两种摄影模式下的乳腺X射线摄影的剂量比较  

Dose comparison of mammography with two photographic modes

作　　者：卢艳会 李俊[1] 罗春燕[1] 陈常群 赵卫[1] 罗珺[1] Lu Yanhui;Li Jun;Luo Chunyan;Chen Changqun;Zhao Wei;Luo Jun(Department of Medical Imaging,First Affiliated Hospital of Kunming Medical University,Kunming 650032,Chin)

机构地区：[1]昆明医科大学第一附属医院医学影像科,昆明650032

出　　处：《中华放射医学与防护杂志》2023年第6期475-482,共8页Chinese Journal of Radiological Medicine and Protection

基　　金：云南省科技计划项目资金基础研究计划(昆医联合专项)(202101AY070001-101);云南省放射与治疗临床医学研究中心(202102AA100067)。

摘　　要：目的对比分析数字乳腺X射线断层融合成像和全数字化乳腺X射线摄影两种模式下乳腺X射线摄影剂量比较,以及平均腺体剂量与乳腺密度、压迫厚度的关系。方法回顾性收集2020年10月至2022年5月在昆明医科大学第一附属医院行数字乳腺X射线断层融合成像(DBT)的乳腺疾病患者以及同时期在本院行全数字化乳腺X射线摄影(FFDM)的体检人群的乳腺X射线摄影资料,记录压迫厚度、压迫力度及平均腺体剂量(AGD),由两名从事乳腺影像诊断的高年资医师依照2013年ACR BI⁃RADS MAMMOGRAPHY对乳腺腺体密度进行分型,分为a(腺体组织<25%)、b(腺体组织约25%~50%)、c(腺体组织约50%~75%)、d(腺体组织>75%)4型,分析在FFDM、DBT模式下,不同腺体密度、不同压迫厚度与AGD的关系。结果无论是FFDM还是DBT模式,随着乳腺腺体密度增加AGD逐渐增加,AGD_(a型)<AGD_(b型)<AGD_(c型)<AGD_(d型),差异有统计学意义(F=861.63、617.83、330.33、451.45、290.47,P<0.001)。行FFDM的c、d型乳腺,压迫厚度为31~40 mm时AGD较低。在相同压迫厚度下,a、b、c、d型乳腺AGD_(DBT)均高于AGD_(FFDM),差异有统计学意义(a型:t=-17.88、-42.19、-29.90、-28.14、-24.95,P<0.001;b型:t=-49.18、-35.94、-27.25、-28.37、-24.10,P<0.001;c型:t=-11.78、-32.90、-23.13、-20.51、-18.24,P<0.001;d型:t=-7.94、-26.24、-17.24、-15.44、-13.81,P<0.001),乳腺厚度为61~70 mm的d型乳腺AGD两者差异最大,为1.07 mGy(95%CI:0.92~1.22)。AGD与乳腺密度、压迫厚度正相关,且FFDM的相关性强于DBT。结论乳腺X射线摄影AGD与乳腺密度、压迫厚度正相关,与FFDM相比,DBT会增加AGD,但AGD增幅在安全范围内,临床工作中行DBT检查对乳腺疾病患者有益。Objective To compare radiation dose between digital breast tomosynthesis(DBT)and full⁃field digital mammography(FFDM),and explore the correlation of average glandular dose(AGD)with breast density and compression thickness.Methods The mammographic data of patients with breast diseases who underwent digital breast tomosynthesis(DBT)and the population who underwent full⁃field digital mammography(FFDM)screening in the First Affiliated Hospital of Kunming Medical University from October 2020 to May 2022 were retrospectively collected.The compression thickness,compression force and AGD were recorded.According to the 2013 ACR BI⁃RADS MAMMOGRAPHY,the breast gland density was classified into 4 types:a(glandular tissue<25%),b(glandular tissue 25%~50%),c(glandular tissue 50%~75%)and d(glandular tissue>75%),by two senior doctors engaged in breast imaging diagnosis.The relationships between different gland densities,different compression thicknesses and AGD under FFDM and DBT mode were analyzed.Results In both FFDM and DBT modes,the AGD increased significantly with the increase of breast density(F=861.63,617.83,330.33,451.45,290.47,P<0.001),and AGD_(a)<AGD_(b)<AGD_(c)<AGD_(d).For type c and d breasts undergoing FFDM,AGD was lowest when the compression thickness was 31~40 mm.Under the same compression thickness,The AGD_(DBT) was significantly higher than the AGD_(FFDM) in all types(Type a:t=-17.88,-42.19,-29.90,-28.14,-24.95,P<0.001;Type b:t=-49.18,-35.94,-27.25,-28.37,-24.10,P<0.001;Type c:t=-11.78,-32.90,-23.13,-20.51,-18.24,P<0.001;Type d:t=-7.94,-26.24,-17.24,-15.44,-13.81,P<0.001).The difference between two AGDs of Type d with compression thickness of 61~70 mm was the largest,which was 1.07 mGy(95%CI:0.92~1.22).The AGD was positively correlated with breast density and compression thickness,and the relationship of FFDM was stronger than that of DBT.Conclusions The AGD is positively correlated with breast density and compression thickness in mammography.Compared with FFDM,DBT can increase AGD,The AGD would increase in

关 键 词：数字乳腺X射线断层融合成像 全数字化乳腺X射线摄影 平均腺体剂量 乳腺密度 压迫厚度 

分 类 号：R816.4[医药卫生—放射医学] R655.8[医药卫生—临床医学]