Diagnostic reference levels in digital mammography: a systematic review

Abstract

This study aims to review the literature on existing diagnostic reference levels (DRLs) in digital mammography and methodologies for establishing them. To this end, a systematic search through Medline, Cinahl, Web of Science, Scopus and Google scholar was conducted using search terms extracted from three terms: DRLs, digital mammography and breast screen. The search resulted in 1539 articles of which 22 were included after a screening process. Relevant data from the included studies were summarised and analysed. Differences were found in the methods utilised to establish DRLs including test subjects types, protocols followed, conversion factors employed, breast compressed thicknesses and percentile values adopted. These differences complicate comparison of DRLs among countries; hence, an internationally accepted protocol would be valuable so that international comparisons can be made.

Diagnostic reference levels for digital mammography in New South Wales

“…If we use a standard‐sized group of patients with compressed breast thickness 60 ± 5 mm to represent the overall population, the 75th percentile at this value is more than double and almost half that of the lowest and highest compressed breast thickness categories respectively. These results alongside the compressed breast thickness‐dependent dose variations demonstrated elsewhere highlight the importance of clearly identifying standard‐sized groups of compressed breast thicknesses when specifying DRLs . Although to date, this is not often seen, such stratification would extend the translation of a ‘ representative patient ’ from average compressed breast thickness to ranges of compressed breast thicknesses that are more representative of the population of women.…”

“…Overall, when taking into consideration the reported compressed breast thicknesses by other international studies, it was found that our reported dose medians and percentiles were less than most of patient studies reviewed by Suleiman et al . in 2014 …”

Mean glandular dose in digital mammography: a dose calculation method comparison

“…27 The same issue exists for the organ dose displayed by the imaging system, where different vendors are using different methods to estimate the organ dose, although it is important to emphasize here that the calculation methods employed by different vendors are not clear. Organ dose displayed by the system could be used as a robust method to evaluate the dose for a wide range of breast thicknesses and systems, as well as facilitating larger sample sizes.…”

Dosimetry in x-ray-based breast imaging

“…It is important to note however, the variety of protocols and data sources used. In their survey of diagnostic reference levels for mammography Suleiman et al (2015) identified publications from 11 countries that used conversion coefficients taken from the work of Dance and colleagues (section 5.1) and 7 that used the conversion coefficients of Wu et al or Boone et al (section 5.2). For the actual measurement protocols themselves there was variation between ACR (1999), IPEM (2005), European and IAEA protocols, although the latter three are quite similar.…”