# Establishing Diagnostic Reference Levels for Mammography Digital Breast Tomosynthesis, Contrast Enhance, Implants, Spot Compression, Magnification and Stereotactic Biopsy in Dubai Health Sector

## TL;DR

This study establishes diagnostic reference levels for various mammography techniques in Dubai to ensure safe radiation doses for patients.

## Contribution

The novelty lies in calculating specific diagnostic reference levels for multiple mammography views and techniques in a Dubai health sector context.

## Key findings

- The highest mean glandular dose was observed for 2D bilateral spot compression with magnification views.
- For CBT group 60–69 mm, median MGD values were 3.35 mGy for MSCC and 4.14 mGy for MSMLO.
- Results align with published diagnostic reference levels using the same statistical methods and CBT groups.

## Abstract

The aim of this patient dose review is to establish a thorough diagnostic reference level (DRL) system. This entails calculating a DRL value for each possible image technique/view considered to perform a diagnostic mammogram in our practice. Diagnostic mammographies from a total of 1191 patients who underwent a diagnostic mammogram study in our designated diagnostic mammography center were collected and retrospectively analyzed. The DRL representing our health sector was set as the median of the mean glandular dose (MGD) for each possible image technique/view, including the 2D standard bilateral craniocaudal (LCC/RCC) and mediolateral oblique (LMLO/RMLO), the 2D bilateral spot compression CC and MLO (RSCC/LSCC and RSMLO/LSMLO), the 2D bilateral spot compression with magnification (RMSCC/LMSCC and RMSMLO/LMSMLO), the 3D digital breast tomosynthesis CC and MLO (RCC/LCC and RMLO/LMLO), the 2D bilateral implant CC and MLO (RIMCC/LIMCC and RIMMLO/LIMMLO), the 2D bilateral contrast enhanced CC and MLO (RCECC/LCECC and RCEMLO/LCEMLO) and the 2D bilateral stereotactic biopsy guided CC (SBRCC/SBLCC). This patient dose review revealed that the highest MGD was associated with the 2D bilateral spot compression with magnification (MSCC/MSMLO) image view. For the compressed breast thickness (CBT) group 60–69 mm, the median and 75th percentile of the MGD values obtained were MSCC: 3.35 and 3.96, MSMLO: 4.14 and 5.25 mGy respectively. Obvious MGD variations were witnessed across the different possible views even for the same CBT group. Our results are in line with the published DRLs when using same statistical quantity and CBT group.