Establishing Diagnostic Reference Levels in Digital Mammography from Eight Mammography Units Using over 30,000 Images
Abstract
:1. Introduction
2. Materials and Methods
3. Results and Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
MGD | Mean glandular dose |
DRL | Diagnostic reference level |
CC | Craniocaudal |
MLO | Mediolateral oblique |
CBT | Compressed breast thickness |
kVp | Peak kilovoltage |
mAs | Tube current |
IQR | Interquartile range |
kVp | Peak kilovoltage |
mAs | Current |
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Unit | Manufacturer | Technology | Anode/Filter | Projections | Cases |
---|---|---|---|---|---|
A | Fuji Innovality | DR | W/Rh | 4520 | 1130 |
B | Fuji Amulet s | DR | W/Rh | 1772 | 443 |
C | Fuji Amulet s | DR | W/Rh | 3436 | 859 |
D | Fuji Amulet s | DR | W/Rh | 5672 | 1418 |
E | Fuji Amulet s | DR | W/Rh | 2832 | 708 |
F | Fuji Amulet s | DR | W/Rh | 2608 | 652 |
G | Fuji Innovality | DR | W/Rh | 6380 | 1595 |
H | Hologic Selenia | DR | W/Ag, W/Rh | 3820 | 955 |
Mammography Unit | A | B | C | D | E | F | G | H | All | ||
---|---|---|---|---|---|---|---|---|---|---|---|
No. of cases | 1130 | 443 | 859 | 1418 | 708 | 652 | 1595 | 955 | 7760 | ||
No. of images | 4520 | 1772 | 3436 | 5672 | 2832 | 2608 | 6380 | 3820 | 31040 | ||
Mean Age (years) (StDev) | 51.30 (11.50) | 55.24 (10.51) | 54.80 (10.29) | 54.85 (13.24) | 55.00 (12.75) | 54.89 (12.60) | 55.32 (12.67) | 51.63 (8.56) | 54.12 (11.51) | ||
Mean Thickness (mm) (StDev) | 56 (13) | 47 (13) | 51 (12) | 56 (13) | 50 (12) | 48 (13) | 57 (13) | 60 (13) | 54 (13) | ||
Mean kVp (StDev) | 29.34 (1.67) | 28.45 (1.35) | 28.82 (1.25) | 29.41 (1.48) | 28.69 (1.37) | 28.55 (1.43) | 29.53 (1.42) | 30.15 (1.84) | 29.11 (1.47) | ||
Mean mAs (StDev) | 67.74 (30.56) | 108.89 (49.33) | 95.81 (40.97) | 54.24 (17.10) | 129.70 (68.66) | 102.92 (38.64) | 70.60 (22.41) | 250.41 (93.11) | 110.03 (45.09) | ||
Mean ESAK (mGy) (IQR) | 3.54 (1.79) | 5.73 (2.78) | 5.44 (3.26) | 3.28 (1.71) | 6.21 (4.2) | 5.23 (2.85) | 3.56 (1.82) | 11.42 (7.98) | 3.9 (3.14) | ||
Mean MGD/View (mGy) | CC | R | 0.92 | 1.58 | 1.47 | 0.86 | 1.59 | 0.93 | 0.93 | 2.61 | 1.36 |
L | 0.92 | 1.57 | 1.40 | 0.85 | 1.59 | 0.92 | 0.92 | 2.48 | 1.33 | ||
