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

The aim of this study was to evaluate the average glandular dose (AGD) in mammography screening of women with breast implants and to compare the AGD and image quality obtained with automatic exposure control (AEC) versus manual exposure settings with standard and Eklund techniques (implant displacement).

A retrospective analysis of 536 patients with breast implants from a national screening program using mammography equipment from a single vendor (Hologic Selenia Dimensions) was performed. Each patient underwent eight images; four standard (CC, MLO) and four Eklund (CCID, MLOID) projections. Exposure parameters, breast thickness, compression force and AGD were assessed. A subset of 35 patients (eight images each) who underwent two consecutive mammograms with different exposure settings (AEC and manual) underwent image quality assessment using a standardized PGMI classification, which was evaluated by three radiologists experienced in mammography reporting.

AGD was significantly higher with AEC in standard projections (CC, MLO), but lower in Eklund projections (CCID, MLOID) than with manual exposure (p < 0.001). Manual exposure settings resulted in better image quality in standard projections, while no significant differences were observed in CCID images. For four out of six quality criteria, MLOID images were superior to manual settings.

AEC leads to lower AGD in implant displacement projections, but increases AGD in standard projections. Manual exposure settings resulted in better image quality for CC, MLO and MLOID projections, while IQ was at an acceptable level even when using AEC. The results emphasize that standard projection mammography in patients with breast implants should be performed with manual exposure settings, while ID projections should be performed with AEC while maintaining sufficient IQ.