Introduction: Breast cancer is the most common cancer among women in Slovenia. Mammography is used as an initial examination for routine screening in patients with breast implants. Mammography in patients with breast implants is performed in four projections; two standard projections and two additional projections using the Eklund technique. Purpose: The purpose of this master's thesis is to evaluate the average glandular dose (AGD) in screening mammography for patients with breast implants and to examine the differences in AGD based on the method of exposure setting. We were interested in how much the AGD differs between the standard and Eklund techniques and whether the method of exposure settings affects the quality of mammograms. Methods: We conducted a retrospective non-interventional study with secondary analysis. The study included 536 patients with breast implants who completed mammography imaging in the screening program DORA between April 21st 2008 and December 31st 2021. We evaluated the AGD values of patients with breast implants based on the projection, breast thickness, and exposure setting method. We compared the AGD between images using the standard technique and those using the Eklund technique. In the last part of the study, three radiologists assessed the quality of the images. Results: In standard images with manual settings, the mean AGD value is statistically significantly lower for breast thicknesses of 6 < 8 cm, 8 < 10 cm, and > 10 cm. In additional images with automatic mode, the mean AGD value is statistically significantly lower for breast thicknesses < 4 cm and 4 < 6 cm. In additional images with breast thickness of 6 < 8 cm, the AGD is statistically significantly lower in manual mode images. There are statistically significant differences in the mean AGD value between images using the standard technique and those using the Eklund technique for both exposure setting methods. The overall assessment of all quality criteria for CC, MLO, and MLOID images was statistically significantly higher with manual settings. Discussion and conclusion: The results indicate that standard images with manual settings have lower AGD values and higher quality ratings. We can conclude that for additional images with breast thickness < 4 cm and 4 < 6 cm, the automatic mode of exposure setting is more appropriate due to lower AGD values. The manual mode is more suitable for breast thicknesses of 6 > 8 cm. Introducing a standardized protocol for imaging breast implants using Hologic machines would be reasonable.
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