Patient investigation of average glandular dose and incident air kerma for digital mammography

Our aim in this study was to investigate the incident air kerma (IAK) and average glandular dose (AGD) for polymethylmethacrylate (PMMA) phantoms and patient breasts for each thickness by use of digital mammography units, and to determine the correlation between phantom and patient measurements. An additional aim was to calculate the numerical value of the diagnostic reference level (DRL) for digital mammography in Japan based on the AGD from patient measurements. Patient-based IAK and AGD values were calculated for 300 patients who underwent mammographic examinations at three institutions. On examination of a 40-mm PMMA phantom, the IAK and the AGD were 7.89 and 1.84 mGy, respectively. The mean patient breast thickness was 37.6 mm, and the mean IAK and the AGD calculated from actual patient data for breast thicknesses between 40 mm and 50 mm were 8.91 and 2.08 mGy, respectively. Approximately 20% of the 300 patients had IAK >10 mGy. The distributions of patient-based IAK and AGD values were higher than the IAK and AGD values for the PMMA phantom. The patient dose with use of the PMMA phantom can be underestimated. The DRL was calculated from patient-based AGDs of the regular breast thickness as 2.0 mGy in Japan.