title: Radiation exposure of contrast-enhanced spectral mammography compared with full-field digital mammography.
abstract: OBJECTIVE
  Contrast-enhanced spectral mammography (CESM) shows promising initial results but comes at the cost of increased dose as compared with full-field digital mammography (FFDM). We aimed to quantitatively assess the dose increase of CESM in comparison with FFDM.
  
  
  METHODS
  Radiation exposure-related data (such as kilovoltage, compressed breast thickness, glandularity, entrance skin air kerma (ESAK), and average glandular dose (AGD) were retrieved for 47 CESM and 715 FFDM patients. All examinations were performed on 1 mammography unit. Radiation dose values reported by the unit were validated by phantom measurements. Descriptive statistics of the patient data were generated using a statistical software package.
  
  
  RESULTS
  Dose values reported by the mammography unit were in good qualitative agreement with those of phantom measurements. Mean ESAK was 10.5 mGy for a CESM exposure and 7.46 mGy for an FFDM exposure. Mean AGD for a CESM exposure was 2.80 mGy and 1.55 mGy for an FFDM exposure.
  
  
  CONCLUSIONS
  Compared with our institutional FFDM, the AGD of a single CESM exposure is increased by 1.25 mGy (+81%), whereas ESAK is increased by 3.07 mGy (+41%). Dose values of both techniques meet the recommendations for maximum dose in mammography.
authors.affiliation: From the *Department of Radiology, Maastricht University Medical Center, Maastricht; †Department of Clinical Physics, Màxima Medical Center, Veldhoven; and ‡GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.
authors.forename: Cécile R L P N
authors.initials: CR
authors.lastname: Jeukens
authors.forename: Ulrich C
authors.initials: UC
authors.lastname: Lalji
authors.forename: Eduard
authors.initials: E
authors.lastname: Meijer
authors.forename: Betina
authors.initials: B
authors.lastname: Bakija
authors.forename: Robin
authors.initials: R
authors.lastname: Theunissen
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Wildberger
authors.forename: Marc B I
authors.initials: MB
authors.lastname: Lobbes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D004781:Environmental Exposure / Q000032:analysis; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide