Ann ICRP — Am J Med — Brambilla M, De Mauri A, Lizio D et al Cumulative radiation dose estimates from medical imaging in paediatric patients with non-oncologic chronic illnesses. A systematic review. Phys Med — Rehani MM Looking for solutions: vision and a call-for-attention for radiation research scientists. Int J Radiat Biol — National Council of Radiation Protection and Measurements Implications of recent epidemiologic studies for the linear-non-threshold model and radiation protection.
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JAMA — J Am Coll Radiol — Circulation — CMAJ — Am J Cardiol — Kidney Int — J Am Soc Nephrol — Coyle J, Kinsella S, McCarthy S et al Cumulative ionizing radiation exposure in patients with end stage kidney disease: a 6-year retrospective analysis.
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Previous NCI Directors. NCI Frederick. Advisory Boards and Review Groups. NCI Congressional Justification. Current Congress. Committees of Interest. Legislative Resources. Recent Public Laws. Search Search. Cancer Information Summaries. Adult Treatment. In this patient, a total of 78 imaging studies 44 CT scans, 33 radiographic examinations, one bone scintigraphy were performed within a follow-up period of six years, with the majority of examinations 55 performed in the first year. Analysis of the patient record revealed that the high number of examinations was necessary due to poor therapeutic response, an iatrogenic pneumothorax and various other major clinical complications.
National and international guidelines for HL and DLBCL suggest a certain number of imaging procedures in the course of the disease as summarized in Table 3 , but do not take into account additional interim examinations performed due to lack of remission or clinical complications.
Accordingly, considerable more imaging studies were performed in our patient cohort in particular in the first year after diagnosis than recommended by the German guidelines for initial workup and therapy monitoring cf. Compared to the German guidelines, more studies than recommended were performed in the observed patient cohort in the first year.
Since this guidelines recommend no diagnostic imaging using ionizing-radiation during the follow-up period at all, all investigations carried-out during this period Table 2 are considered as additionally.
The cumulative organ dose values for the first year and the average annual doses for each of the subsequent years are shown in Fig. Remainder tissues are: adrenals, extrathoracic region, gall bladder, heart, lymphatic nodes, muscle, oral mucosa, pancreas, small intestine, spleen and thymus. For these organs, doses are averaged, as they have a relatively low susceptibility to ionizing radiation.
Remainder tissues: adrenals, extrathoracic region, gall bladder, heart, lymphatic nodes, muscle, oral mucosa, pancreas, small intestine, spleen, thymus.
In the subsequent years 2—6 no significant differences in the average annual effective dose between male and female patients, between diagnoses or tumor stages or between the two considered age groups were observed. Here, the relative contribution of CT scans was Nuclear medicine procedures and radiographies accounted for 1. Figures 4A,B show the distribution of the annual effective dose in the first and the subsequent years stratified by sex and age group.
A,B Estimated average effective doses cumulated over one year in A the first year after diagnosis and B each of the following years stratified by sex and age.
The horizontal line within the box represents the median value, the ends of the box the 75 th and 25 th percentiles. The radiation risks estimated for imaging procedures performed during the first year after diagnosis were significantly different for men and women 0. Estimated values are summarized in Fig. There were no differences between tumor stages. The radiation risks associated with imaging procedures performed on average per year in the subsequent years are also summarized in Fig.
Significant differences were found between men 0. A,B Sex- and age-specific distribution of the average lifetime attributable risk of cancer incidence cumulated over on year in A the first year after diagnosis and B each of the following years. For details of presentation see Fig. For both male and female patients, in the first as well as in the following years, the largest proportion of the annual radiation risk originates from radiation exposure of the remainder tissues The patient with the highest overall summed over six years after diagnosis was once again the year-old female patient with HL who already had the most procedures and the highest cumulative effective dose.
Her lifetime attributable risk of cancer incidence due to all procedures performed in the six years was estimated at 5. The presented retrospective patient study provides a detailed analysis of the individual cumulative radiation exposure and associated cancer risk resulting from diagnostic imaging procedures using ionizing radiation carried-out in patients with HL or DLBCL over a long oberservation period of up to 6 years.
Table 3 The second advantage of our study design is that we included all diagnostic examinations using ionizing radiation over the whole observation period. Hereby, our results clearly demonstrate that patients undergo considerably more examinations when compared to recent guidelines cf.
Every procedure that was done exceeding these suggested numbers was considered as additional and due to complications. This was This has to be accounted for when comparing the results with other studies. In contrast to guidelines that do not consider clinical complications, like atypical pneumonia that frequently occur during therapy and often lead to several thoracic CT examinations, our results provide a realistic scenario without any bias concerning the number, type and radiation dose of examinations clinically performed in patients with HL and DLBCL.
Therefore, the cumulative effective doses estimated for the patients of our study cohort were markedly higher compared to those in a recently published study that used a Monte Carlo simulation to investigate radiation exposure and risk of adult patients with NHL associated with the imaging protocol of the HOVON 84 international multicenter trial 7.
We deliberately considered only patients with HL or DLBCL with an age between 18—55 years to address the higher radiation risk of young and middle-aged patients.
Moreover, elderly patients with both HL or DLBCL have also a considerably reduced disease-related overall survival rate when compared to young and middle-aged patients and thus a considerably decreased likelihood to develop a clinically manifest secondary cancer Within this context, it is important to consider that the minimum latency period to develop a secondary cancer, i.
Women in our patient cohort showed a significantly higher cumulative when compared to men in the first year after diagnosis. Since CT was the main source of ionizing radiation in this study, the higher in women is most likely explained by a limited adaption of the individual CT scan protocol to the individual body size.
Within this context, it is important to consider that over the last years several novel techniques for radiation dose reduction in CT - that were mainly not clinically available during our observation period - have been clinically implemented. Those techniques include more efficient X-ray detectors, iterative reconstruction techniques as well as automated tube current modulation and tube voltage selection based on the individual anatomy of the patient 19 , As one example out of many, a recently published study by Meyer et al.
The interpretation of the cumulative effective dose estimated in this study has to consider that the effective dose characterizes the generic radiation risk of patients because neither the sex nor the age of the patients is considered and is thus not suitable for risk assessment of individual patients.
Therefore, the ICRP stated that the effective dose should neither be used for epidemiological evaluations nor for detailed retrospective investigations of individual exposure and risks The effective dose was determined to be comparable to previous studies.
The individual lifetime attributable risk estimates computed in this study by using most recent organ-, sex- and age-dependent risk models yield a significantly higher cancer risk for women as compared to men. This is called background radiation and it varies across the country. The average American is exposed to about 3 mSv millisieverts of radiation from natural sources over the course of a year. A millisievert is a measure of radiation exposure.
But background radiation exposure varies throughout the United States, and the world. The largest source of background radiation typically about 2 mSv per year is radon, a natural gas found in our homes. Radon levels vary greatly from one part of the country to another.
So, people living in the higher parts of New Mexico and Colorado are exposed to more radiation per year about 1.
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