Average glandular doses in contrast-enhanced spectral mammography (CEM)

Abstract Introduction Contrast-enhanced spectral mammography (CEM) is based on dual-energy breast exposure following intravenous administration of an iodinated contrast agent. Our study quantitatively assessed radiation dose from CEM for different breast thicknesses and compared it with doses from full-field digital mammography (FFDM) and with the dose limits set in the European Guidelines. Materials and Methods We studied 200,976 exposures from 59,438 examinations performed between January 2019 and December 2023 at the National Research Institute of Oncology, using a GE Healthcare Pristina Senographe mammography unit. Radiation exposure–related data, including average glandular dose (AGD) values, were obtained from the GE DoseWatch monitoring system. Doses for CEM exposure pairs (low- and high-energy exposure) were summed. Results Out of 176,700 FFDM exposures, the acceptable dose level was exceeded only in 11 cases (less than 0.01%). For combined CEM exposures, the acceptable dose level was exceeded in 965 out of 5481 cases (17.6%). The doses in FFDM exposures and low-energy CEM exposures are similar. Average glandular dose for FFDM exposures and low-energy CEM exposures is clearly dependent on the breast thickness. In contrast, the dose for a single high-energy CEM exposure is about 0.7 mGy and shows no clear dependency on breast thickness. Acceptable dose levels for combined CEM exposures were exceeded primarily with breasts with small thicknesses, most often (70% of cases) in patients whose breasts were less than 4 cm thick. For breasts from 6 cm and larger, no CEM exposures exceeded acceptable dose levels. Conclusions Although CEM exposures are a combination of two exposures (low- and high-energy), in most cases, the doses associated with CEM exposure do not exceed limits that were originally set for single FFDM exposures.