1
|
Poosiri S, Krisanachinda A, Khamwan K. Evaluation of patient radiation dose and risk of cancer from CT examinations. Radiol Phys Technol 2024; 17:176-185. [PMID: 38048023 DOI: 10.1007/s12194-023-00763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
Computed tomography (CT) examinations have been increasingly requested and become the major sources of patient exposure. The cancer risk from CT scans is contingent upon the amount of absorbed dose of organs. This study aims to determine the organ doses and risk of cancer incidence and mortality from CT examinations at high dose (cumulative effective dose, CED ≥ 100 mSv) in a single day to low dose (CED < 100 mSv) from common CT procedures. Data were gathered from two academic centers of patients aged 15 to 75 years old performed CT examinations during the period of 5 years. CED and organ dose were calculated using Monte Carlo simulation software. Lifetime attributable risk (LAR) was determined following Biological Effects of Ionizing Radiation (BEIR) VII report based on life table and baseline cancer rates of Thai population. At high dose, the highest LAR for breast cancer incidence in young female was 82 per 100,000 exposed patients with breast dose of 148 mGy (CT whole abdomen). The highest LAR for liver cancer incidence in male patient was 72 per 100,000 with liver dose of 133 mGy (multiple CT scans). At low dose, the highest average LAR for breast cancer incidence in young female was 23 per 100,000 while for liver cancer incidence in male patients was 22 per 100,000 (CTA whole aorta). Even though the LAR of cancer incidence and mortality was less than 100 per 100,000, they should not be neglected. The risk of cancer incidence may be increased in later life, particularly in young patients.
Collapse
Affiliation(s)
- Saowapark Poosiri
- Medical Physics Program, Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Anchali Krisanachinda
- Medical Physics Program, Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kitiwat Khamwan
- Medical Physics Program, Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
2
|
Derikvand AM, Bagherzadeh S, MohammadSharifi A, Khoshgard K, AllahMoradi F. Estimation of cancer risks due to chest radiotherapy treatment planning computed tomography (CT) simulations. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2023; 62:269-277. [PMID: 37129707 DOI: 10.1007/s00411-023-01025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/28/2023] [Indexed: 05/03/2023]
Abstract
The objective of our study was to determine organ doses to estimate the lifetime attributable risk (LAR) of cancer incidence related to chest tomography simulations for Radiotherapy Treatment Planning (RTTP) using patient-specific information. Patient data were used to calculate organ doses and effective dose. The effective dose (E) was calculated by two methods. First, to calculate effective dose in a standard phantom, the collected dosimetric parameters were used with the ImPACT CT Patient Dosimetry Calculator and E was calculated by applying related correction factors. Second, using the scanner-derived Dose Length Product, LARs were computed using the US National Academy of Sciences (BEIR VII) model for age- and sex-specific risks at each exposure. DLP, CTDIvol, and scan length were 507 ± 143 mGy.cm, 11 ± 4 mGy, and 47 ± 7 cm, respectively. The effective dose was 10 ± 3 mSv using ImPACT patient dosimetry calculator software and 9 ± 2 mSv using the scanner-derived Dose Length Product. The LAR of cancer incidence for all cancers, all solid cancers and leukemia were 65 ± 29, 62 ± 27, 7 ± 2 cases per 100,000 individuals, respectively. Radiation exposure from the usage of CT for radiotherapy treatment planning (RTTP) causes non-negligible increases in lifetime attributable risk. The results of this study can be used as a guide by physicians to implement strategies based on the As Low As Reasonably Achievable (ALARA) principle that lead to a reduction dose without sacrificing diagnostic information.
Collapse
Affiliation(s)
- Afsaneh Mir Derikvand
- Department of Medical Physics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeed Bagherzadeh
- Department of Medical Physics, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Ali MohammadSharifi
- Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Karim Khoshgard
- Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fariba AllahMoradi
- Department of Medical Physics, Kermanshah University of Medical Sciences (KUMS), Building No. 1Shahid Beheshti Boulevard, Kermanshah, 6715847141, Iran.
