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Glandular Dose of Full Field Digital Mammography in Korean Women Based on Specific Factors

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Glandular Dose of Full Field Digital Mammography in Korean Women Based on Specific Factors BREAST IMAGING Iran J Radiol. 2018 October; 15(4):e62958. doi: 10.5812/iranjradiol.62958. Published online 2018 August 1. Research Article Glandular Dose of Full Field Digital Mammography in Korean Women Based on Specific Factors Seung Hee Han 1, Bong Joo Kang 1, *, Ji Eun Baek 1, Hyun Sil Lee 1 and Sung Hun Kim 1 1Department of Radiology, Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, South Korea *Corresponding author: Bong Joo Kang, Department of Radiology, Mary’s Hospital, College of Medicine, the Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, South Korea. Tel: +82-222586253, Fax: +82-25996771, Email: [email protected] Received 2017 October 17; Revised 2018 June 27; Accepted 2018 July 10. Abstract Background: Mammographic screening for breast cancer has been proved to reduce mortality. However, because of the potential harm of ionizing radiation, radiation dose management has been issued. Objectives: We investigated the influence of several factors on the radiation dose change in full-field digital mammography (FFDM) using a radiation dose management system in Korean women. Patients and Methods: Using an existing radiation dose management system (RadimetricsTM), radiation dose tracking, monitor- ing, and statistical analyses were conducted. Information including parameters, utilization data, and a dose report were sent to the conventional picture archiving, communication system, and radiation dose management system. We reviewed the data and com- pared the parameters (exposure, glandular dose, compression thickness, and compression force) between two different devices, among classifications (plain, spot and magnification view, and implant), and between control modes (auto and manual). An as- sociation between compression thickness and glandular dose was evaluated. Finally, the glandular dose differences based on age, device, classification, control mode, exposure, compression thickness, and compression force were additionally investigated. Results: From February 25th to June 30th, 2015, a total of 15665 mammogram images of 3958 patients were performed and sent to the conventional picture archiving and communication system (PACS) and the radiation dose management system. A significant difference was observed in glandular dose, compression thickness, compression force, and exposure depending on the type of de- vice (P < 0.05). There were significant differences in all of the parameters among the plain view, spot and magnification view, and implant image (P < 0.05). There was a significant difference in compression thickness and compression force depending on the control mode. A strong association was observed between the compression thickness and glandular dose (P < 0.05). Conclusion: There was glandular dose difference according to specific factors including device type, classification, and control mode. Radiation dose management system is useful for identifying factors that affect radiation dose. Keywords: Radiation Dosage, Digital Mammography, Breast 1. Background Several radiation dose management software pro- grams are now used in clinical practice to recruit and an- Mammographic screeningArchive is proved to reduce mortal- alyze patient of radiation doseSID data (10). Radiation dose man- ity from breast cancer (1). Use of ionizing radiation is con- agement systems could help radiologists optimize proto- sidered a potential harm due to the possible risk of induc- cols, reduce radiation dose, and manage quality. To our ing cancer in patients (1,2). It is generally agreed that radi- knowledge, there are no previous data on the application ation dose per examination is a crucial parameter for eval- of this radiation dose management system in mammogra- uation of the radiation-induced breast cancer risk from phy. mammographic screening (1-4). Recently, general consen- sus about the importance of radiation dose management for patient safety has been established, and dose reduc- 2. Objectives tion has become an important issue in patient safety (5-7). Women often receive screening mammograms through- In our study, we investigated the factors associated out their lifetime; however, concern is increasing regard- with an increased radiation dose in full-field digital mam- ing radiation dosage and radiation-induced breast cancer mography (FFDM) and the clinical usefulness of the radia- (8,9). tion dose management system in FFDM. Copyright © 2018, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. www.SID.ir Han SH et al. 3. Patients and Methods