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CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0045-1809902
Original Article

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

Porkodi Dharmalingam 
1   Institute of Radiodiagnosis, Government Kilpauk Medical College and Hospital, Chennai, Tamil Nadu, India
,
Devimeenal Jagannathan
1   Institute of Radiodiagnosis, Government Kilpauk Medical College and Hospital, Chennai, Tamil Nadu, India
› Author Affiliations
Funding None.
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Abstract

Background and Aim

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.

Settings and Design

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

Materials and Methods

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.

Statistical Analysis

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

Results

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.

Conclusion

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).

Keywords

radiation dose - average absorbed glandular dose - contrast-enhanced mammography - digital breast tomosynthesis - synthetic mammography - digital mammography - combo mode - low energy image of CEM - CC views compared with MLO views

Note

This manuscript was presented as an oral proffered paper category at AOCR 2025 on January 26, 2025.




Publication History

Article published online:
24 June 2025

© 2025. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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