Technical note: Skin thickness measurements using high-resolution flat-panel cone-beam dedicated breast CT

Purpose: To determine the mean and range of location-averaged breast skin thickness using high-resolution dedicated breast CT for use in Monte Carlo-based estimation of normalized glandular dose coefficients. Methods: This study retrospectively analyzed image data from a clinical study investigating dedicated breast CT. An algorithm similar to that described by Huang ["The effect of skin thickness determined using breast CT on mammographic dosimetry," Med. Phys. 35(4), 1199-1206 (2008)10.1118/1.2841938] was used to determine the skin thickness in 137 dedicated breast CT volumes from 136 women. The location-averaged mean breast skin thickness for each breast was estimated and the study population mean and range were determined. Pathology results were available for 132 women, and were used to investigate if the distribution of location-averaged mean breast skin thickness varied with pathology. The effect of surface fitting to account for breast curvature was also studied. Results: The study mean (± interbreast SD) for breast skin thickness was 1.44 ± 0.25 mm (range: 0.87-2.34 mm), which was in excellent agreement with Huang Based on pathology, pair-wise statistical analysis (Mann-Whitney test) indicated that at the 0.05 significance level, there were no significant difference in the location-averaged mean breast skin thickness distributions between the groups: benign vs malignant (p = 0.223), benign vs hyperplasia (p = 0.651), hyperplasia vs malignant (p = 0.229), and malignant vs nonmalignant (p = 0.172). Conclusions: Considering this study used a different clinical prototype system, and the study participants were from a different geographical location, the observed agreement between the two studies suggests that the choice of 1.45 mm thick skin layer comprising the epidermis and the dermis for breast dosimetry is appropriate. While some benign and malignant conditions could cause skin thickening, in this study cohort the location-averaged mean breast skin thickness distributions did not differ significantly with pathology. The study also underscored the importance of considering breast curvature in estimating breast skin thickness.