Forward-scattered radiation from the compression paddle should be considered when average (or mean) glandular dose is estimated
Department of Medical Radiation Physics, Lund University Skne University Hospital Malm Malm, SWEDEN firstname.lastname@example.org
From major protocols on dosimetry in mammography there is no doubt that the incident air kerma should be evaluated without backscattered (BS) radiation to the dosemeter. However, forward-scatter (FS) from the compression paddle is neglected. This has resulted in confusion and unnecessary differences in dosimetry methods and results. A recent thesis  and paper  made it clear that FS should be included as for an ionisation chamber in contact with the compression paddle and the contribution reported to the incident air kerma was a factor of 1.06 and 1/0.929=1.076, respectively. It is suggested that this factor should be called forward-scatter factor (FSF) ; cf. backscatter factor (BSF).
1. Hemdal B, PhD Thesis Lund University, Malm (2009) 2. Dance D R et al. Phys Med Biol 54 4361-4372 (2009)
The purpose of this work is to ...
... further investigate the contribution from FS for typical incident air kerma measurements. ... compare with backscatter data. ... discuss some practical consequences that should be considered in dose protocols.
Materials and Methods 1 (2)
Measurements of forward-scatter were performed with
a plane-parallel ionisation chamber (PTW) with volume 0.2 cm3, diameter 13 mm and depth 1.5 mm at a 60 mm distance from the breast support edge to its center.
Four mammography units were used, each one with a compression paddle selected based on clinical relevance.
A = Senographe Essential (GE)
19x23, flex, high edge, 5144833
B = Mammomat Inspiration (Siemens)
24x30, no flex, low edge, 10139964
C = DM 1000 (Agfa), which is based on Lorad M-IV (Hologic)
18x24, flex, high edge, FAB-00207
D = Mammomat Novation (Siemens)
18x24, no flex, high edge, 10048515
Materials and Methods 2 (2)
Estimation of forward scatter factors (FSF) for an ionisation chamber from air kerma (K) measurements, as FSF=Ka / Kb
Compression paddle in Compression paddle up, contact with the chamber beam well collimated Note: The figures only shows the principle, not one of the units in this work.
Results 1 (2)
1,15 Scatter factors
A: 2.72 mm C: 2.13 mm BSF B: 2.43 mm D: 1.51 mm
Half-value layer (mm Al)
Measured FSF values for mammography units A-D. The measured compression paddle thickness (mm) is indicated in each case, A-D. BSF values from the European dose protocol  are also presented.
3. Zoetelief J et al. EUR 16263 (1996)
Results 2 (2)
Forward-scatter factor (FSF) 1,15
A: 2.72 mm C: 2.13 mm FSF=1.076 B: 2.43 mm D: 1.51 mm FSF=1.06
Half-value layer (mm Al)
FSF results in the present work compared to literature data
-- FSF=1.076 from Monte Carlo calculations, 2.4 mm compression paddle . - - FSF=1.06 from a 6 cm3 6M chamber (RADCAL ), MDM unit (Sectra), 2.6 mm compression paddle ~40 cm up (no collimation) compared to close contact in an experimental setup .
4. Hemdal B et al. Radiat Prot Dosim 114 (1-3), 436-443 (2005)
Discussion 1 (2)
The FSF was here found to be 1.02-1.10 and increased with compression paddle thickness, but also with HVL. The FSF could have the same value as the BSF and is consequently as relevant to consider in dose protocols. FSF=1.076  is an example and not a standard value; this Monte Carlo calculated value is in reasonable accordance with the present experimental results. FSF=1.06  is also an example and probably an underestimation as no collimator was used (experimental setup); the purpose was not to determine FSF . Based on the results in this work, FSF=1.06 happens to be the best choice of a standard FSF, with a maximum error of about 8 4%.
Discussion 2 (2)
Some practical consequences for output measurements.
Dosemeters with high FS sensitivity, e.g. ionisation chambers, which for a long time has been the standard dosemeter for output and HVL measurements in mammography.
The compression paddle should be in contact with the chamber. Note: For a well collimated beam (slide 5, Kb), a FSF must be used.
Dosemeters with low FS sensitivity, e.g. dosemeters based on wellcollimated semiconductors, which are increasingly used and now are dominating the usage in e.g. Sweden.
FSF must be used. FS contribution is small regardless of geometry and can be minimized with a high position of the compression paddle; collimation should not be necessary. Suggested strategies to determine the FSF to be used Compare with an ionisation chamber or use a FSF that depend on paddle thickness and possibly HVL, etc or 9 use a standard FSF, e.g. 1.06.
It can be as important to consider FS as BS radiation. Neglection of FS can underestimate AGD/MGD by 10%. Procedures for output measurements in evaluation of incident air kerma
Ionisation chambers in contact with the compression paddle and no FSF is then needed. Dosemeters with low FS sensitivity; correct with a FSF.
Based on the results in this work, FSF=1.06 will lead to a maximum error of about 4% and might be a suitable standard FSF.