Abstract
PURPOSE: To investigate the glandular dose magnitudes and characteristics resulting from image acquisition using a dedicated breast computed tomography (BCT) clinical prototype imaging system. METHODS: The x-ray spectrum and output characteristics of a BCT clinical prototype (Koning Corporation, West Henrietta, NY) were determined using empirical measurements, breast phantoms, and an established spectrum model. The geometry of the BCT system was replicated in a Monte Carlo-based computer simulation using the GEANT4 toolkit and was validated by comparing the simulated results for exposure distribution in a standard 16 cm CT head phantom with those empirically determined using a 10 cm CT pencil ionization chamber and dosimeter. The computer simulation was further validated by replicating the results of a previous BCT dosimetry study. Upon validation, the computer simulation was modified to include breasts of varying sizes and homogeneous compositions spanning those encountered clinically, and the normalized mean glandular dose resulting from BCT was determined. Using the system's measured exposure output determined automatically for breasts of different size and density, the mean glandular dose for these breasts was computed and compared to the glandular dose resulting from mammography. Finally, additional Monte Carlo simulations were performed to study how the glandular dose values vary within the breast tissue during acquisition with both this BCT prototype and a typical craniocaudal (CC) mammographic acquisition. RESULTS: This BCT prototype uses an x-ray spectrum with a first half-value layer of 1.39 mm Al and a mean x-ray energy of 30.3 keV. The normalized mean glandular dose for breasts of varying size and composition during BCT acquisition with this system ranges from 0.278 to 0.582 mGy/mGy air kerma with the reference air kerma measured in air at the center of rotation. Using the measured exposure outputs for the tube currents automatically selected by the system for the breasts of different sizes and densities, the mean glandular dose for a BCT acquisition with this prototype system varies from 5.6 to 17.5 mGy, with the value for a breast of mean size and composition being 17.06 mGy. The glandular dose throughout the breast tissue of this mean breast varies by up to +/- 50% of the mean value. During a typical CC view mammographic acquisition of an equivalent mean breast, which typically results in a mean glandular dose of 2.0-2.5 mGy, the glandular dose throughout the breast tissue varies from approximately 15% to approximately 400% of the mean value. CONCLUSIONS: Acquisition of a BCT image with the automated tube output settings for a mean breast with the Koning Corp. clinical prototype results in mean glandular dose values approximately equivalent to three to five two-view mammographic examinations for a similar breast. For all breast sizes and compositions studied, this glandular dose ratio between acquisition with this BCT prototype and two-view mammography ranges from 1.4 to 7.2. In mammography, portions of the mean-sized breast receive a considerably higher dose than the mean value for the whole breast. However, only a small portion of a breast undergoing mammography would receive a glandular dose similar to that from BCT.