Published ahead of print on October 27, 2005, doi:10.1164/rccm.200505-810OC
Am. J. Respir. Crit. Care Med., Volume 173, Number 2, January 2006, 199-203
A more recent version of this article appeared on January 15, 2006
Submitted on May 23, 2005
Accepted on October 25, 2005
Estimation of Cancer Mortality Associated with Repetitive Computed Tomography Scanning
Pim A de Jong1*, John R Mayo2, Kamran Golmohammadi3, Yasutaka Nakano4, Maarten H Lequin5, Harm A.W.M. Tiddens6, John Aldrich7, Harvey O Coxson2, and Don D Sin8
1 Department of Pediatric Pulmonology, Erasmus MC-Sophia Rotterdam, Rotterdam, The Netherlands; Department of Medicine, Pulmonary Division, James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada,
2 Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada,
3 Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada,
4 Department of Medicine, Pulmonary Division, James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan,
5 Department of Pediatric Radiology, Erasmus MC-Sophia Rotterdam, Rotterdam, The Netherlands,
6 Department of Pediatric Pulmonology, Erasmus MC-Sophia Rotterdam, Rotterdam, The Netherlands,
7 Subdivision of Radiation Physics, Vancouver General Hospital, Vancouver, BC, Canada,
8 Department of Medicine, Pulmonary Division, James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
* To whom correspondence should be addressed. E-mail: pdejong{at}mrl.ubc.ca.
Rationale: Low-dose radiation from computerized 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 cystic fibrosis (CF) patients.
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 milli-Sievert. Survival reduction associated with annual scans from age 2 years until death was approximately 1 month and 2 years for CF cohorts with a median survival of 26 years and 50 years, respectively. Corresponding cumulative cancer mortality was approximately 2% and 13% at age 40 and 65 years, 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 CF patients, the risk of radiation-induced mortality may modestly increase. These data indicate that radiation dose must be considered in routine CT imaging strategies for CF patients, to ensure that benefits outweigh the risks.
Key words: radiation, cancer mortality, Computed Tomography, cystic fibrosis, computational model
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