R + L | 0.92 | 1.57 | 1.43 | 0.85 | 1.59 | 0.92 | 0.92 | 2.54 | 1.34 | ||
MLO | R | 1.04 | 1.98 | 1.79 | 0.99 | 2.07 | 1.06 | 1.06 | 2.95 | 1.61 | |
L | 1.05 | 1.96 | 1.80 | 0.96 | 2.09 | 1.06 | 1.06 | 2.88 | 1.60 | ||
R + L | 1.04 | 1.97 | 1.80 | 0.97 | 2.08 | 1.06 | 1.06 | 2.92 | 1.61 | ||
Median MGD (mGy) (IQR) | 0.91 (0.39) | 1.63 (0.76) | 1.47 (0.79) | 0.86 (0.36) | 1.63 (1.02) | 1.50 (0.69) | 0.94 (0.38) | 2.61 (1.46) | 1.15 (0.84) |
View | CBT (mm) | N | Thickness (mm) | Age (years) | Compression Force (N) | Voltage (kV) | Tube Current (mAs) | Entrance Dose (mGy) |
---|---|---|---|---|---|---|---|---|
Mean ± Std (Range) | ||||||||
MLO | <7 | 2 | 4.5 ± 0.7 | 88.0 ± 0.0 (88–88) | 143.9 ± 28.6 (123.6 –164.1) | 23.0 ± 0.0 (23–23) | 29.5 ± 19.0 (16–43) | 0.5 ± 0.4 (0.3–0.8) |
10–19 | 59 | 16.5 ± 2.3 | 57.3 ± 15.3 (31–86) | 96.3 ± 39.5 (17.4–178.4) | 25.6 ± 0.9 (22–28) | 49.2 ± 24.9 (10–126) | 1.6 ± 0.8 (0.3–3.7) | |
20–29 | 318 | 26.0 ± 2.6 | 54.2 ± 12.7 (25–91) | 104.9 ± 37.2 (0.0–193.1) | 26.2 ± 0.6 (24–28) | 63.4 ± 29.1 (10–164) | 2.1 ± 0.8 (0.3–4.3) | |
30–39 | 1156 | 35.4 ± 2.8 | 54.7 ± 12.1 (28–88) | 111.2 ± 37.6 (0.0–229.0) | 27.6 ± 0.8 (26–30) | 75.2 ± 44.4 (13–368) | 2.9 ± 1.3 (0.6–11.4) | |
40–49 | 2661 | 45.0 ± 2.9 | 54.7 ± 11.4 (25–87) | 109.2 ± 36.5 (15.9–233.2) | 28.1 ± 0.4 (26–33) | 83.6 ± 52.4 (10–454) | 3.6 ± 1.8 (0.4–18.8) | |
50–59 | 4226 | 54.7 ± 2.8 | 55.1 ± 10.5 (25–90) | 108.1 ± 36.0 (0.0–227.8) | 29.5 ± 0.9 (26–34) | 98.1 ± 63.1 (0–507) | 4.8 ± 2.5 (0–24.5) | |
60–69 | 4063 | 64.2 ± 2.9 | 53.9 ± 9.6 (27–83) | 107.3 ± 36.6 (0.0–235.9) | 30.3 ± 0.7 (28–38) | 127.1 ± 93.0 (17–574) | 6.7 ± 4.2 (0.9–30.4) | |
70–79 | 2093 | 73.8 ± 2.8 | 52.8 ± 8.9 (27–86) | 104.3 ± 37.2 (10.9–224.1) | 31.0 ± 1.0 (28–34) | 139.3 ± 89.4 (2–574) | 8.7 ± 5.2 (0–35.1) | |
80–89 | 708 | 83.6 ± 2.9 | 51.9 ± 8.8 (32–82) | 96.4 ± 37.6 (14.0–200.8) | 31.9 ± 1.6 (29–34) | 160.7 ± 98.3 (0–555) | 11.2 ± 7.0 (0–51.6) | |
90–99 | 138 | 93.3 ± 2.9 | 51.6 ± 8.0 (29–76) | 93.5 ± 34.7 (23.4–192.9) | 33.2 ± 1.2 (28–35) | 181.1 ± 103.2 (45–509) | 14.4 ± 8.1 (2.4–41.2) | |
100–109 | 25 | 102.6 ± 2.1 | 52.4 ± 8.7 (43–79) | 81.7 ± 36.0 (27.6–156.8) | 33.9 ± 2.3 (30–37) | 174.5 ± 111.4 (53–428) | 15.2 ± 9.7 (3.5–36.4) | |
