Screening Digital Breast Tomosynthesis: Radiation Dose Among Patients With Breast Implants

Nhu Q Vu; Curran Bice; John Garrett; Colin Longhurst; Daryn Belden; Carolyn Haerr; Lucinda Prue; Ryan W Woods

doi:10.1093/jbi/wbab073

Screening Digital Breast Tomosynthesis: Radiation Dose Among Patients With Breast Implants

J Breast Imaging. 2021 Nov 16;3(6):694-700. doi: 10.1093/jbi/wbab073.

Authors

Nhu Q Vu¹, Curran Bice¹, John Garrett², Colin Longhurst³, Daryn Belden², Carolyn Haerr², Lucinda Prue⁴, Ryan W Woods^{1

2}

Affiliations

¹ University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
² UW Health, Department of Radiology, Madison, WI, USA.
³ University of Wisconsin, Department of Statistics, Madison, WI, USA.
⁴ UnityPoint Health-Meriter, Department of Radiology, Madison, WI, USA.

PMID: 38424937
DOI: 10.1093/jbi/wbab073

Abstract

Objective: To compare the mean glandular dose (MGD), cancer detection rate (CDR), and recall rate (RR) among screening examinations of patients with breast implants utilizing various digital breast tomosynthesis (DBT)-based imaging protocols.

Methods: This IRB-approved retrospective study included 1998 women with breast implants who presented for screening mammography between December 10, 2013, and May 29, 2020. Images were obtained using various protocol combinations of DBT and 2D digital mammography. Data collected included MGD, implant type and position, breast density, BI-RADS final assessment category, CDR, and RR. Statistical analysis utilized type II analysis of variance and the chi-square test.

Results: The highest MGD was observed in the DBT only protocol, while the 2D only protocol had the lowest (10.29 mGy vs 5.88 mGy, respectively). Statistically significant difference in MGD was observed across protocols (P < 0.0001). The highest per-view MGD was among DBT full-field (FF) views in both craniocaudal and mediolateral oblique projections (P < 0.0001). No significant difference was observed in RR among protocols (P = 0.17). The combined 2D (FF only) + DBT implant-displaced (ID) views protocol detected the highest number of cancers (CDR, 7.2 per 1000), but this was not significantly different across protocols (P = 0.48).

Conclusion: The combination of 2D FF views and DBT ID views should be considered for women with breast implants in a DBT-based screening practice when aiming to minimize radiation exposure without compromising the sensitivity of cancer detection. Avoidance of DBT FF in this patient population is recommended to minimize radiation dose.

Keywords: breast implants; digital breast tomosynthesis; radiation dose; screening mammography.