| |
Collapse
|
3
|
Kiani M, Chaparian A. Evaluation of image quality, organ doses, effective dose, and cancer risk from pediatric brain CT scans. Eur J Radiol 2023; 158:110657. [PMID: 36542932 DOI: 10.1016/j.ejrad.2022.110657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The present study was conducted to assess organ doses, effective dose, and image quality, and to estimate the risk of exposure-induced cancer death (REID) in pediatric brain computed tomography examinations. METHODS This investigation was performed on 179 pediatric patients (99 men and 80 women) under 12 years old who underwent non-contrast brain CT scans. Patients were classified into four age groups of ≤ 1, 2-5, 6-9, and 10-12 years old. Organ doses and effective doses were calculated using the ImpactDose program. Cancer risk models presented in the BEIR VII report were used to estimate REID values. Image quality assessment in this study was performed by measuring image quality parameters such as noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). RESULTS The highest organ dose in all age groups belonged to the brain. The mean REID values were 12.34 per 100,000 males and 16.77 per 100,000 females. REID values decreased with the increasing age of patients in both genders and were higher for female children than male children. The mean SNR of gray matter, SNR of white matter, and CNR were 11.04, 10.5, and 2.31, respectively. CONCLUSIONS According to the results of this study, brain CT scans in children are associated with an increased potential risk of cancer. Therefore, minimizing unnecessary radiation exposure in pediatric patients and using alternative imaging modalities are of particular importance. Moreover, optimizing the radiation parameters while maintaining the diagnostic image quality in children should be considered.
Collapse
Affiliation(s)
- M Kiani
- Medical Physics Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Chaparian
- Medical Physics Department, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
4
|
Bárdyová Z, Horváthová M, Gomola I, Neuschl V, Šimková J. PRECAUTION IN THE USE OF EFFECTIVE DOSE IN CORONARY CT ANGIOGRAPHY. RADIATION PROTECTION DOSIMETRY 2022; 198:547-553. [PMID: 36005971 DOI: 10.1093/rpd/ncac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/11/2022] [Accepted: 02/22/2022] [Indexed: 06/15/2023]
Abstract
The effective dose is a quantity used in clinical practice for statistical evaluation of the radiation dose of patients undergoing different types of examinations. Coronary computed tomography angiography (CCTA) is a specific examination whose calculated effective dose may be subject to several biases. For this reason, it is important to consider factors (different examination techniques, heart rate and patient habitus) that may influence its resulting value. Another critical factor is the methodological procedure for calculating the effective dose and cardiac-specific coefficient used to estimate effective dose from the dose-length product in computed tomography. Because CCTA is increasingly used in cardiology, it is recommended that the chest coefficient be replaced with a new cardiac coefficient when calculating the effective dose.
Collapse
Affiliation(s)
- Zuzana Bárdyová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, 918 43 Trnava, Slovak Republic
| | - Martina Horváthová
- Trnava University in Trnava, Faculty of Health Care and Social Work, Department of Laboratory Medicine, Univerzitné námestie 1, 918 43 Trnava, Slovak Republic
| | - Igor Gomola
- Slovak Medical University, Faculty of Public Health, Department of Radiation Hygiene, Limbová 12, 833 03 Bratislava, Slovak Republic
| | - Vladimír Neuschl
- MRI s. r. o., Institute of Imaging Diagnostics, Starohájska 2, 917 01 Trnava, Slovak Republic
| | - Jana Šimková
- MRI s. r. o., Institute of Imaging Diagnostics, Starohájska 2, 917 01 Trnava, Slovak Republic
| |
Collapse
|
5
|
Dalah EZ, Obaideen A, Anam S, Alzimami K, Jambi LK, Bradley DA. Gender based lung cancer risks for symptomatic coronary artery disease patients undergone cardiac CT. PLoS One 2022; 17:e0265609. [PMID: 35404962 PMCID: PMC9000096 DOI: 10.1371/journal.pone.0265609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 03/04/2022] [Indexed: 11/27/2022] Open
Abstract
We estimate the lifetime attributable risk (LAR) of lung cancer incidence in symptomatic Coronary Artery Disease (CAD) patients receiving enhanced Coronary Computed Tomography Angiography (CCTA) and the unenhanced Computed Tomography Calcium Scoring (CTCS) examination. Retrospective analysis has been made of CCTA and CTCS data collected for 87 confirmed CAD adult patients. Patient effective dose (E) and organ doses (ODs) were calculated using CT-EXPO. Statistical correlation and the differences between E and ODs in enhanced CCTA and unenhanced CTCS were calculated using the Pearson coefficient and Wilcoxon unpaired t-test. Following BEIR VII report guidance, organ-specific LARs for the cohort were estimated using the organ-equivalent dose-to-risk conversion factor for numbers of cases per 100,000 patients exposed to low doses of 0.1 Gy. Significant statistical difference (p<0.0001) is found between E obtained for CTCS and that of CCTA. The scan length was found to be greater in CCTA (17.5 ± 2.9 cm) compared to that for CTCS (15 ± 2 cm). More elevated values of dose were noted for the esophagus (4.2 ± 2.15 mSv) and thymus (9.6 ± 2.54 mSv) for both CTCS and CCTA. CTCS organ doses were lower than that of CCTA. Per 100,000 patients, female cumulative doses are seen to give rise to greater lung cancer LARs compared to that for males, albeit with risk varying significantly, noticeably greater for females, younger patients and combined CCTA and CTCS scans. While scan parameters and tube-modulation methods clearly contribute to patient dose, mAs offers by far the greater contribution.