110–119 | 2 | 111.5 ± 0.7 | 61 ± 4.2 (58–64) | 126.4 ± 21.1 (111.4–141.3) | 34.5 ± 3.5 (32–37) | 119.5 ± 44.5 (88–151) | 13.7± 11.5 (5.621.8) | |
Pearson correlation One-way ANOVA | r = 0.0789 p < 0.001 | r = 0.068 p < 0.001 | r = 0.857 p < 0.001 | r = 0.331 p < 0.001 | r = 0.535 p < 0.001 | |||
CC | <7 | 9.0 | 5.9 ± 2.3 | 67.6 ± 17.0 (51–88) | 75.0 ± 40.2 (0–131.6) | 23.4 ± 0.7 (22–24) | 42.9 ± 26.1 (15–98) | 1.0 ± 0.6 (0.3–2.2) |
10–19 | 104.0 | 16.1 ± 2.4 | 57.9 ± 14.6 (31–91) | 94.0 ± 42.5 (11.9–184.6) | 25.8 ± 0.7 (24–28) | 44.5 ± 23.1 (10–109) | 1.4 ± 0.7 (0.3–2.8) | |
20–29 | 585.0 | 25.7 ± 2.7 | 55.7 ± 12.9 (19–91) | 101.1 ± 38.4 (0–222.7) | 26.2 ± 0.5 (24–28) | 60.5 ± 26.6 (12–184) | 2.0 ± 0.8 (0.3–4.7) | |
30–39 | 1949.0 | 35.4 ± 2.8 | 55.2 ± 12.5 (19–88) | 104.0 ± 39.6 (0–234.2) | 27.5 ± 0.7 (25–30) | 72.0 ± 38.1 (10–327) | 2.9 ± 1.2 (0.4–8.6) | |
40–49 | 4143.0 | 44.9 ± 2.8 | 54.3 ± 11.9 (19–87) | 99.0 ± 37.3 (0–228.6) | 28.1 ± 0.7 (25–33) | 78.9 ± 49.0 (8–442) | 3.4 ± 1.7 (0.3–18.3) | |
50–59 | 4882.0 | 54.4 ± 2.8 | 53.8 ± 10.1 (19–90) | 99.0 ± 34.9 (0–229.8) | 29.4 ± 0.7 (26–34) | 93.0 ± 63.6 (8–470) | 4.5 ± 2.4 (0.4–22.5) | |
60–69 | 2837.0 | 63.8 ± 2.8 | 52.5 ± 9.0 (19–86) | 97.1 ± 35.4 (0–231.2) | 30.3 ± 1.0 (26–38) | 124.8 ± 97.6 (8–574) | 6.4 ± 4.2 (0.3–30.4) | |
70–79 | 865.0 | 73.3 ± 2.6 | 51.3 ± 8.4 (20–83) | 90.4 ± 36.2 (0–217.0) | 30.8 ± 1.3 (26–34) | 146.9 ± 99.1 (8–574) | 8.9 ± 5.8 (0.3–35.5) | |
80–89 | 178.0 | 83.2 ± 2.6 | 51.0 ± 7.2 (35–78) | 82.4 ± 36.7 (0–177.5) | 32.2 ± 0.9 (27–34) | 159.6 ± 88.9 (45–441) | 11.1 ± 6.2 (1.9–31.6) | |
90–99 | 25.0 | 92.0 ± 2.1 | 42.9 ± 11.3 (19–58) | 59.2 ± 46.2 (0–139.0) | 32.0 ± 2.4 (27–34) | 144.7 ± 106.5 (45–509) | 10.6 ± 8.1 (2.0–34.4) | |
100–109 | 8.0 | 102.6 ± 2.6 | 51.1 ± 10.1 (37–64) | 57.1 ± 47.9 (0–123.9) | 31.4 ± 3.1 (26–34) | 84.5 ± 26.7 (50–127) | 6.1 ± 3.0 (2.0–9.9) | |
110–119 | 4.0 | 112.0 ± 2.0 | 42.5 ± 26.0 (20–66) | 44.1 ± 52.7 (0–104.9) | 31.8 ± 6.7 (26–38) | 149.8 ± 156.4 (50–379) | 14.8± 16.4 (2.1–36.6) | |
Pearson correlation One-way ANOVA | r = 0.116 p < 0.001 | r = 0.0801 p < 0.001 | r = 0.847 p < 0.001 | r = 0.329 p < 0.001 | r = 0.515 p < 0.001 |
CBT (mm) | Present Work | References | |||
---|---|---|---|---|---|
MGD DRL (mGy) | MGD DRL (mGy)/View | ||||
