Estimation of Radiation Doses and Lifetime Attributable Risk of Radiation-induced Cancer from A Single Coronary Artery Bypass Graft Computed Tomography Angiography

Husam H Mansour,Yasser S Alajerami,Thomas Foster

doi:10.29333/ejgm/11208

Abstract

Introduction: Despite worldwide consensus that coronary artery bypass graft computed tomography angiography (CABG CTA) confers benefit to patients when used for appropriate indications, the increased cancer risk due to radiation dose remains a concern. The aim of this study is the estimation of organ effective dose (ED) and lifetime attributable risk (LAR) of cancer incidence and mortality related to a single CABG CTA procedure. Methods and materials: This retrospective cross-sectional designed study included 102 CABG patients who, from January 2021 to June 2021, underwent a retrospective 64-slice ECG-gated CABG CTA covering the area of the grafts with optimal image quality. The estimation of ED was done using the imPACT CT Dosimetry spreadsheet. LAR of cancer incidence was estimated for CABG CTA using the website X-rayrisk.com. Results: The mean total ED of CABG procedure was 15.35 mSv. The highest organ doses were those to the lungs (5.04 mSv) and breast (4.49 mSv). The cancer risk is higher in female (1 in 1516) than in male patients (1 in 1762). The LAR of cancer is higher for the younger age group in both males and females. The total whole-body ED demonstrated that CABG CTA is equivalent to 154 chest radiographs or 37 screening mammography studies, which in turn correspond to approximately 4.3 or 5-years of natural background radiation, respectively. Conclusions: Despite many benefits of CABG CTA, it is associated with a non-negligible risk of malignancy, so a careful risk/benefit assessment is recommended in justifying CABG CTA procedures, especially for young female patients.

Highlights

Despite worldwide consensus that coronary artery bypass graft computed tomography angiography (CABG Coronary Artery Bypass Graft Computed Tomography Angiography (CTA)) confers benefit to patients when used for appropriate indications, the increased cancer risk due to radiation dose remains a concern
The total whole-body effective dose (ED) demonstrated that CABG CTA is equivalent to 154 chest radiographs or 37 screening mammography studies, which in turn correspond to approximately 4.3 or 5-years of natural background radiation, respectively
Despite many benefits of CABG CTA, it is associated with a non-negligible risk of malignancy, so a careful risk/benefit assessment is recommended in justifying CABG CTA procedures, especially for young female patients

Summary

Introduction

Despite worldwide consensus that coronary artery bypass graft computed tomography angiography (CABG CTA) confers benefit to patients when used for appropriate indications, the increased cancer risk due to radiation dose remains a concern. The aim of this study is the estimation of organ effective dose (ED) and lifetime attributable risk (LAR) of cancer incidence and mortality related to a single CABG CTA procedure. The application of ionizing radiation is increasing dramatically in medical imaging, driven primarily by the increased use of x-ray Computed Tomography (CT). Medical procedures are responsible for approximately one-half of the ionizing radiation exposure to the human population [1,2]. Diagnostic imaging protocols based on multidetector computed tomography (MDCT) are widely used [3]. Concomitant with the technological advances of MDCT, coronary computed tomographic coronary angiography (CCTA) has emerged as a non-invasive, patient-friendly diagnostic modality to detect the presence of coronary atherosclerosis [7]

Objectives

Methods

Results

Conclusion