Comparative Analysis of Radiation Dose in Advanced X-Ray Mammographic Modalities and Evaluation of Potential...

Contrast-enhanced mammography (CEM) is a highly accurate, patient-friendly imaging technique. This study aimed to compare the radiation dose of CEM with other mammographic modalities and examine factors influencing radiation exposure to minimize doses.

This retrospective study was conducted at a tertiary care teaching institute.

We analyzed 184 craniocaudal (CC) and 184 mediolateral oblique (MLO) views from 93 participants who underwent both Combo mode (digital mammography [DM] with digital breast tomosynthesis [DBT]) and CEM. Data on automatic exposure control, average glandular dose (AGD), compressed breast thickness (CBT), compression force (CF), breast density, and the anode/filter used were collected.

Scheffe's post hoc analysis compared AGD across different modalities and factors.

The mean AGD for CEM (including low-energy [LE] and high-energy [HE] components) was 1.35 times that of DM, 1.3 times that of DBT alone or with synthetic mammography (SM), and 0.66 times that of the Combo mode. AGD in CEM_LE and DBT with SM was comparable to DM across views. Higher AGDs were observed in the MLO view, dense breasts, and when using a tungsten-copper anode/filter. AGD positively correlated with CBT and CF.

CEM_LE and DBT with SM, showing similar AGD to DM in this study and comparable diagnostic value in the literature, may reduce the need for additional DM. CC views may be preferred over MLO for delayed imaging of contrast kinetics. With high diagnostic accuracy and acceptable radiation dose, CEM may be preferred over the Combo mode (DM + DBT).