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Estimated Radiation Dose and Cancer Risk

Kwang Pyo Kim, PhD; Andrew J. Einstein, MD, PhD; Amy Berrington de González, DPhil

Arch Intern Med. 2009;169(13):1188-1194.

Background  Multidetector computed tomography has been proposed as a tool for routine screening for coronary artery calcification in asymptomatic individuals. As proposed, such screening could involve tens of millions of individuals, but detailed estimates of radiation doses and potential risk of radiation-induced cancer are not currently available. We estimated organ-specific radiation doses and associated cancer risks from coronary artery calcification screening with multidetector computed tomography according to patient age, frequency of screening, and scan protocol.

Methods  Radiation doses delivered to adult patients were calculated from a range of available protocols using Monte Carlo radiation transport. Radiation risk models, derived using data from Japanese atomic bomb survivors and medically exposed cohorts, were used to estimate the excess lifetime risk of radiation-induced cancer.

Results  The radiation dose from a single coronary artery calcification computed tomographic scan varied more than 10-fold (effective dose range, 0.8-10.5 mSv) depending on the protocol. In general, higher radiation doses were associated with higher x-ray tube current, higher tube potential, spiral scanning with low pitch, and retrospective gating. The wide dose variation also resulted in wide variation in estimated radiation-induced cancer risk. Assuming screening every 5 years from the age of 45 to 75 years for men and 55 to 75 years for women, the estimated excess lifetime cancer risk using the median dose of 2.3 mSv was 42 cases per 100 000 men (range, 14-200 cases) and 62 cases per 100 000 women (range, 21-300 cases).

Conclusions  These radiation risk estimates can be compared with potential benefits from screening, when such estimates are available. Doses and therefore risks can be minimized by the use of optimized protocols.

Author Affiliations: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (Drs Kim and Berrington de González); and Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University College of Physicians and Surgeons, New York, New York (Dr Einstein). Dr Kim is now with the Department of Nuclear Engineering, Kyung Hee University, Gyeonggi-do, Republic of Korea.

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