Breast Radiation Dose With CESM Compared With 2D FFDM and 3D Tomosynthesis Mammography.

OBJECTIVE: We aimed to compare radiation dose received during contrast-enhanced spectral mammography (CESM) using high- and low-energy projections with radiation dose received during 2D full field digital mammography (FFDM) and 3D tomosynthesis on phantoms and patients with varying breast thickness and density. MATERIALS AND METHODS: A single left craniocaudal projection was chosen to determine the doses for 6214 patients who underwent 2D FFDM, 3662 patients who underwent 3D tomosynthesis, and 173 patients who underwent CESM in this retrospective study. Dose measurements were also collected in phantoms with composition mimicking nondense and dense breast tissue. RESULTS: Average glandular dose (AGD) ± SD was 3.0 ± 1.1 mGy for CESM exposures at a mean breast thickness of 63 mm. At this thickness, the dose was 2.1 mGy from 2D FFDM and 2.5 mGy from 3D tomosynthesis. The nondense phantom had a mean AGD of 1.0 mGy with 2D FFDM, 1.3 mGy with 3D tomosynthesis, and 1.6 mGy with CESM. The dense breast phantom had a mean AGD of 1.3 mGy with 2D FFDM, 1.4 mGy with 3D tomosynthesis, and 2.1 mGy with CESM. At a compressed thickness of 4.5 cm, radiation exposure from CESM was approximately 25% higher in dense breast phantoms than in nondense breast phantoms. The dose in the dense phantom at a compressed thickness of 6 cm was approximately 42% higher than the dose in the nondense phantom at a compressed thickness of 4.5 cm. CONCLUSION: CESM was found to increase AGD at a mean breast thickness of 63 mm by approximately 0.9 mGy and 0.5 mGy compared with 2D FFDM and 3D tomosynthesis, respectively. Of note, CESM provides a standard image (similar to 2D FFDM) that is obtained using the low-energy projection. Overall, the AGD from CESM falls below the dose limit of 3 mGy set by Mammography Quality Standards Act regulations.

A primer on the use of dual-energy CT in the evaluation of commonly encountered neoplasms.

Technical improvements in the acquisition and display of dual-energy computed tomography (DECT) have made this technique increasingly applicable to clinical practice, particularly in the setting of oncologic imaging. DECT allows for qualitative and quantitative analysis of tissue composition beyond the standard anatomical evaluation possible with single-energy computed tomography. For example, DECT can be used to interrogate iodine and calcium concentrations and to increase iodine signal, which makes many pathologic processes more conspicuous and provides improved understanding of internal structure within mass lesions. A working understanding of common postprocessing DECT displays will allow radiologists to maximize the additional diagnostic information available in DECT examinations. In this article, we describe common strategies for DECT interrogation by organ system, which may improve the conspicuity and understanding of suspected malignancies.