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Diagnostic reference levels in digital mammography: a systematic review.
Qiumei Liu1, Moayyad E Suleiman2, Mark F McEntee3
1Health and Social Sciences, Singapore Institute of Technology, Dover Road, Singapore.
Summary
Diagnostic reference levels (DRLs) in digital mammography (DM) require consistent protocols for accurate dose monitoring. This review updates DRL establishment methods, incorporating International Commission of Radiation Protection (ICRP) guidelines for better comparability.
Area of Science:
- Medical Imaging
- Radiological Physics
- Radiation Protection
Background:
- Diagnostic reference levels (DRLs) in digital mammography (DM) are crucial for radiation dose monitoring and optimization.
- Previous reviews highlighted inconsistencies in DRL establishment methodologies, complicating international comparisons.
- The International Commission of Radiation Protection (ICRP) released updated guidelines in 2017 to standardize DRL protocols.
Purpose of the Study:
- To provide an updated systematic review of DRLs in DM.
- To identify a more consistent protocol for establishing DRLs based on current guidelines.
- To serve as a resource for future research in DRLs, dose monitoring, and optimization.
Main Methods:
- Systematic literature search across multiple databases (Web of Science, PubMed-MEDLINE, ScienceDirect, CINAHL, Google Scholar).
- Inclusion of 19 relevant articles from an initial pool of 766.
- Analysis of data focusing on DRL establishment methodologies, data sources, protocols, and dose calculation methods.
Main Results:
- Updated ICRP guidelines offer clarifications on data sources (patient data preferred), protocol stratification (breast thickness, detector technology), and DRL quantity (median value at 75th percentile).
- Despite clarifications, a standardized method for estimating mean glandular dose remains lacking, hindering comparisons between studies and systems.
- The review incorporated updated ICRP recommendations, addressing some methodological inconsistencies.
Conclusions:
- While progress has been made in standardizing DRL establishment for DM, further efforts are needed to standardize dose calculation methods.
- This updated review provides valuable insights for researchers and practitioners aiming for consistent DRLs and effective dose optimization in mammography.
- Consistent DRL protocols are essential for reliable dose monitoring and inter-institutional comparisons in digital mammography.
