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Radiation dose with digital breast tomosynthesis compared to digital mammography: per-view analysis

  • Breast
  • Published:
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Abstract

Objectives

To compare radiation dose delivered by digital mammography (FFDM) and breast tomosynthesis (DBT) for a single view.

Methods

4,780 FFDM and 4,798 DBT images from 1,208 women enrolled in a screening trial were used to ground dose comparison. Raw images were processed by an automatic software to determine volumetric breast density (VBD) and were used together with exposure data to compute the mean glandular dose (MGD) according to Dance’s model. DBT and FFDM were compared in terms of operation of the automatic exposure control (AEC) and MGD level.

Results

Statistically significant differences were found between FFDM and DBT MGDs for all views (CC: MGDFFDM=1.366 mGy, MGDDBT=1.858 mGy; p<0.0001; MLO: MGDFFDM=1.374 mGy, MGDDBT=1.877 mGy; p<0.0001). Considering the 4,768 paired views, Bland-Altman analysis showed that the average increase of DBT dose compared to FFDM is 38 %, and a range between 0 % and 75 %.

Conclusions

Our findings show a modest increase of radiation dose to the breast by tomosynthesis compared to FFDM. Given the emerging role of DBT, its use in conjunction with synthetic 2D images should not be deterred by concerns regarding radiation burden, and should draw on evidence of potential clinical benefit.

Key Points

• Most studies compared tomosynthesis in combination with mammography vs. mammography alone.

• There is some concern about the dose increase with tomosynthesis.

• Clinical data show a small increase in radiation dose with tomosynthesis.

• Synthetic 2D images from tomosynthesis at zero dose reduce potential harm.

• The small dose increase should not be a barrier to use of tomosynthesis.

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Abbreviations

AEC:

Automatic exposure control

CC:

Cranio-caudal

CDR:

Cancer detection rate

HVL:

Half value layer

LoA:

Limits of agreement

MLO:

Medio-lateral oblique

MGD:

Mean glandular dose

PMMA:

Polymethylmethacrylate

SD:

Standard deviation

VBD:

Volumetric breast density

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Author information

Authors and Affiliations

  1. Radiology Unit, Veneto Institute of Oncology IOV- IRCCS, via Gattamelata, 64, 35128, Padua, Italy

    Gisella Gennaro

  2. U.O. Senologia Clinica e Screening Mammografico, Department of Diagnostics, Azienda Provinciale Servizi Sanitari (APSS), Trento, Italy

    D. Bernardi

  3. Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia

    N. Houssami

Authors
  1. Gisella Gennaro
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  2. D. Bernardi
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  3. N. Houssami
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Corresponding author

Correspondence to Gisella Gennaro.

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Guarantor

The scientific guarantor of this publication is Gisella Gennaro

Conflict of interest

The authors of this manuscript are grateful to Volpara Solutions for the software use.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

One of the authors (G.G.) has significant statistical expertise

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board (Ethics Committee) approval was obtained.

Methodology

• Retrospective

• Experimental

• Performed at one institution

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Gennaro, G., Bernardi, D. & Houssami, N. Radiation dose with digital breast tomosynthesis compared to digital mammography: per-view analysis. Eur Radiol 28, 573–581 (2018). https://doi.org/10.1007/s00330-017-5024-4

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  • DOI: https://doi.org/10.1007/s00330-017-5024-4

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