Mammography diagnostic reference levels in Western Australia
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SCIENTIFIC NOTE
Mammography diagnostic reference levels in Western Australia Cameron Storm1 · Alicia Harvey1 · Mario Djukelic1 Received: 15 June 2020 / Revised: 22 July 2020 / Accepted: 30 July 2020 © Australasian College of Physical Scientists and Engineers in Medicine 2020
Abstract Mammography dose data has been collected from Western Australian units to establish Diagnostic Reference Levels for the state. Reference levels have been determined for a variety of phantom thicknesses for both full field digital mammography units and digital breast tomosynthesis units. Levels for the American College of Radiology (ACR) Phantom have been established as 1.3 mGy and 1.5 mGy mean glandular dose for full field digital mammography and digital breast tomosynthesis respectively. 2 cm PMMA was 0.9 mGy and 1.0 mGy and 6 cm PMMA had values of 2.0 mGy and 2.3 mGy. This data can be utilised to help establish national reference levels in the future. Keywords Mammography · MGD · DRL
Introduction Diagnostics reference levels (DRLs) have been identified as a critical component for the optimisation of patient dose in medical imaging [1, 2]. The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) has established a national DRL service for multi detector computed tomography, image guided interventional procedures and a variety of nuclear medicine procedures. This allows Australian practices to compare their facility typical doses to national DRLs. DRLs have not yet been established for other medical imaging modalities, including mammography. The importance of a national DRL service for mammography is highlighted by two key factors. Firstly, mammography is the only medical imaging modality in Australia that allows asymptomatic patients to be exposed to ionising radiation. BreastScreen Australia is the national breast cancer screening program available to all women aged between 50 and 74. Breast cancer screening is considered a critical factor for public health, and it has been demonstrated that the mortality rate from breast cancer in Australia has almost halved since its introduction in 1991 [3]. The benefits of screening programs are still debated, with publications drawing attention to the negatives of overdiagnosis, harmful * Cameron Storm [email protected] 1
outcomes from the treatment of over-diagnosed cancers, anxiety caused to patients and importantly the idea that the radiation from screening can cause fatal breast cancers [4, 5]. In this context, the optimization of patient dose is therefore critical. Secondly, the International Commission on Radiological Protection (ICRP) increased the tissue weighting factor for glandular breast tissue from 0.05 [6] to 0.12 in Publication 103 [7]. Given the radiosensitivity of glandular breast tissue, it is important to optimise mammography procedures [2]. DRLs are an important component for the optimisation of mammography doses. Other groups have recognized the importance of DRLs for dose optimisation and have acted on the paucity of nationally available
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