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Diagnostic Reference Levels in Mammography in the Asian Context

Background: Breast cancer is the most frequent cancer among the female population globally. Therefore, early detection is helpful for effective treatments and to reduce the mortality rate. Mammography is a radiological examination done with low-energy X-rays to detect abnormalities in breast tissue. This study aims to review the literature to evaluate the techniques, protocols, and conversion factors used to determine the diagnostic reference levels (DRLs); within the Asian continent using both phantom- and patient-based data. 
Methods: Related articles were systematically reviewed via Pub Med, Google scholar, and freehand search with the aid of relevant terms. Related abstracts in English were screened, and suitable articles were selected after reviewing the full-text. Four hundred and thirty abstracts were screened for relevance, and 12 articles were selected. 
Results: The study comprises four phantom-based and eight patient-based studies. The studies varied between the types of test subjects, conversion factors, breast compression thickness, and dose calculation protocols. This obstructs continuing the DRLs with the updates and comparisons among countries. Establishments of DRLs in Asian countries are less than the rest of the world. DRLs should be measured continuously, and should be updated based on other clinical parameters of the patients. 
Conclusion: DRLs in mammography were measured from time to time in different geographical locations in Asia by following various techniques. But when compared with the other regions of the world, there is less consideration for establishing DRLs in Asia. There should be standard protocols and updated conversion factors according to the advancements of the technology to ensure radiation protection with optimal absorbed dose with appropriate image quality.