研究目的
This study compared radiation dosage and image quality between DBT + 2DSM versus FFDM.
研究成果
This study suggests the possibility of quantitative comparison of radiation dosage data between different imaging studies using Radimetrics. Moreover, image acquisition with DBT plus 2DSM can be accomplished with lower absorbed radiation doses and achieve higher image quality compared to FFDM alone and also compared to the current standard of FFDM plus DBT. Therefore, this study suggests that DBT with 2DSM has potential as an alternative to conventional FFDM.
研究不足
This study has a few limitations. First, data were collected in a retrospective manner and the patients were not randomized. The study population of patients who underwent FFDM and DBT has the tendency to be highly proportionate with respect to malignant lesions and the reviewers were aware of the indications for DBT which may increase the possibility of bias. However, this study group allows for more direct comparison of radiation dosage and image quality by eliminating patient specific variabilities. Second, all scans were performed in a single institution with a single vendor machine. The 2DSM images were from a single version of the software from the same manufacturer. Third, there is a difference in the study dates of DBT and FFDM, which could lead to differences in physiological status or compression state of the breast. Lastly, mean glandular dose has the potential to be overestimated compared to actual exposed dose and the radiation exposure may also be affected by the breast density which was not included in this study. Despite the potential to be overestimated, it provides a method to compare dosimetry consequences of different imaging technologies, acquisition techniques, or protocols.
1：Experimental Design and Method Selection:
Retrospective study design comparing radiation dosage and image quality between digital breast tomosynthesis (DBT) with two-dimensional synthetic mammography (2DSM) and full-field digital mammography (FFDM). Radiation dosimetry parameters (entrance dose and mean glandular dose) were obtained using the Radimetrics program. Image quality was assessed using a 5-point scoring system for lesion clarity.
2：Sample Selection and Data Sources:
208 patients (from an initial 374) who underwent both DBT with 2DSM and FFDM studies at Korea University Guro Hospital between June 2015 and February 2017 were included. Patients were selected based on having both exams and available radiation dosage data, with exclusions for those with only one exam or missing data.
3：List of Experimental Equipment and Materials:
Selenia Dimensions mammography system (Hologic, Marlborough, MA) for acquiring DBT and FFDM images. Radimetrics software (Bayer HealthCare, Whippany, NJ) for radiation dosage data. C-view 2D reconstruction system (Hologic) for 2DSM images.
4：Experimental Procedures and Operational Workflow:
Both DBT and FFDM were acquired using standard compression methods. DBT obtained 15 low-dose projection images along a 15-degree arc, reconstructed into 2DSM images. Radiation dosage data (entrance dose and mean glandular dose) were extracted using Radimetrics. Image analysis was performed by two specialized breast radiologists who evaluated lesion clarity and compared modalities in blinded and side-by-side sessions.
5：Data Analysis Methods:
Statistical analysis included Wilcoxon signed rank test for radiation dosage parameters, kappa values for inter-observer agreement, McNemar's test for diagnostic accuracy, Mann-Whitney U test for image quality scores, and chi-squared test for modality preference. Analysis was performed using SPSS and MedCalc with a p-value threshold of 0.05.
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