Determination of local diagnostic reference levels for mammography in Fars Province, Iran

The most common cancer that strikes women is breast cancer. It is diagnosed using mammography, which is considered a gold standard diagnostic tool in detecting breast cancer. Despite the use of ionizing radiation, mammography should be performed according to the ALARA principle, ensuring that radiation dose is optimized while maintaining adequate image quality for accurate diagnosis. This study sought to determine the LDRL for mammography in Fars Province, Iran, in line with the guidelines provided in ICRP Publication 135. This analytical study involved the extraction of data from the DICOM header of quality-controlled mammography devices in 62 centers in Fars Province. In total, 27,345 mammogram reports ranging from 2004 to 2025 were analyzed. Technical information about mammography was obtained through kVp, mAs, anode filter combination, and patient information, including age and compressed breast thickness. Data from the past five years and projections of CC and MLO were considered in the analysis.The study determined LDRLs for both Entrance Surface Air Kerma (Kae) and organ dose. For Kae, which does not require breast thickness correction, the LDRL was established at 5.94 mGy for the CC view and 9.49 mGy for the MLO view. The LDRLs for organ dose were further stratified by breast thickness. A comparison with national and international standards revealed that while the LDRL for the CC view was lower than the NDRLs of the UK and Ireland, it remained higher than previously reported levels in Iran. Notably, the LDRL for the MLO view was found to be higher than levels reported in other Iranian studies and international benchmarks. These findings highlight the necessity for protocol optimization, particularly for the MLO view, to align local practices with global dose reduction standards.