Abstract
Background/Objectives: Full-spine radiography is frequently performed from childhood to adulthood, raising concerns about radiation-induced breast cancer risk. To assess such probabilistic risks as cancer, accurate estimation of equivalent and effective organ doses is essential. The purpose of this study is to investigate X-ray imaging conditions for radiation reduction based on breast organ dose and to evaluate the accuracy of simulation software for dose calculation. Methods: Breast organ doses from full-spine radiography were calculated using the Monte Carlo-based dose calculation software PCXMC. Breast organ doses were estimated under various technical conditions of full-spine radiography (tube voltage, distance, grid presence, and beam projection). Dose reduction methods were explored, and variations in dose and error due to phantom characteristics and photon history number were evaluated. Results: Among the X-ray conditions, the greatest radiation reduction effect was achieved by changing the imaging direction. Changing from the anteroposterior to posteroanterior direction reduced doses by approximately 76.7% to 89.1% (127.8–326.7 μGy) in children and 80.4% to 91.1% (411.3–911.1 μGy) in adults. In addition, the study highlighted how phantom characteristics and the number of photon histories influence estimated doses and calculation error, with approximately 2 × 106 photon histories recommended to achieve a standard error ≤ 2%. Conclusions: Modifying radiographic conditions is effective for reducing breast radiation exposure in patients with scoliosis. Furthermore, to ensure the accuracy of dose calculation software, the number of photon histories must be adjusted under certain conditions and used while verifying the standard error. This study demonstrates how technical modifications, projection selection, and phantom characteristics influence breast radiation exposure, thereby supporting the need for patient-tailored imaging strategies that minimize radiation risk while maintaining diagnostic validity. The findings may be useful in informing radiographic protocols and the development of safer imaging guidelines for both pediatric and adult patients undergoing spinal examinations.