Normalized glandular dose (DgN) coefficients obtained using homogeneous breast phantoms are commonly used in breast dosimetry for mammography. However, glandular tissue is heterogeneously distributed in the breast. This study aimed to construct three-layer heterogeneous mammographic phantoms (THEPs) to examine the effect of glandular distribution on DgN coefficient. Each layer of THEPs was set to 25%, 50%, or 75% glandular fraction to emulate heterogeneous glandular distribution. Monte Carlo simulation was performed to attain mean glandular dose (MGD) and air kerma at 22-36 kVp and W/Al, W/Rh, and W/Ag target-filter combinations. The heterogeneous DgN coefficient was calculated as functions of the mean glandular fraction (MGF), breast thickness, tube voltage, and half-value layer. At 50% MGF, the heterogeneous DgN coefficients for W/Al, W/Rh, and W/Ag differed by 40.3%, 36.7%, and 31.2%. At 9-cm breast thickness, the DgN values of superior and inferior glandular distributions were 25.4% higher and 29.2% lower than those of uniform distribution. The proposed THEPs can be integrated with conventional breast dosimetry to consider the heterogeneous glandular distribution in clinical practice.Breast cancer is the second most common cause of cancer deaths among women 1 , and its incidence increases annually. X-ray mammography has become a primary tool for breast cancer screening because of the high sensitivity and specificity for microcalcification and mass detection 2 . Mammography is also adopted for the high effectiveness/cost ratio. However, the glandular tissue in the breast is sensitive to radiation. The radiation exposure during mammography may increase the risk of radiation-induced secondary breast malignancy 3 . Therefore, assessment of glandular dose in the breast is crucial.In modern breast dosimetry, one of the most critical parameters is the normalized glandular dose (DgN) coefficient, which is obtained using Monte Carlo simulation of mean glandular dose (MGD) in a breast phantom 4 . Boone used simple homogeneous breast phantoms to simulate the breast absorbed dose and applied a G factor to calculate MGD 5 . He further proposed monoenergetic DgN coefficients to facilitate rapid calculation of the DgN coefficient for arbitrary X-ray energy spectra 6 . Dance et al. 7 employed homogeneous semicylindrical phantoms to assess MGD conversion factor g, breast composition factor c, and X-ray spectrum factor s. The authors further supplemented the conversion factors for the high-energy spectra used for contrast enhanced digital mammography by using the same homogeneous breast model 8 . The above method is now the standard breast dosimetry protocols for mammography in the United Kingdom, European Union, and IAEA and is also adopted in the quality assurance protocols in USA. Sarno et al. 9 used homogeneous semi-cylinder and ad hoc shaped phantoms to exam MGD in mammography and calculate the t-factor (relative glandular dose, RGD) and T-factor in digital breast tomosynthesis (DBT).Three-dimensional (3D) imaging modalit...

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