The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study

PURPOSEThe purpose of this study was to evaluate the effect of outside-field-of-view (FOV) lead shielding on the entrance surface dose (ESD) of the breast on an anthropomorphic X-ray phantom for a variety of axial skeleton X-ray examinations.METHODSUsing an anthropomorphic phantom and radiation dosimeter, the ESD of the breast was measured with and without outside-FOV shielding in anterior-posterior (AP) abdomen, AP cervical spine, occipitomental 30° (OM30) facial bones, AP lumbar spine, and lateral lumbar spine radiography. The effect of several exposure parameters, including a low milliampere-seconds technique, grid use, automatic exposure control use, wraparound lead (WAL) use, trolley use, and X-ray table use, on the ESD of the breast with and without outside-FOV shielding was investigated. The mean ESD (μSv) and standard deviation for each radiographic protocol were calculated. A one-tailed Student’s t-test was carried out to evaluate whether ESD to the breast was reduced with the use of outside-FOV shielding.RESULTSA total of 920 breast ESD measurements were recorded across the different protocol parameters. The largest decrease in mean ESD of the breast with outside-FOV shielding was 0.002 μSv (P = 0.084), recorded in the AP abdomen on the table with a grid, OM30 on the table with a grid, OM30 standard protocol on the trolley, and OM30 on the trolley with WAL protocols. This decrease was found to be statistically non-significant.CONCLUSIONThis study found no significant decrease in the ESD of the breast with the use of outside-FOV shielding for the AP abdomen, AP cervical spine, OM30 facial bones, AP lumbar spine, or lateral lumbar spine radiography across a range of protocols

Breast cancer in the Arabian gulf countries: Defining mammographic density presentation and optimising diagnosis of breast cancer

Aims: 1) to report participation rates in breast self-examination (BSE), clinical breast examination (CBE) and mammography among women living in Ras Al Khaimah (RAK) and to examine their beliefs, attitudes and knowledge regarding breast cancer and early detection practices, 2) to report mammographic density patterns and their associations with demographic and reproductive factors in RAK and Riyadh. Methods: In the first study, 102 women were interviewed and a total of 366 and 792 mammographs were collected for the second and third studies, respectively. The first and second studies were carried out in RAK whereas the third study was conducted in Riyadh. The American College of Radiology, Breast Imaging Reporting and Data System (ACR, BI-RADS) 5th version and the Laboratory for Individualized Breast Radiodensity Assessment (LIBRA) software were used to estimate mammographic density. Results: In the first study BSE was practiced and CBE and mammography were performed on 51, 40 and 38 women, respectively. Only 4% were aware about the appropriate age to start mammography screening and 84.3% did not know the correct screening interval. Reasons for not planning to undergo CBE or mammography screenings were fear of cancer, pain during the examination and absence of doctor’s recommendation. In the second study, 22%, 43%, 24% and 11% women were allocated to BI-RADS a, b, c and d, respectively. Emirati women were significantly less likely to have increased mammographic density than Western women. In the third study, a mean percent density of 10.3cm2 and dense breast area of 19.1cm2 were reported. BMI, menopausal status and age at menarche remained significant predictors for mammographic density. Conclusions: This thesis has two main outcomes. First, establishing culturally sensitive public awareness and education programs is a priority in RAK. Second, mammography would be considered a modality of choice for breast cancer screening among Emirati and Saudi women