Collapse
Affiliation(s)
- Entesar Zawam Dalah
- Department of Diagnostic Imaging, HQ Dubai Health Authority, Dubai, UAE
- Department of Medical Diagnostic Imaging, University of Sharjah, Sharjah, UAE Radiology
- * E-mail:
| | | | - Sabaa Anam
- Department of Medical Diagnostic Imaging, University of Sharjah, Sharjah, UAE Radiology
| | - Khalid Alzimami
- Department of Radiological Sciences, Applied Medical Sciences College, King Saud University, Riyadh, Saudi Arabia
| | - Layal Khalid Jambi
- Department of Radiological Sciences, Applied Medical Sciences College, King Saud University, Riyadh, Saudi Arabia
| | - David A. Bradley
- Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey, United Kingdom
- Centre for Biomedical Physics, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| |
Collapse
|
6
|
Chaparian A, Asemanrafat M, Lotfi M, Rasekhi A. Impact of iterative reconstruction algorithms on image quality and radiation dose in computed tomography scan of patients with malignant pancreatic lesions. JOURNAL OF MEDICAL SIGNALS & SENSORS 2022; 12:69-75. [PMID: 35265468 PMCID: PMC8804595 DOI: 10.4103/jmss.jmss_81_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/06/2021] [Accepted: 02/03/2021] [Indexed: 12/24/2022]
Abstract
Background: The objective of this study was to investigate the influence of iterative reconstruction (IR) algorithm on radiation dose and image quality of computed tomography (CT) scans of patients with malignant pancreatic lesions by designing a new protocol. Methods: The pancreas CT was performed on 40 patients (23 males and 17 females) with a 160-slice CT scan machine. The pancreatic parenchymal phase was performed in two stages: one with a usual dose of radiation and the other one after using a reduced dose of radiation. The images obtained with usual dose were reconstructed with Filtered Back Projection (FBP) method (Protocol A); and the images obtained with the reduced dose were reconstructed with both FBP (Protocol B) and IR method (Protocol C). The quality of images and radiation dose were compared among the three protocols. Results: Image noise was significantly lower with Protocol C (10.80) than with Protocol A (14.98) and Protocol B (20.60) (P < 0.001). Signal-to-noise ratio and contrast-to-noise ratio were significantly higher with Protocol C than with Protocol A and Protocol B (P < 0.001). Protocol A and Protocol C were not significantly different in terms of image quality scores. Effective dose was reduced by approximately 48% in Protocol C compared with Protocol A (1.20 ± 0.53 mSv vs. 2.33 ± 0.86 mSv, P < 0.001). Conclusion: Results of this study showed that applying the IR method compared to the FBP method can improve objective image quality, maintain subjective image quality, and reduce the radiation dose of the patients undergo pancreas CT.
Collapse
|
7
|
Omidi R, Zare MH, Zamani H, Dalvand S, Masjedi H, Razavi-Ratki SK, Rahbar S. Patterns and trends of population radiation exposure and projected the risk of exposure-induced death from gamma camera examinations in Yazd Province. J Med Imaging Radiat Sci 2021; 52:595-605. [PMID: 34782277 DOI: 10.1016/j.jmir.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/02/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The use of nuclear medicine examinations as imaging modalities has recently increased. This study aimed to assess the radiation dose delivered to patients from common diagnostic nuclear medicine examinations and estimate the risk of exposure-induced death (REID). In addition, the frequency of nuclear medicine procedures were evaluated from 2015-2018. MATERIALS AND METHODS The data were collected from adult patients who had undergone cardiac, skeletal, renal, lacrimal, and thyroid imaging. For each patient, the effective dose was calculated using dose conversion factors, and REID was estimated using PCXMC. The frequency of examinations between 2015 and 2018 was obtained from the hospital information system (HIS). RESULTS The highest estimated effective dose was attributed to the scans of myocardial stress (8.09 ± 1.28 mSv), myocardial rest (5.59 ± 1.27 mSv), and thyroid imaging (3.93 ± 0.55 mSv). In addition, cardiac stress examination had the highest REID values for solid cancers (212.5 ± 67.5) and bone scans had the highest REID values for leukemia (11.5 ± 2.5). A large increase in the number of myocardial perfusion scans was a significant contributor to an increase in collective effective dose from 23.37 man-Sv in 2015 to 49.47 man-Sv in 2018, a compound annual growth rate (CAGR) of 26%. CONCLUSION Although the annual frequency and per capita effective dose of nuclear medicine procedures in Yazd Province increased continuously, they were comparably lower than those reported for other countries. Despite this, the cancer risks of nuclear medicine scans at the individual level are negligible (around 0.01% excess fatal cancer risk), yet the increasing tendency for these examinations could be of concern.
