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Talebi AS, Bodaghi R, Bagherzadeh S. Lifetime attributable risks (LARs) of cancer in the fetus associated with maternal radiography examinations. Int J Radiat Biol 2024; 100:420-426. [PMID: 38193807 DOI: 10.1080/09553002.2023.2295294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/14/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE For various reasons, pregnant women are occasionally exposed to ionizing radiation during radiology examinations. In these situations, it is essential to determine the radiation dose to the fetus and any associated risks. The present study attempts to calculate the mean dose for the fetus to estimate the possible cancer induction and cancer mortality risks resulting from maternal radiography exams. MATERIAL AND METHODS The GATE Monte Carlo platform and a standard voxelized pregnant phantom were employed to calculate fetal radiation dose during maternal radiography exams. The data published in Biological Effects of Ionizing Radiation VII were used to convert fetal dose to lifetime attributable risks (LARs) of cancer incidence and cancer-related mortality. RESULTS The fetal doses and LARs of cancer incidence and cancer-related mortality for the radiographs of the chest and skull were negligible. The maximum LAR values for the lateral view of the abdomen in computed and digital radiography are 5598.29 and 2238.95 per 100,000 individuals, respectively. The computed radiography of the lateral view of the abdomen revealed the highest LAR of cancer-related mortality (2074.30 deaths for every 100,000 people). CONCLUSION The radiation dose incurred by the fetus due to chest and skull radiographs was minimal and unlikely to cause any abnormalities in the fetus. The discernible elevation in the lifetime attributable risk associated with cancer incidence and mortality arising from lateral computed radiography examinations of the abdomen warrants careful consideration within the realm of maternal radiography examinations.
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Affiliation(s)
- Asra Sadat Talebi
- Department of Medical Physics, Tarbiat Modares University, Tehran, Iran
| | - Roghiyeh Bodaghi
- Department of Medical Physics, Tarbiat Modares University, Tehran, Iran
| | - Saeed Bagherzadeh
- Department of Medical Physics, Tarbiat Modares University, Tehran, Iran
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Hu Y, Ma M, Yin H, Ren P, Tian X, Zheng Z, Zhong Z, Wang Z, Yang Z, Chen H. Assessment of cumulative cancer risk attributable to diagnostic X-ray radiation: a large cohort study. Eur Radiol 2023; 33:1769-1778. [PMID: 36370173 DOI: 10.1007/s00330-022-09178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the risk of cancer induced by diagnostic X-ray exposure in multiple radiological examinations and to explore the relevant influences to provide a reference for rational usage of X-ray examinations. METHODS Data for all adult patients who underwent X-ray examinations from August 2004 to April 2020 in a general hospital was collected, including sex, age, primary diagnosis, and X-ray examination. Based on the Biological Effects of Ionizing Radiations report, age and sex and effective dose for a single X-ray examination were used to calculate the lifetime attributable risk (LAR). Patients whose cancer LAR values were in the top 5% were considered to have a high cancer risk; the factors influencing this status were explored by using multivariate logistic regression analyses. RESULTS In total, 1,143,413 patients with 3,301,286 X-ray examinations were included. LARs of cancer incidence and death were < 0.2% and < 0.13% among 95% of patients and they were > 1% among 0.21% and 0.07% of patients. High risks of incidence and death were significantly associated with corrected exposure frequency (odds ratio [OR], 1.080 and 1.080), sex (OR, male vs. female, 0.421 and 0.372), and year of birth (OR, 1.088 and 1.054), with all p values < 0.001. Among 20 disease categories, congenital disease (OR, 3.792 and 4.024), genitourinary disease (OR, 3.608 and 3.202), digestive disease (OR, 3.247 and 3.272), and tumor disease (OR, 2.706 and 2.767) had the strongest associations with high risks of incidence and death (all p values < 0.001). CONCLUSIONS Cancer risk induced by diagnostic X-ray examinations can be considered acceptable clinically. Patients having certain diseases are potentially at a relative higher risk due to recurrent examinations. KEY POINTS • It was the first large-scale investigation of cumulative X-ray exposure in China, involving more than 3.3 million X-ray scans of all types of diagnostic X-ray examinations for about 1.1 million patients during the past 16 years. • The study revealed that the incidence risk of cancer induced by X-ray-related examinations was 0.01% on average, which was substantially lower than that of cancer induced by non-X-ray radiation. The risk could be considered acceptable clinically. • Patients having certain diseases were potentially at a relatively higher cancer risk due to recurrent X-ray examinations. The cumulative effect of X-ray exposure could not be ignored and was worthy of attention.
