Lifetime Attributable Risk Of Cancer Research Articles

The Information Imperative: Is It Time for an Informed Consent Process Explaining the Risks of Medical Radiation?

We believe that the radiology community should take the initiative to adopt guidelines and require that all imaging facilities use some form of active information process describing the risks of medical radiation.

86 Radiation Exposure Among Highest CT Scan Utilizers

The risk of cancer from CT scan radiation is a rising concern in the medical field. Our objective was to determine how many patients received more than 10 CT scans in the ED over the course of 7 years and to quantify their radiation exposure and cancer risk. An electronic chart review was performed at our inner city, academic institution with an annual census of 110,000 patients. All patients who underwent a CT scan performed during ED management between the dates of January 2001 and December 2007 were identified. Specific, pre-determined data elements (eg, subject demographics, type of CT scan) were extracted by 2 researchers blinded to hypothesis, using a pre-formatted data form. After identifying patients with more than 10 CTs performed during the study period, radiation exposure was calculated based on accepted and reported radiation doses for the respective anatomic CTs, and lifetime attributable cancer risk was calculated based on BEIR VII projections (7th report of the Biological Effects of Ionizing Radiation). Over the 7-year study period, 24,393 patients received 34,671 CT scans. 25 (0.1%) patients received more than 10 CTs, 272 (1%) received 5-10 CTs and 4239 (17%) received 2 CTs. Among those with more than 10 CTs, the mean, median, and range for number of CTs were 13.8, 13, and 11-23. The mean age of these patients was 53.3 years, with a range of 26-84 years. Mean radiation exposure was 93.8 mSv (range 24-240). The average lifetime attributable cancer risk above baseline in this group is 0.9% with a range from 0.2% to 2.4%. Among those undergoing CT in our ED, although high exposure patients (>10 scans) constituted a very small minority, attributable cancer risk increases (up to 2.4%) for these patients may have important public health implications.

CT Dose Index and Patient Dose: They AreNotthe Same Thing

Estimates of individual patient risk, and epidemiologic studies assessing potential late effects, must use patient size–specific dose estimates—they cannot use only scanner output (volume CT dose index or dose-length product).

64-절편 다행검출 CT 검사에서의 환자선량과 암 발생의 Lifetime Attributable Risk(LAR) 평가

This study was to estimate the radiation dose associated with 64-slice multidetector CT(MDCT) in clinical practice and quantify the potential cancer risk associated with these examinations. Lifetime attributable risks(LAR) were estimated with models developed in the national Academies` Biological Effects of Ionizing Radiation VII report. Mean effective dose were 1.48mSv in Brain axial scan, 7.66mSv in chest routine contrast, 12.17mSv in coronary angiogram, 24.52mSv in Dynamic abdomen scan. LAR estimates for brain routine varied from 1 in 7463 for man to 1 in 4926 for women. In chest routine with contrast, LAR varied from 1 in 1449 for men to 1 in 952. LAR of Abdomen dynamic CT varied from 1 in 453 for men to 1 in 298 for women. So, 64-slice MDCT scan is associated with non-negligible LAR of cancer. Doses can be reduced by careful attention to scanning protocol.

Radio induced cancer risk during ERCP: Is it a real clinical problem?

in recent years many factors have been shown to influence dose received by the patient during ERCP. Therefore it is necessary to update radio induced cancer risk. to calculate lifetime attributable risk of cancer during ERCP. To compare the risk with the most common X-ray examinations. descriptive study with 393 consecutive ERCP performed at one center. Equipment used was Philips BV pulsera. In each exploration demographic and anthropometric variables of the patient were collected. Dosimetric quantities were calculated from exposure parameters. Effective dose was estimated using specific conversion factors. Organ doses and radio induced cancer incidence was estimated. dose area product was 0.82 mGym2(IQR 0.4-1.5) with an average fluoroscopy time of 2 minutes and 45 seconds. Entrance surface dose was 30.7 mGy (IQR 15-60.8) and effective dose was 0.44 mSv (IQR 0.2-0.9). Multivariate analysis identified that difficult papillary cannulation (β 0.4; p = 0.009), patient age (β-0.01; p = 0.001) and therapeutic applied (β= 0.89; p < 0.001) influenced dose-area product. The ERCP dose would be equivalent to the radiation received by twenty chest radiographs and would be about fourteen times smaller than a barium enema or twenty times less than that received during an abdominal CT. Life-time attributable risk of cancer incidence was 4.08 and 16.81 per million procedures in diagnostic and therapeutic ERCP respectively. from the radiological point of view, ERCP is a safe technique that uses low exposure levels compared to other explorations commonly used in medicine. It implies a reasonably low risk of radio induced cancer.

