Diagnostic reference levels (DRLs) in digital mammography in the European context – a systematic review
Journal
Polish Journal of Medical Physics and Engineering
Date Issued
2025-08-28
Author(s)
Arifi, Mirjeta Mediji
Ristova, Mimoza M.
DOI
10.2478/pjmpe-2025-0028
Abstract
This systematic review examines the establishment of Diagnostic Reference Levels (DRLs) in digital mammography
across 18 European countries, based on studies from 2005-2025. A total of 353 articles were identified through the comprehensive search of academic networks: Google Scholar, PubMed, Research Gate, Academia. Only 18 peer-reviewed
studies met inclusion criteria – reporting Mean Glandular Dose (MGD)-based DRLs from Finland to Malta. Eight
studies used patient data, four used phantom measurements, and six used both. To overcome the challenging comparison of the variety of reported parameters, we undertook some data harmonisation procedures, focusing on a common
Compressed Breast Thickness (CBT) range of 50-59 mm. The DRLs varied notably by country, with 75th percentile
MGDs ranging from 1.1 to 2.6 mGy and 95th percentile from 1.6 to 2.9 mGy, averaging to 1.44 mGy, which is lower than
the achievable European level (2 mGy). The harmonisation approach enabled the derivation of a comparable dataset of
average MGDs, facilitating cross-country comparisons and insights into radiation dose optimisation in digital mammography across Europe.
across 18 European countries, based on studies from 2005-2025. A total of 353 articles were identified through the comprehensive search of academic networks: Google Scholar, PubMed, Research Gate, Academia. Only 18 peer-reviewed
studies met inclusion criteria – reporting Mean Glandular Dose (MGD)-based DRLs from Finland to Malta. Eight
studies used patient data, four used phantom measurements, and six used both. To overcome the challenging comparison of the variety of reported parameters, we undertook some data harmonisation procedures, focusing on a common
Compressed Breast Thickness (CBT) range of 50-59 mm. The DRLs varied notably by country, with 75th percentile
MGDs ranging from 1.1 to 2.6 mGy and 95th percentile from 1.6 to 2.9 mGy, averaging to 1.44 mGy, which is lower than
the achievable European level (2 mGy). The harmonisation approach enabled the derivation of a comparable dataset of
average MGDs, facilitating cross-country comparisons and insights into radiation dose optimisation in digital mammography across Europe.