Have a personal or library account? Click to login
Diagnostic reference levels (DRLs) in digital mammography in the European context – a systematic review Cover

Diagnostic reference levels (DRLs) in digital mammography in the European context – a systematic review

Open Access
|Aug 2025

References

  1. Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol. 2005;16(3):481-488. doi:10.1093/annonc/mdi098
  2. Hendrick RE, Botsco M, Plott CM. Quality control in mammography. Radiol Clin North Am. 1995;33(6):1041-1057. PMID: 7480654.
  3. European Commission: Directorate-General for Health and Consumers, Karsa, L. v., Holland, R., Broeders, M., Wolf, C. d. et al., European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis.4th Edition, Supplements. Publications Office of the European Union; 2013. Accessed January 28, 2025. https://data.europa.eu/doi/10.2772/13196
  4. Dosimetry in Diagnostic Radiology: An International Code of Practice. INTERNATIONAL ATOMIC ENERGY AGENCY, Technical Reports Series No. 457, IAEA, Vienna 2007; https://www.iaea.org/publications/7638/dosimetry-in-diagnostic-radiology-an-international-code-of-practice
  5. Quality Assurance Programme for Digital Mammography. INTERNATIONAL ATOMIC ENERGY AGENCY; Human Health Series No. 17, IAEA, Vienna 2011. https://www.iaea.org/publications/8560/quality-assurance-programme-for-digital-mammography
  6. Sechopoulos I, Dance DR, Boone JM, Bosmans HT, Caballo M, et al. Joint AAPM Task Group 282/EFOMP Working Group Report: Breast dosimetry for standard and contrast-enhanced mammography and breast tomosynthesis. Med Phys. 2024;51(2):712-739. doi:10.1002/mp.16842
  7. Dance DR, Sechopoulos I. Dosimetry in x-ray-based breast imaging. Phys Med Biol. 2016;61(19):R271. doi:10.1088/0031-9155/61/19/R271
  8. Vañó E, Miller DL, Martin CJ, Rehani MM, Kang K, et al. ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging. Ann ICRP. 2017;46(1):1-144. doi:10.1177/0146645317717209
  9. Pereira L, Ferreira MT, Lima AGF, Lima I, Morandi V, et al. Biological effects induced by doses of mammographic screening. Phys Medica PM Int J Devoted Appl Phys Med Biol Off J Ital Assoc Biomed Phys AIFB. 2021;87:90-98. doi:10.1016/j.ejmp.2021.06.002
  10. Suleiman ME, McEntee MF, Cartwright L, Diffey J, Brennan PC. Diagnostic reference levels for digital mammography in New South Wales. J Med Imaging Radiat Oncol. 2017;61(1):48-57. doi:10.1111/1754-9485.12540
  11. Jensen JE, Butler PF. Breast exposure: nationwide trends; a mammographic quality assurance program results to date. Radiol Technol. 1978;50(3):251-257.
  12. Suleiman ME, Brennan PC, McEntee MF. Diagnostic reference levels in digital mammography: a systematic review. Radiat Prot Dosimetry. 2015;167(4):608-619. doi:10.1093/rpd/ncu365
  13. Hemamala U, Weerakoon BS. Diagnostic Reference Levels (DRLs) in Digital Mammography: A Systematic Review. 2022; 5(2): 1080https://www.semanticscholar.org/paper/Diagnostic-Reference-Levels-(DRLs)-in-Digital-A-Hemamala-Weerakoon/95b77470d5b70e5bb462ccd4e85508d87e7111b6
  14. Buhari S, Mohammed R. Mammography Diagnostic Reference Level for Breast Cancer Screening Procedures: A Systematic Review. Nursing Clinics of North America. (2023). 2. 3. 10.31579/2835-8147/020.
  15. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. doi:10.1136/bmj.b2700
  16. Cornell JE. The PRISMA extension for network meta-analysis: bringing clarity and guidance to the reporting of systematic reviews incorporating network meta-analyses. Ann Intern Med. 2015;162(11):797-798. doi:10.7326/M15-0930
  17. Wu X, Barnes GT, Tucker DM. Spectral dependence of glandular tissue dose in screen-film mammography. Radiology. 1991;179(1):143-148. doi:10.1148/radiology.179.1.2006265
  18. Boone JM. Glandular Breast Dose for Monoenergetic and High-Energy X-ray Beams: Monte Carlo Assessment. Radiology. 1999;213(1):23-37. doi:10.1148/radiology.213.1.r99oc3923
  19. Dance DR, Skinner CL, Young KC, Beckett JR, Kotre CJ. Additional factors for the estimation of mean glandular breast dose using the UK mammography dosimetry protocol. Phys Med Biol. 2000;45(11):3225-3240. doi:10.1088/0031-9155/45/11/308
