Contrast Enhancement Digital Mammography dosimetry: preliminary evaluation of dose increase in thick/dense breast

Congress:

EuroSafe Imaging 2021

Poster Number:

ESI-13005

Type:

EuroSafe Imaging

Keywords:

Breast, Contrast agents, Radioprotection / Radiation dose, Mammography, Contrast agent-intravenous, Dosimetry, Radiation safety, Cancer, Multidisciplinary cancer care, Quality assurance

Authors:

E. M. L. Vaccara, N. Brunetti, M. Calabrese, A. Garlaschi, L. Ridolfi, G. Pellecchia, M. Dordolo, C. Gavotti, F. Levrero

DOI:

10.26044/esi2021/ESI-13005

DOI-Link:

https://dx.doi.org/10.26044/esi2021/ESI-13005

Purpose or learning objective

In our hospital, a new Hologic Selenia 3Dimensions tomosynthesis allows to perform Contrast Enhancement Digital Mammography (CEDM), that has a bigger cancer detection-rate respect to conventional Full Field Digital Mammography (FFDM), but it has the disadvantage of introducing an increased radiation exposure. The new European Directive, transposed by Legislative Decree 101/2020, provides that the information relating to the exposure is part of the report of the medical-radiological procedure. Since the estimation of the accuracy of the effective dose (E) value given to the patient is...

Methods or background

As is known, CEDM consists of two exposures: The first realized with low energy due to W/Rh or W/Ag (Anode/Filter combination) The second at high energy due to W/Cu. The internal protocol provides for the injection of the iodinated contrast agent and the wait of two minutes; then, for each craniocaudal (CC) and mediolateral oblique (MLO) projection on both breasts. Typically, it begins from the side where there is the disease you want to investigate. The system acquires two separated but nearly simultaneous low and...

Results or findings

Based on our Poly Methyl MethAcrylate (PMMA) measurements, the dose limits would be respected even if we did an FFDM before the injection and a CEDM after the injection. In fact, the EUREF dose limits are perfectly respected for all thicknesses investigated, as can be seen in the figure.[Fig 4] A very interesting thing is that the dose increase compared to conventional mammography (FFDM) is not only due to the double exposure (high energy contributes only 25%), but to the low energy exposure which alone...

Conclusion

CEDM is commonly utilised for multiple clinical indications from screening to final diagnosis, dosimetric aspects could have relevance on patient enrolment.

References

"EUREF, Correction/updates on: European protocol for the quality control of the physical and technical aspects of mammography screening chapter", 2d digital mammography -01/2017 "Breast Density" Dr Bruno Di Muzio and Radswiki et al (https://radiopaedia.org/articles/breast-density)

Personal information and conflict of interest

E. M. L. Vaccara: Nothing to disclose N. Brunetti: Nothing to disclose M. Calabrese: Nothing to disclose A. Garlaschi: Nothing to disclose L. Ridolfi: Nothing to disclose G. Pellecchia: Nothing to disclose M. Dordolo: Nothing to disclose C. Gavotti: Nothing to disclose F. Levrero: Nothing to disclose

Fig 1: Work-flow

Fig 2: AGD comparison

Fig 3: AGD discrepancy

Fig 4: EUREF constraints

Fig 5: CEDM dose, normalized respecting to FFDM dose

Fig 6: BI-RADS density class of the first enrolled patients

Fig 7: The trend of the mean value of CEDM AGD for different thickness class