Homogeneous vs. patient specific breast models for Monte Carlo evaluation of mean glandular dose in mammography

Purpose: To compare, via Monte Carlo simulations, homogeneous and non-homogenous breast models adopted for mean glandular dose (MGD) estimates in mammography vs. patient specific digital breast phantoms. Methods: We developed a GEANT4 Monte Carlo code simulating four homogenous cylindrical breast models featured as follows: (1) semi-cylindrical section enveloped in a 5-mm adipose layer; (2) semi-elliptical section with a 4-mm thick skin; (3) semi-cylindrical section with a 1.45-mm skin layer; (4) semi-cylindrical section in a 1.45-mm skin layer and 2-mm subcutaneous adipose layer. Twenty patient specific digital breast phantoms produced from a dedicated CT scanner were assumed as reference in the comparison. We simulated two spectra produced from two anode/filter combinations. An additional digital breast phantom was produced via BreastSimulator software. Results: With reference to the results for patient-specific breast phantoms and for W/Al spectra, models #1 and #3 showed higher MGD values by about 1% (ranges [-33%; + 28%] and [-31%; + 30%], respectively), while for model #4 it was 2% lower (range [-34%; + 26%]) and for model #2-11% (range [-39%; + 14%]), on average. On the other hand, for W/Rh spectra, models # 1 and # 4 showed lower MGD values by 2% and 1%, while for model # 2 and # 3 it was 14% and 8% lower, respectively (ranges [-43%; + 13%] and [-41%; + 21%]). The simulation with the digital breast phantom produced with BreastSimulator showed a MGD overestimation of + 33%. Conclusions: The homogeneous breast models led to maximum MGD underestimation and overestimation of 43% and 28%, respectively, when compared to patient specific breast phantoms derived from clinical CT scans.