  20. Perry N, Broeders M, Wolf C de, Törnberg S, Holland R, et al. European Commission, eds. European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis. Fourth edition. Publications Office; 2006.
  21. Lekatou A, Metaxas V, Messaris G, Antzele P, Tzavellas G, Panayiotakis G. INSTITUTIONAL BREAST DOSES IN DIGITAL MAMMOGRAPHY. Radiat Prot Dosimetry. 2019;185(2):239-251. doi:10.1093/rpd/ncz005
  22. Parmaksız A, Ataç GK, Bulur E, İnal T, Alhan A. AVERAGE GLANDULAR DOSES AND NATIONAL DIAGNOSTIC REFERENCE LEVELS IN MAMMOGRAPHY EXAMINATIONS IN TURKEY. Radiat Prot Dosimetry. 2020;190(1):100-107. doi:10.1093/rpd/ncaa080
  23. Rafajlovic S, Ciraj-Bjelac O, Bozovic P. Towards National Diagnostic Reference Levels for Mammography in Serbia. Radiat Prot Dosimetry. Published online November 24, 2020:ncaa173. doi:10.1093/rpd/ncaa173
  24. Dupont L, Aberle C, Botsikas D, Ith M, Lima TVM, et al. Proposed DRLs for mammography in Switzerland. J Radiol Prot Off J Soc Radiol Prot. 2024;44(2). doi:10.1088/1361-6498/ad37c8
  25. Kelaranta A, Toroi P, Timonen M, Komssi S, Kortesniemi M. Conformance of mean glandular dose from phantom and patient data in mammography. Radiat Prot Dosimetry. 2015;164(3):342-353. doi:10.1093/rpd/ncu261
  26. Sá dos Reis C, Fartaria MJ, Garcia Alves JH, Pascoal A. PORTUGUESE STUDY OF MEAN GLANDULAR DOSE IN MAMMOGRAPHY AND COMPARISON WITH EUROPEAN REFERENCES. Radiat Prot Dosimetry. 2018;179(4):391-399. doi:10.1093/rpd/ncx300
  27. Hauge IHR, Bredholt K, Olerud HM. New diagnostic reference level for full-field digital mammography units. Radiat Prot Dosimetry. 2013;157(2):181-192. doi:10.1093/rpd/nct136
  28. Michielsen K, Jacobs J, Lemmens K, Nens, J, Zoetelief, J, et al. Results of a European dose survey for mammography. Radiat Prot Dosimetry. 2008;129(1-3): 199-203. doi:10.1093/rpd/ncn152
  29. Chevalier M, Morán P, Ten JI, Fernández Soto JM, Cepeda T, Vañó E. Patient dose in digital mammography. Med Phys. 2004;31(9):2471-2479. doi:10.1118/1.1784591
  30. Ślusarczyk-Kacprzyk W, Skrzyński W, Fabiszewska E. Evaluation of Doses and Image Quality in Mammography with Screen-Film, CR, and DR Detectors - Application of the ACR Phantom. Pol J Radiol. 2016;81:386-391. doi:10.12659/PJR.897304
  31. Loveland J, Young KC, Oduko JM, Mackenzie A. Radiation doses in the United Kingdom breast screening programmes 2016-2019. Br J Radiol. 2022;95(1135):20211400. doi:10.1259/bjr.20211400
  32. Mediji-Arifi M, Ristova M. Establishing Diagnostic Reference Levels in Digital Mammography from Eight Mammography Units Using over 30,000 Images. Diagnostics. 2025;15(6):682. doi:10.3390/diagnostics15060682
  33. Avramova-Cholakova S, Vassileva J. A survey of the state of mammography practice in Bulgaria. Radiat Prot Dosimetry. 2011;147(1-2):184-186. doi:10.1093/rpd/ncr320
  34. Borg M, Badr I, Royle GJ. Mammography equipment performance, image quality, and mean glandular dose in Malta. Radiat Prot Dosimetry. 2013;156(2):168-183. doi:10.1093/rpd/nct051
  35. Baldelli P, McCullagh J, Phelan N, Flanagan F. Comprehensive dose survey of breast screening in Ireland. Radiat Prot Dosimetry. 2011;145(1):52-60. doi:10.1093/rpd/ncq375
  36. Faj D, Posedel D, Stimac D, Ivezic Z, Kasabasic M, et al. Survey of mammography practice in Croatia: equipment performance, image quality and dose. Radiat Prot Dosimetry. 2008;131(4):535-540. doi:10.1093/rpd/ncn283
  37. Ghetti C, Ortenzia O, Palleri F, Sireus M. Definition of Local Diagnostic Reference Levels in a Radiology Department Using a Dose Tracking Software. Radiat Prot Dosimetry. 2017;175(1):38-45. doi:10.1093/rpd/ncw264
  38. Kunosic S, Čeke D, Kopric M, Lincender L. Determination of mean glandular dose from routine mammography for two age groups of patients. Healthmed. 2010 4(1):125-131.
DOI: https://doi.org/10.2478/pjmpe-2025-0028 | Journal eISSN: 1898-0309 | Journal ISSN: 1425-4689
Language: English
Page range: 246 - 255
Submitted on: May 9, 2025
Accepted on: Jul 25, 2025
Published on: Aug 28, 2025
Published by: Polish Society of Medical Physics
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2025 Mirjeta Mediji Arifi, Mimoza M. Ristova, published by Polish Society of Medical Physics
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.