Compression force variability and its impact on radiation dose in Saudi breast cancer screening mammography: An analysis across centers, operators, and equipment

Objectives: This study aims to investigate the variability in applied compression force (CF) within the Saudi breast cancer screening program centers. Methods: A dataset of 187,788 mammograms from nine breast-screening centers collected between 2012 and 2021 were analyzed. Variations in CF by centre, operator, and manufacturer were tested. Correlations with exposure factors and radiation dose with CF were tested. In the sub-analysis, 865 mammograms with BI-RADS density categories were included along with data regarding 12 operators. Results: Significant variability in CF across operators, centers, and machines (p < 0.0001), with an overall mean CF of 135.07 ± 37 N. Most CF measurements (60 %–70 %) adhered to international recommendations. Fuji recorded the highest mean CF of 133.3 N, while Hologic had the lowest at 120.5 N. A weak negative correlation existed between CF and mean glandular dose (MGD) (r = −0.205, p < 0.001), with CF explaining only 1.7 % of the variance in MGD while mAs was responsible for 73.2 % of MGD variability. No significant differences in CF were noted across BI-RADS categories (p = 0.241). Conclusions: While a significant proportion of CF values align with international standards, considerable variability exists, influenced by equipment type and operator. The findings aligned with previous recommendations about the importance of developing more precise, evidence-based CF guidelines.