title: Breast Radiation Dose With CESM Compared With 2D FFDM and 3D Tomosynthesis Mammography.
abstract: OBJECTIVE
  We aimed to compare radiation dose received during contrast-enhanced spectral mammography (CESM) using high- and low-energy projections with radiation dose received during 2D full field digital mammography (FFDM) and 3D tomosynthesis on phantoms and patients with varying breast thickness and density.
  
  
  METHODS
  A single left craniocaudal projection was chosen to determine the doses for 6214 patients who underwent 2D FFDM, 3662 patients who underwent 3D tomosynthesis, and 173 patients who underwent CESM in this retrospective study. Dose measurements were also collected in phantoms with composition mimicking nondense and dense breast tissue.
  
  
  RESULTS
  Average glandular dose (AGD) ± SD was 3.0 ± 1.1 mGy for CESM exposures at a mean breast thickness of 63 mm. At this thickness, the dose was 2.1 mGy from 2D FFDM and 2.5 mGy from 3D tomosynthesis. The nondense phantom had a mean AGD of 1.0 mGy with 2D FFDM, 1.3 mGy with 3D tomosynthesis, and 1.6 mGy with CESM. The dense breast phantom had a mean AGD of 1.3 mGy with 2D FFDM, 1.4 mGy with 3D tomosynthesis, and 2.1 mGy with CESM. At a compressed thickness of 4.5 cm, radiation exposure from CESM was approximately 25% higher in dense breast phantoms than in nondense breast phantoms. The dose in the dense phantom at a compressed thickness of 6 cm was approximately 42% higher than the dose in the nondense phantom at a compressed thickness of 4.5 cm.
  
  
  CONCLUSIONS
  CESM was found to increase AGD at a mean breast thickness of 63 mm by approximately 0.9 mGy and 0.5 mGy compared with 2D FFDM and 3D tomosynthesis, respectively. Of note, CESM provides a standard image (similar to 2D FFDM) that is obtained using the low-energy projection. Overall, the AGD from CESM falls below the dose limit of 3 mGy set by Mammography Quality Standards Act regulations.
authors.affiliation: 1 Department of Radiology, Diagnostic Physics Division, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054.
authors.forename: Judy R
authors.initials: JR
authors.lastname: James
authors.affiliation: 1 Department of Radiology, Diagnostic Physics Division, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054.
authors.forename: William
authors.initials: W
authors.lastname: Pavlicek
authors.affiliation: 1 Department of Radiology, Diagnostic Physics Division, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054.
authors.forename: James A
authors.initials: JA
authors.lastname: Hanson
authors.affiliation: 1 Department of Radiology, Diagnostic Physics Division, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Boltz
authors.affiliation: 2 Department of Radiology, Breast Imaging Division, Mayo Clinic Arizona, Phoenix, AZ.
authors.forename: Bhavika K
authors.initials: BK
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000000981:diagnostic imaging* / Q000528:radiation effects*; D003287:Contrast Media; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008327:Mammography / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis* / Q000517:prevention & control / Q000706:statistics & numerical data; D011835:Radiation Protection / Q000379:methods; D011856:Radiographic Image Enhancement / Q000295:instrumentation / Q000379:methods*; D011874:Radiometry; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: 3D tomosynthesis; breast imaging; contrast-enhanced spectral mammography; full field digital mammography; radiation dose