Impact of Reduced Patient Life Expectancy on Potential Cancer Risks from Radiologic Imaging

Center for Radiological Research and Department of Medicine and Radiology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY 10032, USA.
Radiology (Impact Factor: 6.87). 07/2011; 261(1):193-8. DOI: 10.1148/radiol.11102452
Source: PubMed

ABSTRACT To quantify the effect of reduced life expectancy on cancer risk by comparing estimated lifetime risks of lung cancer attributable to radiation from commonly used computed tomographic (CT) examinations in patients with and those without cancer or cardiac disease.
With the use of clinically determined life tables, reductions in radiation-attributable lung cancer risks were estimated for coronary CT angiographic examinations in patients with multivessel coronary artery disease who underwent coronary artery bypass graft (CABG) surgery and for surveillance CT examinations in patients treated for colon cancer. Statistical uncertainties were estimated for the risk ratios in patients who underwent CABG surgery and patients with colon cancer versus the general population.
Patients with decreased life expectancy had decreased radiation-associated cancer risks. For example, for a 70-year-old patient with colon cancer, the estimated reduction in lifetime radiation-associated lung cancer risk was approximately 92% for stage IV disease, versus 8% for stage 0 or I disease. For a patient who had been treated with CABG surgery, the estimated reduction in lifetime radiation-associated lung cancer risk was approximately 57% for a 55-year-old patient, versus 12% for a 75-year-old patient.
The importance of radiation exposure in determining optimal imaging usage is much reduced for patients with markedly reduced life expectancies: Imaging justification and optimization criteria for patients with substantially reduced life expectancies should not necessarily be the same as for those with normal life expectancies.

Download full-text


Available from: Igor Shuryak, Sep 29, 2015
35 Reads
  • Source
    • "Fully diagnostic PET/CT studies may expose patients to radiation doses as high as 25 mSv. However, Brenner and Hall [170] have correctly pointed to the greatly reduced relevance of this perceived risk for patients with limited life expectancy [171]. Furthermore, a recent analysis concluded that “risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable and may be nonexistent” and that “predictions of hypothetical cancer incidence and deaths in patient populations exposed to such low doses are highly speculative and should be discouraged” because they “are harmful … and may cause some patients and parents to refuse medical imaging procedures” [172]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The discovery of the Warburg effect in the early twentieth century followed by the development of the fluorinated glucose analogue 18F-fluorodeoxyglucose (18F-FDG) and the invention of positron emission tomographs laid the foundation of clinical PET/CT. This review discusses the challenges and obstacles in clinical adoption of this technique. We then discuss advances in instrumentation, including the critically important introduction of PET/CT and current PET/CT protocols. Moreover, we provide evidence for the clinical utility of PET/CT for patient management and its potential impact on patient outcome, and address its cost and cost-effectiveness. Although this review largely focuses on 18F-FDG imaging, we also discuss a variety of additional molecular imaging approaches that can be used for cancer phenotyping with PET. Throughout this review we emphasize the critical contributions of CT to the strength of PET/CT.
    09/2013; 1(3). DOI:10.1007/s40134-013-0016-x
  • Source
    • "[30] [31] [32] [33] [34] "
    [Show abstract] [Hide abstract]
    ABSTRACT: To overcome the health hazards related to the over dosage of radiopharmaceuticals, a study was conducted on 120 patients of different genders and age groups (from 10 – 50 years), who visited Punjab Institute of Nuclear Medicine (PINUM) at Faisalabad in Pakistan for thyroid scan. Patients were treated with different doses of Technitium-99m ranging from 1 to 5 mCi. Infinia Hawkeye-4 SPECT/CT was used to investigate Technitium-99m uptake measurements by thyroid. The results revealed that instead of presently used Technitium-99m dose of 3-10 mCi to get a thyroid scan in 1–4 min, the same scan can be acquired with a dose of 2-3 mCi in 4-8 min. The study helped to perform thyroid scan with a reduced dose of lowest activity to save patients, attendants and general public from hazardous effects of over dose of radioactive materials.
  • Source
    • "This education also emphasises the situations in which the reduction in the dose is especially important. For example, the patient's age is a major factor since the potential risk of radio-induced cancer due to low-doses of X-rays decreases with age [40]. Special care is the rule for young subjects. "
    [Show abstract] [Hide abstract]
    ABSTRACT: With an improvement in the temporal and spatial resolution, computed tomography (CT) is indicated in the evaluation of a great many osteoarticular diseases. New exploration techniques such as the dynamic CT and CT bone perfusion also provide new indications. However, CT is still an irradiating imaging technique and dose optimisation and reduction remains primordial. In this paper, the authors first present the typical doses delivered during CT in osteoarticular disease. They then discuss the different ways to optimise and reduce these doses by distinguishing the behavioural factors from the technical factors. Among the latter, the optimisation of the milliamps and kilovoltage is indispensable and should be adapted to the type of exploration and the morphotype of each individual. These technical factors also benefit from recent technological evolutions with the distribution of iterative reconstructions. In this way, the dose may be divided by two and provide an image of equal quality. With these dose optimisation and reduction techniques, it is now possible, while maintaining an excellent quality of the image, to obtain low-dose or even very low-dose acquisitions with a dose sometimes similar that of a standard X-ray assessment. Nevertheless, although these technical factors provide a major reduction in the dose delivered, behavioural factors, such as compliance with the indications, remain fundamental. Finally, the authors describe how to optimise and reduce the dose with specific applications in musculoskeletal imaging such as the dynamic CT, CT bone perfusion and dual energy CT.
    Diagnostic and interventional imaging 12/2012; 94(4). DOI:10.1016/j.diii.2012.05.017
Show more