Estimates of lifetime attributable risk of cancer after a single radiation exposure from 64-slice computed tomographic coronary angiography

Estimates of lifetime attributable risk of cancer after a single radiation exposure from 64-slice computed tomographic coronary angiography

Estimates of lifetime attributable risk of cancer after a single radiation exposure from 64-slice computed tomographic coronary angiography

AimsTo estimate the life attributable risk (LAR) of cancer incidence over a wide range of dose radiation exposure and a large spectrum of possible diagnostic computed tomographic coronary angiography (CTCA)...

Radiation Dose Associated with Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer

Background: Use of computed tomography (CT) for diagnostic evaluation has increased dramatically over the past 2 decades. Even though CT is associated with substantially higher radiation exposure than conventional radiography, typical doses are not known. We sought to estimate the radiation dose associated with common CT studies in clinical practice and quantify the potential cancer risk associated with these examinations.

Radiation Dose Associated With Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer

Radiation Dose Associated With Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer

Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.

Use of computed tomography (CT) for diagnostic evaluation has increased dramatically over the past 2 decades. Even though CT is associated with substantially higher radiation exposure than conventional radiography, typical doses are not known. We sought to estimate the radiation dose associated with common CT studies in clinical practice and quantify the potential cancer risk associated with these examinations. We conducted a retrospective cross-sectional study describing radiation dose associated with the 11 most common types of diagnostic CT studies performed on 1119 consecutive adult patients at 4 San Francisco Bay Area institutions in California between January 1 and May 30, 2008. We estimated lifetime attributable risks of cancer by study type from these measured doses. Radiation doses varied significantly between the different types of CT studies. The overall median effective doses ranged from 2 millisieverts (mSv) for a routine head CT scan to 31 mSv for a multiphase abdomen and pelvis CT scan. Within each type of CT study, effective dose varied significantly within and across institutions, with a mean 13-fold variation between the highest and lowest dose for each study type. The estimated number of CT scans that will lead to the development of a cancer varied widely depending on the specific type of CT examination and the patient's age and sex. An estimated 1 in 270 women who underwent CT coronary angiography at age 40 years will develop cancer from that CT scan (1 in 600 men), compared with an estimated 1 in 8100 women who had a routine head CT scan at the same age (1 in 11 080 men). For 20-year-old patients, the risks were approximately doubled, and for 60-year-old patients, they were approximately 50% lower. Radiation doses from commonly performed diagnostic CT examinations are higher and more variable than generally quoted, highlighting the need for greater standardization across institutions.

Radiation exposure from pediatric head CT: a bi-institutional study

Medical radiation from CT should be kept as low as reasonably achievable (ALARA), particularly in young patients. To examine radiation dose from head CT in children in a trauma center (TC) and a regional children's hospital (RCH). A random sample of 240 children (0-3, 4-9, 10-14 years of age) from the TC were compared with a similar cohort from the RCH. All children had undergone at least one head CT scan without contrast enhancement; data from PACS and Department of Radiology Information System were used to estimate normalized effective dose (ED). Lifetime attributable risk of cancer incidence was estimated using the Biologic Effects of Ionizing Radiation (BEIR) VII report. The mean normalized ED was significantly higher in the youngest children at the TC (2.74 mSv in those aged 0-3 years vs. 2.23 mSv in those aged 10-14 years; P<0.001) and at the RCH (2.44 mSv in those aged 0-3 years vs. 1.71 mSv in those aged 10-14 years; P<0.001). Each decreasing year of age was independently associated with a 0.06 mSv higher mean normalized ED (P<0.001). After adjusting for the age difference between the institutions, the mean normalized ED was 0.44 mSv lower at the RCH than at the TC across all ages (95% CI 0.31-0.58, P<0.001). A higher lifetime attributable risk of cancer was associated with younger age. The radiation dose from head CT in children as defined by the normalized ED was highest in the youngest children and varied significantly between institutions in this bi-institutional study.

