Two-Dimensional Mammography Imaging Techniques for Screening Women with Silicone Breast Implants: A Pilot Phantom Study

This study aimed to evaluate the impact of three two-dimensional (2D) mammographic acquisition techniques on image quality and radiation dose in the presence of silicone breast implants (BIs). Then, we propose and validate a new International Atomic Energy Agency (IAEA) phantom to reproduce these techniques. Images were acquired on a single Hologic Selenia Dimensions^® unit. The mammography of the left breast of a single clinical case was included. Three methods of image acquisition were identified. They were based on misused, recommended, and reference settings. In the clinical case, image criteria scoring and the signal-to-noise ratio on breast tissue (SNR_BT) were determined for two 2D projections and compared between the three techniques. The phantom study first compared the reference and misused settings by varying the AEC sensor position and, second, the recommended settings with a reduced current-time product (mAs) setting that was 13% lower. The signal-difference-to-noise ratio (<i>SDNR</i>) and detectability indexes at 0.1 mm (d' 0.1 mm) and 0.25 mm (d' 0.25 mm) were automatically quantified using ATIA software. Average glandular dose (AGD) values were collected for each acquisition. A statistical analysis was performed using Kruskal-Wallis and corrected Dunn tests (<i>p</i> < 0.05). The SNR_BT was 2.6 times lower and the AGD was -18% lower with the reference settings compared to the recommended settings. The SNR_BT values increased by +98% with the misused compared to the recommended settings. The AGD increased by +79% with the misused settings versus the recommended settings. The median values of the reference settings were 5.8 (IQR 5.7-5.9), 1.2 (IQR 0.0), 7.0 (IQR 6.8-7.2) and 1.2 (IQR 0.0) mGy and were significantly lower than those of the misused settings (<i>p</i> < 0.03): 7.9 (IQR 6.1-9.7), 1.6 (IQR 1.3-1.9), 9.2 (IQR 7.5-10.9) and 2.2 (IQR 1.4-3.0) mGy for the <i>SDNR</i>, d' 0.1 mm, d' 0.25 mm and the AGD, respectively. A comparison of the recommended and reduced settings showed a reduction of -6.1 ± 0.6% (<i>p</i> = 0.83), -7.7 ± 0.0% (<i>p</i> = 0.18), -6.4 ± 0.6% (<i>p</i> = 0.19) and -13.3 ± 1.1% (<i>p</i> = 0.53) for the <i>SDNR</i>, d' 0.1 mm, d' 0.25 mm and the AGD, respectively. This study showed that the IAEA phantom could be used to reproduce the three techniques for acquiring 2D mammography images in the presence of breast implants for raising awareness and for educational purposes. It could also be used to evaluate and optimize the manufacturer's recommended settings.