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Estimation of Cancer Mortality Associated with Repetitive Computed Tomography Scanning

Departments of Pediatric Pulmonology and Allergology and Pediatric Radiology, Erasmus MC–Sophia Rotterdam, Rotterdam, The Netherlands; James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital; Pulmonary Division, Department of Medicine, University of British Columbia; Subdivision of Radiation Physics, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia; Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada; and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan

Correspondence and requests for reprints should be addressed to Pim A. de Jong, M.D., Ph.D, Erasmus MC–Sophia Children's Hospital, Department of Pediatric Pulmonology and Allergology, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. E-mail: pdejong{at}mrl.ubc.ca

Rationale: Low-dose radiation from computed tomography (CT) may increase the risk of certain cancers, especially in children.

Objective: We sought to estimate the excess all-cause and cancer-specific mortality, which may be associated with repeated CT scanning of patients with cystic fibrosis (CF).

Methods: The radiation dose was calculated for a published CF surveillance CT scanning protocol of biennial CT scans, and the risk per scan was estimated using atom-bomb survivor data. A computational model was developed to calculate the excess mortality in a CF cohort associated with radiation from the CT scan and to evaluate the effects of background survival, scanning interval, and level of CT radiation used. The model assumed that there would be no survival benefits associated with repeated surveillance CT scanning.

Results: The average radiation dose for the published CT protocol was 1 mSv. Survival reduction associated with annual scans from age 2 yr until death was approximately 1 mo and 2 yr for CF cohorts, with a median survival of 26 and 50 yr, respectively. Corresponding cumulative cancer mortality was approximately 2 and 13% at age 40 and 65 yr, respectively. Biennial CT scanning reduced all-cause and cumulative cancer mortality by half.

Conclusion: Routine lifelong annual CT scans carry a low risk of radiation-induced mortality in CF. However, as the overall survival increases for patients with CF, the risk of radiation-induced mortality may modestly increase. These data indicate that radiation dose must be considered in routine CT imaging strategies for patients with CF, to ensure that benefits outweigh the risks.

Key Words: cancer mortality • computational model • computed tomography • cystic fibrosis • radiation

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