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Affiliation(s)
- Yanjun Hu
- School of Biomedical Engineering, Capital Medical University, No. 10, Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, People's Republic of China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, People's Republic of China.,Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Moxuan Ma
- School of Biomedical Engineering, Capital Medical University, No. 10, Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, People's Republic of China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Hongxia Yin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Pengling Ren
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Xin Tian
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Zhimin Zheng
- School of Biomedical Engineering, Capital Medical University, No. 10, Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, People's Republic of China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Zhaohui Zhong
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China.
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, No. 10, Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, People's Republic of China. .,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, People's Republic of China.
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Kaur S, Mehra R. Dosimetric impact of natural terrestrial radioactivity on residents of lower Himalayas, India. Environ Geochem Health 2022; 44:603-629. [PMID: 33098496 DOI: 10.1007/s10653-020-00748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
A comprehensive radio-ecological evaluation of soil samples of Solan and Shimla districts of Himachal Pradesh has been carried out for risk and dose assessment. Twenty-six randomly selected environmental soil samples were analysed for natural radionuclide concentrations (226Ra, 232Th and 40K) using NaI(Tl) scintillator detector. The average concentration of 226Ra, 232Th and 40K was observed as 37, 59 and 430 Bq kg-1, respectively, which exceeded the worldwide average of 33, 45 and 412 Bq kg-1 reported by UNSCEAR (Sources and effects of ionizing radiation. Report to the general assembly with scientific annexes, New York, 2008). Radium equivalent activity (Raeq), hazard indices (Hex, Hin) and radioactivity level indices (Iϒr, Iα, AUI) and Clark value were checked against their threshold limits, and their mean values were safely below the recommended criteria. This confirms the soil applicability for construction purposes. Indoor and outdoor dose rates (Ḋ), age-dependent annual effective doses (AED), organ-specific doses and lifetime attributable cancer risk (both cancer incidence and cancer mortality) were also computed. Strong positive correlation was established between radon/thoron exhalation rate and their parent radionuclides. Multivariate statistical technique was employed to explore spatial distribution of radionuclides and homogeneity between various radiological parameters.
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Affiliation(s)
- Sarabjot Kaur
- Environment Monitoring and Assessment Laboratory, Department of Physics, Dr. B R Ambedkar National Institute of Technology, Jalandhar, Punjab, 144011, India
| | - Rohit Mehra
- Environment Monitoring and Assessment Laboratory, Department of Physics, Dr. B R Ambedkar National Institute of Technology, Jalandhar, Punjab, 144011, India.
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García-Hernández T, Romero-Expósito M, Sánchez-Nieto B. Low dose radiation therapy for COVID-19: Effective dose and estimation of cancer risk. Radiother Oncol 2020; 153:289-295. [PMID: 33065184 PMCID: PMC7553901 DOI: 10.1016/j.radonc.2020.09.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE The objective of this work is to evaluate the risk of carcinogenesis of low dose ionizing radiation therapy (LDRT), for treatment of immune-related pneumonia following COVID-19 infection, through the estimation of effective dose and the lifetime attributable risk of cancer (LAR). MATERIAL AND METHODS LDRT treatment was planned in male and female computational phantoms. Equivalent doses in organs were estimated using both treatment planning system calculations and a peripheral dose model (based on ionization chamber measurements). Skin dose was estimated using radiochromic films. Later, effective dose and LAR were calculated following radiation protection procedures. RESULTS Equivalent doses to organs per unit of prescription dose range from 10 mSv/cGy to 0.0051 mSv/cGy. Effective doses range from 204 mSv to 426 mSv, for prescription doses ranging from 50 cGy to 100 cGy. Total LAR for a prescription dose of 50 cGy ranges from 1.7 to 0.29% for male and from 4.9 to 0.54% for female, for ages ranging from 20 to 80 years old. CONCLUSIONS The organs that mainly contribute to risk are lung and breast. Risk for out-of-field organs is low, less than 0.06 cases per 10000. Female LAR is on average 2.2 times that of a male of the same age. Effective doses are of the same order of magnitude as the higher-dose interventional radiology techniques. For a 60 year-old male, LAR is 8 times that from a cardiac CT, when prescription dose is 50 cGy.
