Comparison of radiation dose in contrast-enhanced spectral mammography (CESM), full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT)

Introduction

The use of contrast-enhanced spectral mammography (CESM) has increased in recent years, as has awareness of radiation dose safety among professionals and patients. The principal aim of this study was to compare radiation exposure measured using the entrance surface dose (ESD) and the average glandular dose (AGD) in CESM, Full-Field Digital Mammography (FFDM) and Digital Breast Tomosynthesis (DBT). Our second objective was to evaluate differences caused by compressed breast thickness, compression force and patient age.

Methods

A retrospective observational study included all patients who had undergone a CESM between May 2021 and May 2022. Data was collected on ESD and AGD from the different CESM studies, and breast density and volume were determined by two expert radiologists. The comparative analysis focused on the dose of radiation received during the craniocaudal (CC) projection of the right breast in CESM studies and FFDM or DBT, performed within a 12-month period. Lastly, a statistical analysis was performed to determine the influence of breast compression thickness, compression force and patient age.

Results

Seventy-seven patients participated in the comparative study and forty-four in the dosimetric study. Differences in radiation dose (ESD/AGD) were found among the three breast imaging techniques. The dose in CESM (1.70/5.39 mGy) was lower than in DBT (2.19/6.79 mGy) and higher than in FFDM (1.26/4.06 mGy) for an average breast compression thickness of 59.64 mm. A positive correlation was observed between the dose received in CESM and breast compression thickness (ρ = 0.55), and a negative correlation was observed with patient age (ρ = −0.27). No differences in dosimetric variables were observed for different compression forces.

Conclusions

The ESD and AGD in the CC projection of the right breast in CESM are higher than in FFDM but lower than in DBT. The dose had a positive correlation with breast compression thickness and a negative correlation with patient age.