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

By R. Smith-Bindman, J. Lipson, R. Marcus, K. P. Kim, M. Mahesh, R. Gould, A. D. de González, Diana L. Miglioretti. Archives of Internal Medicine, 2009

2,539 citations recorded by the source corpus.

Background Use of computed tomography (CT) for diagnostic evaluation has increased dramatically over the past two decades. Even though CT is associated with substantially higher radiation exposure than conventional x-rays, typical clinical doses are not known. We sought to estimate the radiation dose associated with common CT studies in clinical practice; assess variation in dose across types of studies, patients, and institutions; and quantify the potential cancer risk associated with these examinations. Methods Retrospective cross-sectional study describing radiation dose associated with the 11 most common types of diagnostic CT studies performed on 1,119 consecutive adult patients at four San Francisco Bay Area institutions between January 1 and May 30, 2008. We estimated lifetime attributable risks of cancer by study type from these measured doses. Results Radiation doses varied significantly between the different types of CT studies. The overall median effective doses ranged from 2.1 milli-Sieverts (mSv) for a routine head CT (interquartile range [IQR] 1.8–2.8) to 31 mSv (IQR 21–43) for a multiphase abdomen and pelvis CT. 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 CTs 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 a coronary angiography CT at age 40 will develop cancer from that CT (1 in 600 men), compared with an estimated 1 in 8,100 women who had routine head CT at the same age (1 in 11, 080 men). For 20-year olds the risks were approximately doubled, and for 60-year olds, the risks were approximately 50% lower. Conclusion Radiation doses from commonly performed diagnostic CT examinations were higher and more variable than generally quoted, highlighting the need for greater standardization across institutions. For individuals, and especially younger female patients, the benefits of CT imaging must be balanced against the potential harm from its associated radiation.

Subfields: Biomedical Engineering, Radiology, Nuclear Medicine and Imaging

View Paper: https://www.semanticscholar.org/paper/08ea7ea19ecf7d055e6dc8308f0edceeb5beb6f8

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In Biomedical Engineering

1. Xiaochuan Pan
2. Emil Y. Sidky
3. Ge Wang
4. Mannudeep K. Kalra
5. Yi Zhang
6. Uwe Kruger
7. Hongming Shan
8. Ling Sun

In Radiology, Nuclear Medicine and Imaging

1. Xiaochuan Pan
2. Emil Y. Sidky
3. Ge Wang
4. Yi Zhang
5. Mannudeep K. Kalra
6. Uwe Kruger
7. Hongming Shan
8. Ling Sun

Citations in the corpus

• 3D Convolutional Encoder-Decoder Network for Low-Dose CT via Transfer Learning from a 2D Trained Network (2018, positive): “The widespread use of CT, however, has raised public concerns that, while CT helps a large number of patients, additional cancer cases could be induced by CT-related x-ray radiation [2], [3].”
• Pediatric Computed Tomography and Associated Radiation Exposure and Estimated Cancer Risk (2013, background): “We found that radiation doses from CT for adults are higher and more variable than generally quoted.(1,15) Doses received by children have been less well studied,(16) and most studies have been in select populations such as trauma(17,18) or cancer patients.”
• Evaluation of Sparse-view Reconstruction from Flat-panel-detector Cone-beam CT (2010, background): “Studies indicate that dose from CT scans may have a lifetime attributable risk of cancer higher than previously assumed (Brenner and Hall 2007, Gonzalez et al 2009, Smith-Bindman et al 2009).”
• Brain tumor detection and classification using machine learning: a comprehensive survey (2021, background): “The associated risks of cancers have been quantified according to CT radiation doses [37, 38].”
• Coronavirus disease 2019 (COVID-19) pandemic and pregnancy (2020, background): “JUNE 2020 crosses the placenta, studies have not demonstrated teratogenicity or thyroid dysfunction in the newborn.(25)”
• Global vascular guidelines on the management of chronic limb-threatening ischemia (2019, background): “the amount of iodinated contrast material and the dose of ionizing radiation used while maximizing imaging of the distal vasculature.(268,283-285) In general, diagnostic DSA is widely available, and the complication rate is low.”
• A Review on a Deep Learning Perspective in Brain Cancer Classification (2019, background): “In one study, it is shown that the risk of radiation in CT is 100 times higher than in a normal X-ray diagnosis [35].”
• Modern Diagnostic Imaging Technique Applications and Risk Factors in the Medical Field: A Review (2022, background): “Over the last two decades, CT is used largely in many clinical labs in different countries [18].”