was 2.72 ± 0.04 mGy. The average compressed breast thickness was 61.4 ± 0.03 mm. The average compression force was 109 ± 7 N. A dose reference level value of 1.75 mGy was established for the screening programme. The results of this clinical dose survey provide a valuable indication of the dose performance of modern full field digital mammographic imaging systems. The results demonstrate clearly the dose benefits of digital mammography. The dose benefit of digital screening was further demonstrated by the establishment of a comparatively lower diagnostic reference level for the screening programme. The comparison of the dose performance of individual X-ray systems with the diagnostic reference level highlights the need for more optimisation within the service.

A method for calculating the dose length product from CT DICOM images

OBJECTIVE

The dosimetric calculations in CT examinations are currently based on two quantities: the volume weighted CT dose index (CTDI(vol)) and the dose-length product (DLP). The first quantity is dependent on the exposure factors, scan field of view, collimation and pitch factor selections, whereas the second is additionally dependent on the scan length.

METHODS

In this study a method for the calculation of these quantities from digital imaging and communication in medicine (DICOM) CT images is presented that allows an objective audit of patient doses. This method was based on software that has been developed to enable the automatic extraction of the DICOM header information of each image (relating to the parameters that affect the aforementioned quantities) into a spreadsheet with embedded functions for calculating the contribution of each image to the CTDI(vol) and DLP values. The applicability and accuracy of this method was investigated using data from actual examinations carried out in three different multislice CT scanners. These examinations have been performed with the automatic exposure control systems activated, and therefore the tube current and tube loading values varied during the scans.

RESULTS

The calculated DLP values were in good agreement (±5%) with the displayed values. The calculated average CDTI(vol) values were in similar agreement with the displayed CTDI(vol) values but only for two of the three scanners. In the other scanner the displayed CTDI(vol) values were found to be overestimated by about 25%. As an additional application of this method the differences among the tube modulation techniques used by the three CT scanners were investigated.

CONCLUSION

This method is a useful tool for radiation dose surveys.

Mammography radiation dose: initial results from Serbia based on mean glandular dose assessment for phantoms and patients

The primary objective of this study is to investigate the actual mammography dose levels in Serbia and establish a baseline dose database for the future screening programme. The mean glandular dose (MGD) was assessed for standard size breast substituted by 45 mm polymethyl methacrylate (PMMA) phantom and imaged under typical clinical conditions at 30 screen-film mammography facilities. Average MGD was (1.9 +/- 1.0) mGy, with a range of 0.12-5.2 mGy. These results were used for the calculation of the initial diagnostic reference levels in mammography in Serbia, which was set to 2.1 mGy for a standard breast. At some facilities, high doses were observed and the assessed MGD was supplemented by a patient dose survey. MGD was measured for 53 women having a diagnostic mammography in cranio-caudal (CC) and mediolateral oblique (MLO) projections at the largest mammography facilities in Serbia. The parameters recorded were: age, compressed breast thickness, tube potential (in kV), tube loading (in mAs) and the MLO projection angle. The average MGD per image was 2.8 mGy for the CC projection and 4.3 mGy for the MLO projection. Dose to breast was compared with dose for PMMA phantoms of various sizes, assessed at the same facilities. The results have indicated that phantom dose values can assist in setting optimisation activities in mammography. Both phantom and patient dose values indicated unnecessary high doses in facilities with an extremely high mammography workload. For these facilities, urgent dose-reduction measures and follow-up actions were recommended.

Safety and efficacy for new techniques and imaging using new equipment to support European legislation: an EU coordination action

The past two decades have witnessed a technologically driven revolution in radiology. At the centre of these developments has been the use of computing. These developments have also been driven by the introduction of new detector and imaging devices in radiology and nuclear medicine, as well as the widespread application of computing techniques to enhance and extract information within the images acquired. Further advances have been introduced into digital practice. These technological developments, however, have not been matched by justification and optimisation studies to ensure that these new imaging devices and techniques are as effective as they might be, or performed at the lowest possible dose. The work programme of the SENTINEL Coordination Action was subdivided into eight work packages: functional performance and standards; efficacy and safety in digital radiology, dentistry and nuclear medicine, cardiology, interventional radiology, population screening/sensitive groups; justification, ethics and efficacy; good practice guidance and training; and project management. The intention of the work programme was to underwrite the safety, efficacy and ethical aspects of digital practice as well as to protect and add value to the equipment used in radiology.