Radiation risks to lymphoma patients undergoing 18F-FDG studies

e22024 Background: To investigate radiation risks to patients undergoing 18F-FDG studies that take into account patient age, sex, and weight. Methods: We obtained patient demographics and weights of 54 consecutive patients with lymphoma who each underwent a18F-FDG PET study. The administered activity was converted into an effective dose using the patient size dependent dosimetry data provided in ICRP Publication 80. Patient effective doses were converted into estimates of the lifetime attributable risk of cancer incidence and cancer mortality using age and sex dependent risk factors provided in BEIR VII. Results: The average patient age/weight in this study was 43 years/68 kg for males and 33 years/61 kg for females. Patient effective dose are proportional to patient weight(-0.784) (r2 &gt;0.99). The average administered activity was 410 MBq, which resulted in an average effective dose of 8.5 mSv for males and 8.9 mSv for females. The average cancer incidence was 0.71/1,000 cases for males, and 1.27/1,000 cases for females, with cancer mortality being about half the incidence. Cancer rates for the youngest patients were an order of magnitude higher than those for the oldest patients. Conclusions: Average lifetime attributable cancer risks to lymphoma patients from a single FDG-PET study is approximately 1 per 1,000, but are strongly influenced by patient age, gender and weight. Cancer risk in younger patients is a magnitude of order greater. No significant financial relationships to disclose.

Commentary on Estimating the risk of cancer associated with image-related radiation during surveillance for stage I testicular cancer using computerized tomography

Computerized tomography has a critical role in the surveillance of stage I nonseminomatous germ cell tumors of the testis. Some protocols call for up to 16 computerized tomography scans over 5 years, thereby exposing young patients to a significant amount of radiation. We estimated the lifetime risk of cancer incidence and cancer death from imaging related radiation received during surveillance of stage I nonseminomatous germ cell tumor. Using a model with a 64-slice computerized tomography scanner obtaining images of the abdomen and pelvis with or without chest in a standardized, phantom male patient, organ specific radiation doses were estimated using Monte Carlo simulation techniques. Lifetime attributable risks of cancer were estimated using the approach outlined in the Biological Effects of Ionizing Radiation VII Phase 2 report. With a 5-year surveillance protocol as suggested by the National Comprehensive Cancer Network, lifetime cancer risk ranged from 1 in 52 (1.9%) for an 18-year-old to 1 in 63 for a 40-year-old patient (1.2%). If chest computerized tomography is also performed, the risk increases to 1 in 39 (2.6%) and 1 in 85 (1.6%), respectively. Lung and colon cancer accounted for most of the risk. The relative risk of a secondary malignancy with surveillance compared with a single scan after retroperitoneal lymph node dissection is approximately 15.2. Computerized tomography used in testicular cancer surveillance protocols imparts large radiation doses and is associated with a significant risk of cancer. This risk should be factored into counseling patients with stage I nonseminomatous germ cell tumor.

Estimating the Risk of Cancer Associated With Imaging Related Radiation During Surveillance for Stage I Testicular Cancer Using Computerized Tomography

