Forward-scattered radiation from the compression paddle should be considered in glandular dose estimations

From major protocols on dosimetry in mammography, there is no doubt that the incident air kerma should be evaluated without backscattered radiation to the dosemeter. However, forward-scattered radiation from the compression paddle is neglected. The aim of this work was to analyse the contribution of forward-scattered radiation for typical air kerma measurements. Measurements of forward-scatter were performed with a plane-parallel ionisation chamber on four mammography units. The forward-scatter contribution to the air kerma was 2-10 % and increased with the compression paddle thickness, but also with the half-value layer value. For incident air kerma in mammography, it can be as important to consider forward-scattered as backscattered radiation. If an ionisation chamber is used, the compression paddle should be in contact with the chamber; otherwise the air kerma and absorbed dose will be underestimated. If a dosemeter based on semiconductors with much less sensitivity to scattered radiation is used, it is suggested that a forward-scatter factor (FSF) is applied. Based on the results of this work, FSF = 1.06 will lead to a maximum error of ~4 %.