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Affiliation(s)
| | - Maite Romero-Expósito
- Área de Ciencias Básicas y Ambientales, Instituto Tecnológico de Santo Domingo (INTEC), P.O. Box 342-9/249-2, Santo Domingo, Dominican Republic
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Ghetti C, Ortenzia O, Maddalo M, Altabella L, Sverzellati N. Dosimetric and radiation cancer risk evaluation of high resolution thorax CT during COVID-19 outbreak. Phys Med 2020; 80:119-124. [PMID: 33171381 PMCID: PMC7604119 DOI: 10.1016/j.ejmp.2020.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/12/2020] [Accepted: 10/22/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The aim of this work was to evaluate the dosimetric impact of high-resolution thorax CT during COVID-19 outbreak in the University Hospital of Parma. In two months we have performed a huge number of thorax CT scans collecting effective and equivalent organ doses and evaluating also the lifetime attributable risk (LAR) of lung and other major cancers. MATERIALS AND METHOD From February 24th to April 28th, 3224 high-resolution thorax CT were acquired. For all patients we have examined the volumetric computed tomography dose index (CTDIvol), the dose length product (DLP), the size-specific dose estimate (SSDE) and effective dose (E103) using a dose tracking software (Radimetrics Bayer HealthCare). From the equivalent dose to organs for each patient, LAR for lung and major cancers were estimated following the method proposed in BEIR VII which considers age and sex differences. RESULTS Study population included 3224 patients, 1843 male and 1381 female, with an average age of 67 years. The average CTDIvol, SSDE and DLP, and E103 were 6.8 mGy, 8.7 mGy, 239 mGy·cm and 4.4 mSv respectively. The average LAR of all solid cancers was 2.1 cases per 10,000 patients, while the average LAR of leukemia was 0.2 cases per 10,000 patients. For both male and female the organ with a major cancer risk was lung. CONCLUSIONS Despite the impressive increment in thoracic CT examinations due to COVID-19 outbreak, the high resolution low dose protocol used in our hospital guaranteed low doses and very low risk estimation in terms of LAR.
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Affiliation(s)
- C Ghetti
- Department of Medical Physics, University Hospital of Parma, Italy
| | - O Ortenzia
- Department of Medical Physics, University Hospital of Parma, Italy.
| | - M Maddalo
- Department of Medical Physics, University Hospital of Parma, Italy
| | - L Altabella
- Department of Medical Physics, University Hospital of Parma, Italy
| | - N Sverzellati
- Department of Medicine and Surgery, Division of Radiology, University of Parma, Italy
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Branchini M, Del Vecchio A, Gigliotti CR, Loria A, Zerbi A, Calandrino R. Organ doses and lifetime attributable risk evaluations for scoliosis examinations of adolescent patients with the EOS imaging system. Radiol Med 2018; 123:305-13. [PMID: 29164365 DOI: 10.1007/s11547-017-0828-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The goal of this work is to evaluate organ doses and lifetime attributable risk of cancer incidence and mortality in scoliosis examinations of adolescent patients performed with EOS imaging system, in order to optimize patient dose and protocols. METHODS An anthropomorphic phantom of a normal patient, with thermoluminescent dosimeters in correspondence with the main organs at risk, was imaged with both EOS and computed radiography (CR). For each modality, effective dose was calculated from the measured organ doses. Lifetime attributable risk was computed accordingly to the Committee on the Biological Effects of Ionizing Radiation (BEIR VII) and Public Health England (HPA) publications. RESULTS Except for testes and eyes, which were excluded from the scan in CR protocol, for all the other organs the doses delivered with CR examination were higher than these delivered by EOS system. The effective dose in EOS examination (0.43 ± 0.04 mSv) is about two times less than the dose in computed radiography with anti-scatter grid examination (0.87 ± 0.09 mSv), and, consequently, also the cancer probability is lower (5.4 vs 9.7 number of any cancers induction cases per 100,000 person examined, for a 20-year-old male patient). CONCLUSIONS The EOS system is efficient in limiting patient dose. The shielding of testes and the exclusion of eyes from the scan could allow to further reduce the dose.
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Robinson JB, Ali RM, Tootell AK, Hogg P. Does collimation affect patient dose in antero-posterior thoraco-lumbar spine? Radiography (Lond) 2017; 23:211-215. [PMID: 28687288 DOI: 10.1016/j.radi.2017.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The purpose of this study is to determine the effect of collimation on the lifetime attributable risk (LAR) of cancer incidence in all body organs (effective risk) in patients undergoing antero-posterior (AP) examinations of the spine. This is of particular importance for patients suffering from scoliosis as in their case regular repeat examinations are required and also because such patients are usually young and more susceptible to the effects of ionising radiation than are older patients. METHODS High sensitivity thermo-luminescent dosimeters (TLDs) were used to measure radiation dose to all organs of an adult male dosimetry phantom, positioned for an AP projection of the thoraco-lumbar spine. Exposures were made, first applying tight collimation and then subsequently with loose collimation, using the same acquisition factors. In each case, the individual TLDs were measured to determine the local absorbed dose and those representing each organ averaged to calculate organ dose. This information was then used to calculate the effective risk of cancer incidence for each decade of life from 20 to 80, and to compare the likelihood of cancer incidence when using tight and loose collimation. RESULTS The calculated figures for effective risk of cancer incidence suggest that the risk when using loose collimation compared to the use of tight collimation is over three times as high and this is the case across all age decades from 20 to 80. CONCLUSION Tight collimation can greatly reduce radiation dose and risk of cancer incidence. However collimation in scoliotic patients can be necessarily limited.