Collapse
Affiliation(s)
- Reza Omidi
- Medical Physics Department, Student at Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Hosein Zare
- Medical Physics Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamed Zamani
- Medical Physics Department, Student at Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saman Dalvand
- Medical Physics Department, Student at Tarbiat Modares University, Tehran, Iran.
| | - Hamidreza Masjedi
- Medical Physics Department, Student at Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seid Kazem Razavi-Ratki
- Clinical Research Development Center of Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Shohadaye Gomnam Blvd, Yazd, Yazd Province, Yazd, Iran.
| | - Shiva Rahbar
- Medical Physics Department, Student at Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
8
|
Bagherzadeh S, Jabbari N, Khalkhali HR. Radiation dose and cancer risks from radiation exposure during abdominopelvic computed tomography (CT) scans: comparison of diagnostic and radiotherapy treatment planning CT scans. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:579-589. [PMID: 34542682 DOI: 10.1007/s00411-021-00942-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
In the present study, radiation doses and cancer risks resulting from abdominopelvic radiotherapy planning computed tomography (RP-CT) and abdominopelvic diagnostic CT (DG-CT) examinations are compared. Two groups of patients who underwent abdominopelvic CT scans with RP-CT (n = 50) and DG-CT (n = 50) voluntarily participated in this study. The two groups of patients had approximately similar demographic features including mass, height, body mass index, sex, and age. Radiation dose parameters included CTDIvol, dose-length product, scan length, effective tube current, and pitch factor, all taken from the CT scanner console. The ImPACT software was used to calculate the patient-specific radiation doses. The risks of cancer incidence and mortality were estimated based on the BEIR VII report of the US National Research Council. In the RP-CT group, the mean ± standard deviation of cancer incidence risk for all cancers, leukemia, and all solid cancers was 621.58 ± 214.76, 101.59 ± 27.15, and 516.60 ± 189.01 cancers per 100,000 individuals, respectively, for male patients. For female patients, the corresponding risks were 742.71 ± 292.35, 74.26 ± 20.26, and 667.03 ± 275.67 cancers per 100,000 individuals, respectively. In contrast, for DG-CT cancer incidence risks were 470.22 ± 170.07, 78.23 ± 18.22, and 390.25 ± 152.82 cancers per 100,000 individuals for male patients, while they were 638.65 ± 232.93, 62.14 ± 13.74, and 575.73 ± 221.21 cancers per 100,000 individuals for female patients. Cancer incidence and mortality risks were greater for RP-CT than for DG-CT scans. It is concluded that the various protocols of abdominopelvic CT scans, especially the RP-CT scans, should be optimized with respect to the radiation doses associated with these scans.
Collapse
Affiliation(s)
- Saeed Bagherzadeh
- Department of Medical Physics, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Nasrollah Jabbari
- Solid Tumor Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran.
| | - Hamid Reza Khalkhali
- Patient Safety Research Center, Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
9
|
Ausoni S, Azzarello G. Development of Cancer in Patients With Heart Failure: How Systemic Inflammation Can Lay the Groundwork. Front Cardiovasc Med 2020; 7:598384. [PMID: 33195486 PMCID: PMC7649135 DOI: 10.3389/fcvm.2020.598384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
In the last decade, cardiologists and oncologists have provided clinical and experimental evidence that cancer, and not only chemotherapeutic agents, can cause detrimental effects on heart structure and function, a consequence that has serious clinical implications for patient management. In parallel, the intriguing idea that heart failure (HF) may be an oncogenic condition has also received growing attention. A number of epidemiological and clinical studies have reported that patients with HF have a higher risk of developing cancer. Chronic low-grade systemic inflammation has been proposed as a major pathophysiological process linking the failing heart to the multi-step process of carcinogenesis. According to this view, pro-inflammatory mediators secreted by the damaged heart generate a favorable milieu that promotes tumor development and accelerates malignant transformation. HF-associated inflammation synergizes with tumor-associated inflammation, so that over time it is no longer possible to distinguish the effects of one or the other. Experimental studies have just begun to search for the molecular effectors of this process, with the ultimate goal that of identifying mechanisms suitable for anti-cancer target therapy to reduce the risk of incident cancer in patients already affected by HF. In this review we critically discuss strengths and limitations of clinical and experimental studies that support a causal relationship between HF and cancer, and focus on HF-associated inflammation, cardiokines and their endocrine functions linking one and the other disease.
Collapse
Affiliation(s)
- Simonetta Ausoni
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Giuseppe Azzarello
- Local Health Unit 3 Serenissima, Department of Medical Oncology, Mirano Hospital, Venice, Italy
| |
Collapse
|