Radioprotection 61-2 | Página 67

136 N. A. Alomairy et al.: Radioprotection 2026, 61( 2), 132 – 139

Table 5. Comparison of the MGD and CBT values from this study with those reported in other researches in the literature.

projections. The ESD, a key component of MGD, depends on a variety of parameters including exposure factors( such as tube voltage( kVp) and tube current-time( mAs)), the quality of the X-ray beam( which is influenced by the half-value layer( HVL)), the combination of target filter and filter materials, and breast thickness( Suliman et al., 2023). All of these play a significant role in determining the overall radiation dose and influences the differences in MGD between the two kinds of projection.

4.2 Analysis of factors influencing MGD

A pivotal observation in the study was the significant negative correlation between age and MGD. This suggests that as age increases, patients may have less glandular tissue and doses tend to slightly decrease, although the association is not very strong. Additionally, a strong positive correlation exists between tube voltage and both tube current( r = 0.612, p < 0.001) and ESD( r = 0.537, p < 0.001). These findings indicate that higher kVp settings are associated with increased mAs, greater ESD, and thicker breast compression, all required to maintain image quality.

The tube current had a highly significant correlation with ESD( r = 0.923 and p < 0.001), indicating that as one increases the tube current, the entrance surface dose also goes up directly, thus the optimization of this factor becomes necessary. CBT was significantly positively correlated with tube voltage, current, and ESD( r = 0.745, p < 0.001; r = 0.562, p < 0.0; r = 0.30, p < 0.001) and negatively correlated with MGD( r = �0.420, p < 0.001), suggesting that while thicker breasts result in higher ESDs, they are associated with lower MGDs. This inverse relationship is due to the operation of modern automatic exposure control( AEC) systems. They actively adjust exposure settings based on patient anatomy to attain the most optimum dose. In our set-up, the Fujifilm AMULET Innovality uses W / Rh anode-filter combinations and optimized beam qualities, which allow for reduced MGD even with denser breasts without sacrificing image quality. The system software is expected to decrease glandular dose by way of enhanced filtration and beam quality change with the rise in breast thickness. Although the opposite trend is not extensively documented in recent literature, similar findings can be seen in recent research involving digital systems with AEC optimization and dose modulation strategies( Di Maria et al., 2024; Suliman et al., 2023).

Overall, the analysis indicates that the tube current-time, mAs, is the most influential variable and is strongly related to the doses, ESD and MGD, while tube voltage, kVp, is another important variable that influences ESD and breast thickness. On the other hand, the weak negative correlation of age with both doses might indicate the less direct effect on dose-related variables. This could imply that as CBT increases, so does the possibility that MGD might be inversely related to the fact that thicker breasts require higher ESD to obtain adequate imaging, while the overall glandular dose may be reduced. These correlations indicate a complex interaction between patient factors and technical parameters that requires an imaging technique adjusted to individual profiles in order to optimize radiation exposure.

The multivariate regression analysis also confirmed that compressed breast thickness was independently associated with a decrease in MGD, even after other exposure parameters were accounted for. This supports the theory that new advanced AEC systems and beam filtration lower the glandular dose in thicker breasts. These findings are in agreement with recent studies by Suliman et al.( 2023) and Di Maria et al.( 2024). The positive influences of ESD and kVp reported in our regression model are both in line with our univariate correlation results and previous research, evidencing their dominant status in regulating glandular dose. The negative correlation between mAs and MGD may be indicative of systemspecific exposure compensation settings made by the digital mammography machine. These conclusions highlight the importance of employing multivariate techniques to untangle the complex relationship between the technical and patientrelated factors determining radiation dose in mammography.

4.3 Comparison with international studies

The MGDs for CC and MLO projections were 0.32 and 0.36 mGy respectively. These values are considerably lower compared to most of the international literature and benchmarks, as reflected in Tamam et al.( 2021), Alahmad et al.( 2023), Lekatou et al.( 2019), and Josephine et al.( 2020), and are below the international benchmarks sets by the IAEA( Di Maria et al., 2024; Uniyal et al., 2024), EC( Lekatou et al., 2019), and SFDA( SFDA, 2022). This low MGD is significant because of the high radiosensitivity of breast tissue, emphasizing the importance of adhering to diagnostic reference levels( DRLs). Additionally, the range of the