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Affiliation(s)
| | - R M Ali
- University of Salford, UK; University of Kufa, Iraq
| | | | - P Hogg
- University of Salford, UK
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Slovis BH, Shah KH, Yeh DD, Seethala R, Kaafarani HMA, Eikermann M, Raja AS, Lee J. Significant but reasonable radiation exposure from computed tomography-related medical imaging in the ICU. Emerg Radiol 2016; 23:141-6. [PMID: 26738733 DOI: 10.1007/s10140-015-1373-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/21/2015] [Indexed: 12/19/2022]
Abstract
Admission to an intensive care unit (ICU) is associated with increased medical imaging and radiation exposure, yet few studies have estimated the risk of cancer associated with these examinations. The purpose of this study was to review computed tomography (CT) scans performed on patients admitted to two urban academic ICUs, predict their radiation exposure, and calculate their estimated lifetime attributable risk of cancer (LAR). An electronic chart review was performed on all CT scans performed between January 2007 and December 2011. The estimated effective dose of radiation was calculated for each CT, and the LAR for each patient was predicted. Mean radiation exposure was 22.2 ± 25.0 mSv with a mean LAR of 0.1 ± 0.2 % and a median of 0.6 % with a range of <0.001 to 3.4 %. Our cohort received radiation doses higher than recommended by guidelines; however, the critical nature of their admission may have warranted these imaging studies. Estimated risk of cancer in this population was overall low.
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Affiliation(s)
- Benjamin H Slovis
- Department of Emergency Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kaushal H Shah
- Department of Emergency Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - D Dante Yeh
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raghu Seethala
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthias Eikermann
- Division of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jarone Lee
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- , 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
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Lee YJ, Chung YE, Lim JS, Kim JH, Kim YJ, Lee HJ, You JS, Kim MJ, Kim KW. Cumulative radiation exposure during follow-up after curative surgery for gastric cancer. Korean J Radiol 2012; 13:144-51. [PMID: 22438681 PMCID: PMC3303897 DOI: 10.3348/kjr.2012.13.2.144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 09/16/2011] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To quantify the cumulative effective dose (cED) of radiation due to repeated CT and PET/CT examinations after curative resection of gastric cancer and to assess the lifetime attributable risk (LAR) estimates based on Biological Effects of Ionizing Radiation VII models. SUBJECTS AND METHODS Patients who underwent a curative resection for gastric cancer between January 2006 and December 2006 and were followed-up until May 2010 were included in this study. The cED was calculated by using the dose-length product values and conversion factors for quantitative risk assessment of radiation exposure. cED and LAR were compared between early and advanced gastric cancer patients and among American Joint Committee on Cancer TNM stage groups (stage I, II, and III). The nonparametric Mann-Whitney U and Kruskal-Wallis tests, followed by a post-hoc analysis with Bonferroni adjustment, were employed as part of the statistical analysis. RESULTS The overall median cED was 57.8 mSv (interquartile range [IQR], 43.9-74.7). The cED was significantly higher in the advanced (median, 67.0; IQR, 49.1-102.3) than in the early gastric cancer group (median, 52.3; IQR, 41.5-67.9) (p < 0.001), and increased as the TNM stage increased. For radiation exposure, 62% of all patients received an estimated cED of over 50 mSv, while 11% of patients received over 100 mSv. The median LAR of cancer incidence was 0.28% (IQR, 0.20-0.40) and there were significant differences between the early gastric cancer and advanced gastric cancer group (p < 0.001) as well as among the three TNM stage groups (p = 0.015). The LAR of cancer incidence exceeded 1% in 2.4% of the patients. CONCLUSION The cED increases proportionally along with tumor stage and, even in early gastric cancer or stage I patients, cED is much higher than that found among the general population. Considering the very good prognosis of early gastric cancer after curative surgery, the cED should be considered when designing a postoperative follow-up CT protocol.
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Affiliation(s)
- Yeo Jin Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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