CC | MLO | CC | MLO | All View | |
<7 | 0.94 | 0.44 | |||
10–19 | 1.08 | 1.17 | |||
20–29 | 1.11 | 1.17 | 0.97 (CBT:20–29 mm) [9] | ||
30–39 | 1.3 | 1.32 | 1.6 (CBT:36 mm) [21]; 3.48 (CBT:36 mm) [23]; | 1.12 (CBT:30–39 mm) [9] | |
40–49 | 1.31 | 1.38 | 2.4 (CBT: 45 mm) [21] 2.03 (CBT: 44 mm) [23] | 1.31 (CBT:40–49 mm) [9] | |
50–59 | 1.61 | 1.75 | 1.68 (CBT: 50.9 mm) [22] 2.5 (CBT: 50–60 mm) [24] 1.6 (CBT: 50 mm) [25] | 2.25 (CBT: 58.9 mm) [22] 1.8 (CBT: 50 mm) [25] | 1.65 (CBT:50–59 mm) [9] 1.7 (CBT:50 mm) [25] |
60–69 | 2.11 | 2.25 | 1.23 (CBT: 60–69 mm) [26] | 1.32 (CBT: 60–69 mm) [26] | 2.35 (CBT: 60–69 mm) [9] |
70–79 | 2.81 | 2.80 | 2.08 (CBT: 70–79 mm) [9] | ||
80–89 | 3.2 | 3.38 | 2.34 (CBT: 80–89 mm) [9] | ||
90–99 | 2.54 | 4.02 | 2.63 (CBT: 90–99 mm) [9] | ||
100–109 | 1.63 | 4.40 | 3.31 (CBT:100–110 mm) [9] |
CBT Range (mm) | MGD Typical Value (mGy) | MGD European DLR (mGy) | ||
---|---|---|---|---|
CC | MLO | Acceptable | Achievable | |
20–29 | 0.92 | 0.94 | <1.0 | <0.6 |
30–39 | 1.07 | 1.09 | <1.5 | <1.0 |
40–49 | 1.09 | 1.15 | <2.0 | <1.6 |
50–59 | 1.30 | 1.40 | <2.5 | <2.0 |
60–69 | 1.63 | 1.74 | <3.0 | <2.4 |
70–79 | 2.05 | 2.04 | <4.5 | <3.6 |
80–89 | 2.34 | 2.40 | / | / |
90–99 | 2.15 | 2.87 | <6.5 | <5.1 |
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Mediji-Arifi, M.; Ristova, M. Establishing Diagnostic Reference Levels in Digital Mammography from Eight Mammography Units Using over 30,000 Images. Diagnostics 2025, 15, 682. https://doi.org/10.3390/diagnostics15060682
Mediji-Arifi M, Ristova M. Establishing Diagnostic Reference Levels in Digital Mammography from Eight Mammography Units Using over 30,000 Images. Diagnostics. 2025; 15(6):682. https://doi.org/10.3390/diagnostics15060682
Chicago/Turabian StyleMediji-Arifi, Mirjeta, and Mimoza Ristova. 2025. "Establishing Diagnostic Reference Levels in Digital Mammography from Eight Mammography Units Using over 30,000 Images" Diagnostics 15, no. 6: 682. https://doi.org/10.3390/diagnostics15060682
APA StyleMediji-Arifi, M., & Ristova, M. (2025). Establishing Diagnostic Reference Levels in Digital Mammography from Eight Mammography Units Using over 30,000 Images. Diagnostics, 15(6), 682. https://doi.org/10.3390/diagnostics15060682