Organ dose and total effective dose of whole-body CT in multiple myeloma patients

Robert Hemke,Jad Husseini,Kai Yang,F. Joseph Simeone,Miriam A. Bredella

doi:10.1007/s00256-019-03292-z

Abstract

ObjectiveTo evaluate organ dose and total effective dose of whole-body low-dose CT (WBLDCT) performed on different CT-scanner models in patients with multiple myeloma (MM) and to compare it to the effective dose of radiographic skeletal survey and representative diagnostic CTs.Material and methodsWe retrospectively analyzed data from 228 patients (47.4% females, mean age 67.9 ± 10.4 years, mean weight 81.8 ± 22.4 kg) who underwent WBLDCT for the work-up or surveillance of MM. Patients were scanned using one of six multi-detector CT-scanners. Organ doses and total effective doses per scan were calculated using a commercially available dose-management platform (Radimetrics, Bayer Healthcare, Leverkusen, Germany). The median effective dose was compared to radiographic skeletal survey and representative diagnostic CTs.ResultsThe mean effective dose of our WBLDCT-protocol was 4.82 mSv. A significantly higher effective dose was observed in females compared to males (4.95 vs. 4.70 mSv, P = 0.002). Mean organ dose ranged from 3.72 mSv (esophagus) to 13.09 mSv (skeleton). Mean effective dose varied amongst different CT-scanners (range 4.34–8.37 mSv). The median effective dose of WBLDCT was more than twice the dose of a skeletal survey (4.82 vs. 2.04 mSv), 23% higher than a diagnostic contrast-enhanced chest CT (3.9 mSv), 46% lower than a diagnostic contrast-enhanced abdomen/pelvis CT (9.0 mSv), and 45% lower than a lumbar spine CT (8.7 mSv).ConclusionsWBLDCT in MM has a higher effective dose than a radiographic skeletal survey, but a lower effective dose than diagnostic CTs of lumbar spine, abdomen and pelvis. This underlines the broad applicability of WBLDCT in the management of MM patients.

Highlights

Multiple myeloma (MM) is the second most common hematological malignancy with an incidence that has risen over the past decades [1, 2]
Our study showed that whole-body low-dose computed tomography (CT) (WBLDCT) in MM patients has a higher effective dose than that of a radiographic skeletal survey, but a lower effective dose than that of diagnostic CTs of the lumbar spine, abdomen and pelvis
According to the most recent International Myeloma Working Group (IMWG) diagnostic criteria, lesions measuring 5 mm on CT or magnetic resonance imaging (MRI) are included in the diagnostic criteria of MM [4], and it is of clinical importance to detect bone involvement in MM and its precursors

Summary

Introduction

Multiple myeloma (MM) is the second most common hematological malignancy with an incidence that has risen over the past decades [1, 2] It is characterized by the abnormal proliferation of monoclonal plasma cells in the bone marrow, which can lead to replacement of normal myelopoiesis, bone destruction and bone marrow failure [3]. Cross-sectional imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and integrated positron emission tomography/CT (PET/CT), have proven to be more accurate in detecting osteolytic and marrow replacing lesions as compared to skeletal surveys using radiographs [8,9,10,11,12,13,14]. More accurate diagnosis, staging and follow-up of MM is possible [8, 9]

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Conclusion