Comparison of average glandular dose in mammography for patients with breast implants when using automatic or manual exposure technique

Anja Šimunović Simić ¹, Erna Alukić ², Laura Jurša ²

⁰Institute of Oncology Ljubljana, Mammography screening Programme, Zaloška 2, 1000 Ljubljana, Slovenia.

European Journal of Radiology +

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October 3, 2025

View abstract on PubMed

Summary

For mammograms with breast implants, manual settings reduce radiation dose and improve image quality in standard views. Automatic exposure control (AEC) is better for implant displacement views, lowering dose while maintaining acceptable image quality.

Area Of Science

Radiology
Medical Imaging
Radiation Dosimetry

Background

Mammography is crucial for breast cancer screening.
Women with breast implants require specialized imaging techniques.
Optimizing radiation dose and image quality is essential in mammography.

Purpose Of The Study

To evaluate average glandular dose (AGD) in mammography for women with breast implants.
To compare AGD and image quality between automatic exposure control (AEC) and manual settings.
To assess standard and Eklund (implant displacement) techniques.

Main Methods

Retrospective analysis of 536 patients with breast implants.
Mammography equipment from a single vendor (Hologic Selenia Dimensions).
Evaluation of exposure parameters, breast thickness, compression force, AGD, and image quality (PGMI classification) in standard (CC, MLO) and Eklund (CCID, MLOID) projections.

Main Results

AGD was higher with AEC in standard projections but lower in Eklund projections compared to manual settings (p < 0.001).
Manual settings yielded better image quality in standard projections (CC, MLO).
No significant difference in CCID image quality; MLOID images were superior with manual settings for most criteria.

Conclusions

AEC lowers AGD in implant displacement projections but increases it in standard projections.
Manual settings improve image quality in standard and some implant displacement views.
Standard projections benefit from manual settings; implant displacement views are best with AEC for dose reduction while maintaining quality.

Keywords:

Eklund technique Image quality Mammography with breast implant Radiation dose