Computerized tomography has a critical role in the surveillance of stage I nonseminomatous germ cell tumors of the testis. Some protocols call for up to 16 computerized tomography scans over 5 years, thereby exposing young patients to a significant amount of radiation. We estimated the lifetime risk of cancer incidence and cancer death from imaging related radiation received during surveillance of stage I nonseminomatous germ cell tumor. Using a model with a 64-slice computerized tomography scanner obtaining images of the abdomen and pelvis with or without chest in a standardized, phantom male patient, organ specific radiation doses were estimated using Monte Carlo simulation techniques. Lifetime attributable risks of cancer were estimated using the approach outlined in the Biological Effects of Ionizing Radiation VII Phase 2 report. With a 5-year surveillance protocol as suggested by the National Comprehensive Cancer Network, lifetime cancer risk ranged from 1 in 52 (1.9%) for an 18-year-old to 1 in 63 for a 40-year-old patient (1.2%). If chest computerized tomography is also performed the risk increases to 1 in 39 (2.6%) and 1 in 85 (1.6%), respectively. Lung and colon cancer accounted for most of the risk. The relative risk of a secondary malignancy with surveillance compared to a single scan after retroperitoneal lymph node dissection is approximately 15.2. Computerized tomography used in testicular cancer surveillance protocols imparts large radiation doses and is associated with a significant risk of cancer. This risk should be factored into counseling patients with stage I nonseminomatous germ cell tumor.

Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: Insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report

Occupational doses from fluoroscopy-guided interventional procedures are the highest ones registered among medical staff using x-rays. The aim of the present study was to evaluate the order of magnitude of cancer risk caused by professional radiation exposure in modern invasive cardiology practice. From the dosimetric Tuscany Health Physics data bank of 2006, we selected dosimetric data of the 26 (7 women, 19 men; age 46 +/- 9 years) workers of the cardiovascular catheterization laboratory with effective dose >2 mSv. Effective dose (E) was expressed in milliSievert, calculated from personal dose equivalent registered by the thermoluminescent dosimeter, at waist or chest, under the apron, according to the recommendations of National Council of Radiation Protection. Lifetime attributable risk of cancer was estimated using the approach of Biological Effects of Ionizing Radiation 2006 report VII. Cardiac catheterization laboratory staff represented 67% of the 6 workers with yearly exposure >6 mSv. Of the 26 workers with 2006 exposure >2 mSv, 15 of them had complete records of at least 10 (up to 25) consecutive years. For these 15 subjects having a more complete lifetime dosimetric history, the median individual effective dose was 46 mSv (interquartile range = 24-64). The median risk of (fatal and nonfatal) cancer (Biological Effects of Ionizing Radiation 2006) was 1 in 192 (interquartile range = 1 in 137-1 in 370). Cumulative professional radiological exposure is associated with a non-negligible Lifetime attributable risk of cancer for the most exposed contemporary cardiac catheterization laboratory staff.

Obesity Is a Major Determinant of Radiation Dose in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation

This study sought to evaluate the impact of obesity on patient radiation dose during atrial fibrillation (AF) ablation procedures under fluoroscopic guidance. Obesity is a risk factor for AF and its recurrence after ablation. It increases patient radiation dose during fluoroscopic imaging, but this effect has not been quantified for AF ablation procedures. Effective radiation dose and lifetime attributable cancer risk were calculated from dose-area product (DAP) measurements in 85 patients undergoing AF ablation guided by biplane low-frequency pulsed fluoroscopy (3 frames/s). Three dose calculation methods were used (Monte Carlo simulation, dose conversion coefficients, and depth-profile dose curves). Median DAP for all patients was 119.6 Gy x cm2 (range 13.9 to 446.3 Gy x cm2) for procedures with a median duration of 4 h and 83 +/- 26 min of fluoroscopy. Body mass index was a more important determinant of DAP than total fluoroscopy time (r = 0.74 vs. 0.37, p < 0.001), with mean DAP values per hour of fluoroscopy of 58 +/- 40 Gy x cm2, 110 +/- 43 Gy x cm2, and 184 +/- 79 Gy x cm2 in normal, overweight, and obese patients, respectively. The corresponding effective radiation doses for AF ablation procedures were 15.2 +/- 7.8 mSv, 26.7 +/- 11.6 mSv, and 39.0 +/- 15.2 mSv, respectively (Monte Carlo). Use of conversion coefficients resulted in higher effective dose estimates than other methods, particularly in obese patients. Mean attributable lifetime risk of all-cancer mortality was 0.060%, 0.100%, and 0.149%, depending on weight class. Obese patients receive more than twice the effective radiation dose of normal-weight patients during AF ablation procedures. Obesity needs to be considered in the risk-benefit ratio of AF ablation and should prompt further measures to reduce radiation exposure.