Establishment of local diagnostic reference levels in mammography: multicenter retrospective study in Trujillo, Peru

Querebalú García C.; Panizo Olivos P.E.; Garnique Millones E.; Barragan Mondragon C.H.; Márquez Pachas J.F.; Carrasco Solis E.B. · Revista Mexicana de Fisica (2026) · DOI: 10.31349/revmexfis.72.041101

Resumen

Radiation exposure in mammography can vary considerably across centers, potentially affecting both diagnostic quality and patient safety. In Trujillo, Peru, no locally adjusted absorbed dose values were previously available. Therefore, the objective of this study was to establish local diagnostic reference levels (LDRLs) for digital mammography within the EsSalud hospital network (Social Health Insurance) in Trujillo. A retrospective, multicenter study was conducted in three hospitals, analyzing 133 digital mammograms acquired with Hologic Selenia Dimensions systems. Technical parameters such as kilovoltage, tube load, compression force, compressed breast thickness, and average glandular dose (AGD) were collected and processed using automated systems. The LDRLs, defined as the 75th percentile of the AGD distribution, were determined for the craniocaudal (CC) and mediolateral oblique (MLO) projections. Multiple linear regression analysis was performed to identify independent predictors of AGD. The proposed LDRLs were 1.78 mGy for CC and 2.12 mGy for MLO, values well below the reference level of 3 mGy recommended by the Basic Safety Standards of the International Atomic Energy Agency (IAEA), and 30-39% lower than the regional LDRLs previously reported for direct digital radiography (DDR) systems in Latin America. Tube load (β=0.886, p<0.001 for CC; β=0.572, p<0.001 for MLO) and compressed breast thickness (β=0.193, p<0.001 for CC; β=0.297, p=0.001 for MLO) were identified as the most significant technical predictors of AGD. The established LDRLs demonstrate optimized dosimetric practices within the EsSalud network in Trujillo, ensuring that patient doses are appropriate, consistent, and aligned with international standards. Their implementation will facilitate ongoing dose monitoring, protocol standardization, and the strengthening of radiation protection in breast cancer screening programs.

Instituciones: Universidad Nacional Mayor de San Marcos; Universidad Nacional de Ingeniería