# Assessment of a Patient Dose Monitoring System for Average
## 5 Conclusions  
In this study, a patient dose monitoring system, DoseWatch, was assessed by comparing the average glandular dose (AGD) displayed by two mammographic units with the AGD estimated through independent calculations. For this purpose, two AGD calculation methods, the Dance and Boone models, were employed, considering two different breast density estimations: a glandularity estimate based on a polynomial fit depending on age and thickness, and a glandularity estimate using actual breast density through LIBRA software (for two subgroups of patients).  
The mean AGD values obtained using the Dance method and glandularity estimation by LIBRA are fully comparable to those provided by DoseWatch. This confirms that the mammography units in this study use the Dance model for dose calculation, along with a glandularity estimation method very similar to LIBRA. Furthermore, the mean AGD obtained using the Dance model and glandularity estimation through the polynomial fit of the tabulated factors was closer to the values provided by DoseWatch than the AGD calculated with the Boone method. This is evident, as Hologic mammography systems use the Dance model, although differences remain statistically significant.  
However, the approximation of using the Dance method to calculate AGD without estimating the actual glandularity of the patients could be suitable for patients with age, kV, HVL, and CBT values falling within the range of tabulated values for the c and g coefficients according to the Dance model. This is because assessing breast density with LIBRA is time-consuming and difficult to perform for all patients, and the doses obtained using this method are always conservatively lower than those provided by DoseWatch. In the future, for completeness, we plan to use the new breast dosimetry method [40] to calculate the average glandular dose from our available data.  
In conclusion, estimating the real glandularity in the selected patients allowed for the determination of average glandular dose values comparable to those provided by the Hologic systems considered, thereby validating a reliable independent AGD calculation method. This also confirms the usefulness of DoseWatch in clinical routines to extract a large volume of data for subsequent analysis. Future developments will focus on evaluating and verifying AGD for patient age, kV, HVL, and CBT groups outside the range of the Dance model using appropriate corrective factors.  
Conceptualization, C.M. and G.R.B.; methodology, C.M., G.R.B. and G.S.; software, A.D. and G.R.B.; validation, E.B., N.C., M.P. and L.Z.; formal analysis, G.R.B.; investigation, M.P. and L.Z.; resources, G.R.B., E.B. and N.C.; data curation, G.R.B., G.S. and A.D.; writing--original draft preparation, G.R.B.; writing--review and editing, G.R.B., C.M. and G.S.; visualization, G.R.B. and A.D.; supervision, C.M.; project administration, C.M. and G.S. All authors have read and agreed to the published version of the manuscript.  
This research received no external funding.  
**Institutional Review Board Statement:** Not applicable.  
**Informed Consent Statement:** Not applicable.  
**Data Availability Statement:** The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding author.  
**Acknowledgments:** The authors would like to thank the Department of Senology of the Humanitas Istituto Clinico Catanese for the valuable support.  
**Conflicts of Interest:** The authors declare no conflicts of interest.