Table 1. Patient and Image (View) Characteristics Characteristics Values 3.1. Patients Patient (n = 3958) Our institutional review board approved this prospec- Age tive study and waived informed patient consent. We per- Mean (SD) 52.94 (10.17) formed radiation dose tracking, monitoring, and statisti- Median (min - max) 53 (22 - 85) cal analysis using an existing radiation dose management Device No. (%) system (RadimetricsTM [Bayer HealthCare, Whippany, NJ]) Lorad selenia 2405 (60.76) from February 25th to June 30th, 2015. During this period, Mammomat inspiration 1553 (39.24) a total of 15665 images were obtained from 3958 patients Image number per patient who underwent a mammogram for screening or diagno- Mean (SD) 3.74 (0.84) sis. The mean age of the patients was 52.94 years (range, 22 Median (min - max) 4 (1 - 9) - 58). We used two different devices: Lorad Selenia (Hologic Sum of glandular dose (mGy) Company, Bedford, MA, USA) and Mammomat Inspiration Mean (SD) 7.09 (3.49) (Siemens, Erlangen, Germany). The Mammomat Inspira- Median (min - max) 6.66 (0.74 - 46.93) tion unit was used from January 1, 2009, and the Lorad Sele- IQR 4.44 - 8.85 nia was used from August 1, 2006. Utilization data, param- Image (view) (n = 15665) eters, and mammography dosage reports were sent to the Device No. (%) conventional picture archiving and communication sys- Lorad selenia 9086 (58) TM tem (PACS) and the Radimetrics Enterprise platform. The Mammomat inspiration 6579 (42) radiation dose management system extracted the mean Classification No. (%) glandular dose from the digital imaging and communica- Plain 14925 (95.28) tions in medicine (DICOM) tag ‘Organ Dose (0040, 0316)’, Spot and magnification 570 (3.64) as defined in the DICOM Standard, and presented it to the Implant 170 (1.09) application for data aggregation for analysis (11). The radi- Control mode No. (%) ation dose management system showed the mean glandu- Auto 15416 (98.41) lar dose per laterality (left or right) of the breast according Manual 249 (1.59) to the ‘L’ or ‘R’ value in the image level DICOM tag ‘Later- Exposure (µAs) ality (0020, 0062)’ and summed the mean glandular dose Mean (SD) 94510.49 (31969.93) within the same laterality (11). Data regarding exposure, Median (Q1 - Q3) 89590 (74210 - 110000) compression thickness, and compression force were also Compression thickness (mm) extracted from the DICOM tags of each image and used for Mean (SD) 47 (12.70) analysis. We reviewed the data using our personal comput- Median (Q1 - Q3) 47 (39 - 55) ers by accessing the web server of the radiation dose man- Compression force (N) agement system. Patient and image (view) characteristics Mean (SD) 101.33 (28.66) are shown in Table 1. Median (Q1 - Q3) 100.70 (84.20 - 117.80) Glandular dose (mGy) 3.2. Analyzing Factors Affecting Radiation Dose Mean (SD) 1.79 (0.74) We compared how the parameters (glandular dose, ex- Median (Q1 - Q3) 1.72 (1.21 - 2.21) posure, compression thickness, and compression force) Abbreviations: IQR, interquartile range (means standard deviation); µAs, mi- are influenced by the devices, classifications, and control croampere; N, Newton; Q1, lower quartile, Q3, upper quartile; SD, standard de- modes. We evaluated theArchive association between compres- viation. of SID sion thickness and glandular dose. Additionally, we investigated the difference in glandu- (R Foundation for Statistical Computing, Vienna, Austria; lar dose depending on age, device, classification (plain, https://www.r-project.org/). We performed normality as- spot and magnification view, implant), control mode sessment of data before choosing the statistic tests. The (auto, manual), exposure (µAs, microampere), compres- normality was assessed by performing the Kolmogorov- sion thickness, and compression force. Smirnov test on the parameters (glandular dose, exposure, compression thickness, and compression force). The P 3.3. Statistical Analysis value < 0.01 and the number of subjects in each compara- All statistical analyses were performed using the SAS tive group was at least 200, we used parametric analysis, t- Enterprise software package Guide 5.1 (SAS Institute, Inc., test and ANOVA. comparisons of the parameters (glandular Cary, North Carolina, USA) or R software version 2.15.3 dose, exposure, compression thickness, and compression 2 Iran J Radiol. 2018; 15(4):e62958. www.SID.ir Han SH et al. force) between devices and between the control modes 4.4. Factors Affecting Glandular Dose were conducted using independent Student’s t-tests. Com- A negative correlation was observed between patient parison of the parameters among classifications and the age and glandular dose. There was a difference in glan- association between compression thickness and glandular
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