Radioprotection 2026, 61( 2), 132 – 139 © N. A. Alomairy et al., Published by EDP Sciences 2026 https:// doi. org / 10.1051 / radiopro / 2025039
Available online at: www. radioprotection. org
ARTICLE
Evaluating factors affecting mean glandular dose in mammography: a retrospective analysis
N. A. Alomairy *
, R. A. Awaji, S. I. Hurubi, S. M. Ajlan, W. A. Alshamrani and A. A. Shbier
Diagnostic Radiograph Technology( DRT), Jazan University, Jazan, Saudi Arabia. Received: 10 March 2025 / Accepted: 7 September 2025
Abstract – Breast cancer is common among women, and mammography plays a key role in early diagnosis with radiation hazards. This study estimates MGD in a university hospital and compares it with international guidelines to ensure optimal protection. A retrospective cross-sectional study was conducted using a sample of 325 female patients who underwent a routine mammography from January 2022 to October 2024 at a university hospital. MGD was calculated using standard dosimetric equations such as entrance surface dose( ESD), compressed breast thickness( CBT), tube voltage( kVp), and tube current( mAs) for both craniocaudal( CC) and medial oblique( MLO) views. Statistical computation was carried out using the SPSS software along with Pearson’ s correlation to assess the association between the technical parameters and radiation dose. The mean MGD for CC and MLO projections were 0.34 mGy and 0.36 mGy, respectively. MGD was found to be significantly low compared to international reference levels, reflecting effective dose management. MGD correlated positively with mAs and negatively with CBT, and was the lowest reported internationally, indicating optimized imaging protocols. This study confirms that Saudi mammography practices meet ALARA standards, ensuring high-quality imaging with minimal radiation. Further research should assess long-term outcomes and explore lower-dose techniques.
Keywords: breast cancer( BC) / compressed breast thickness( CBT) / mean glandular dose( MGD) / entrance skin dose( ESD)
1 Introduction
Breast cancer( BC) is the most prevalent female malignancy, accounting for 10.4 % of all female cancers worldwide, and is the second most common and fifth highest mortality among all cancers in the world( Samaila & Rilwanu, 2024; Sharma et al., 2010; Suliman et al., 2023). In Saudi Arabia, it is the most common cause of cancer death among women with a 29.7 % incidence rate in 2018( Abusanad, 2022; Alqahtani et al., 2020; Basudan, 2022). Therefore, Early detection significantly improves survival and can be achieved through breast self-examination, clinical tests, and mammography( Alahmad et al., 2023; Suliman et al., 2023).
Mammography is a low-energy X-ray imaging technique used for breast screening and diagnosis( Josephine et al., 2020; Suliman et al., 2023). Standard screening follows international guidelines and includes craniocaudal( CC) and mediolateral oblique( MLO) views, which enhance lesion detection and reduce recall rates( Alahmad et al., 2023; Lekatou et al., 2019).
* Corresponding author: nalumairi @ jazanu. edu. sa
Breast compression is used to minimize breast thickness. This improves picture quality while also reducing the dispersed radiation and patient radiation dose( Josephine et al., 2020). Despite its benefits in early cancer detection, mammography uses ionizing radiation, which can damage DNA and increase cancer risk( Kosar, 2022; Pereira et al., 2021; Tahiri et al., 2021). Given the breast tissue’ s high radiosensitivity, exposure must be kept as low as reasonably achievable( Grimm et al., 2022; Tamam et al., 2021).
International bodies have set diagnostic reference levels( DRLs) to optimize patient dose while ensuring image quality. The International Atomic Energy Agency( IAEA) recommends a normal breast dose of 3 mGy for standard breast imaging examinations( Di Maria et al., 2024; Schiabel et al., 2023; Uniyal et al., 2024). The European Commission( EC) guidelines specify a DRL of 2.5 mGy for a standard compressed breast thickness( CBT) of 53 mm( Dalah et al., 2024; Garba et al., 2021; Lekatou et al., 2019; Nassar et al., 2023). In Saudi Arabia, a DRL of 1.44 mGy( 1.36 mGy for CC view and 1.54 mGy for MLO view) for a ranged CBT of( 40 – 50 mm) was set by the Saudi Food and Drug Authority( SFDA, 2022).
This is an Open Access article distributed under the terms of the Creative Commons Attribution License( https:// creativecommons. org / licenses / by / 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.