Background: Among medical technologies that use ionizing radiation, CT is currently the radio diagnostic technic that can deliver the highest radiation to the Patient compared with other conventional procedures. In developing countries, the uses and risks of CT have not been well characterized. Objective: To estimate the lifetime attributable risk (LAR) incidence and mortality for cancer for each procedure for adult’s patients who had Computed Tomography examinations in 10 imaging centers in the city of Douala-Cameroon so as to provide a reference data. Materials and Methods: We conducted a cross-sectional study describing radiation dose associated with the 8 most common types of diagnostic CT studies performed on 1287 consecutive adult patients at 10 Douala radiology department. We estimated lifetime attributable risks of cancer by study type from these measured doses. Estimation of LAR for cancer incidence and mortality was based on the effective dose, patient’s sex and age at exposure using the BIER VII preferred models. Results: Mean effective dose from CT scans examinations varied from: 0.30 and 8.81 mSv. The highest doses were observed for lumbar spine CT (8.81 mSv), followed by abdomen-pelvis procedure (6.46 mSv), chest-abdomen-pelvic CT (6.61 mSv), chest CT (3.90 mSv), cervical Spine CT (3.05 mSv), head CT (1.7 mSv) and lower for sinus CT (0.30 mSv). The LAR values of all cancer from patients’ CT scans obtained vary from 67.13 excess per 100,000 (about 1 in 1489) and 0.45 excess per 100,000 (about 1 in 222,222). All cancer risk was high for lumbar spine CT in women 20 years old (67.13 excess deaths in 100,000 scans) followed by chest-abdomen-pelvic CT (50.36 excess deaths in 100,000 scans) and abdomen-pelvic CT (49.22 excess deaths in 100,000 scans) for the same age group. The LAR of incidence and mortality values were higher from female’s patients than males and higher for younger than older patients. Conclusion: This study was set out to estimate the LAR values associated with adult common CT scans procedures. The data indicates, LAR risks related to induced cancer from CT exposures were estimated to be low. This risk can be relatively significant for younger age group compared to older age group. The LAR values obtained will help to better evaluate radiation exposure risk, before ordering a CT scans examinations.
References
[1]
United Nations Scientific Committee on the Effects of Atomic Radiation (2010) Report of the United Nations Scientific Committee on the Effects of Atomic Radiation to the General Assembly. In: United Nations Scientific Committee on the Effects of Atomic Radiation, Ed., United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) Reports, UN, 1-20. https://doi.org/10.18356/9b8f628f-en
[2]
National Research Council of the National Academies (2006) Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII, Phase 2. National Academies Press.
[3]
Cordoliani, Y.-S. (2008) Vademecum du Scanner multicoupe. Publication en ligne.
[4]
United Nations Scientific Commitee on the Effects of Atomic Radiation (2000) Sources and Effects of Ionizing Radiation. Vol. 1. United Nations.
[5]
Brenner, D.J. and Elliston, C.D. (2004) Estimated Radiation Risks Potentially Associated with Full-Body CT Screening. Radiology, 232, 735-738. https://doi.org/10.1148/radiol.2323031095
[6]
Tubiana, M., Aurengo, A., Averbeck, D. and Masse, R. (2006) The Debate on the Use of Linear No Threshold for Assessing the Effects of Low Doses. Journal of Radiological Protection, 26, 317-324. https://doi.org/10.1088/0952-4746/26/3/n01
[7]
Wall, B.F., Kendall, G.M., Edwards, A.A., Bouffler, S., Muirhead, C.R. and Meara, J.R. (2006) What Are the Risks from Medical X-Rays and Other Low Dose Radiation? The British Journal of Radiology, 79, 285-294. https://doi.org/10.1259/bjr/55733882
[8]
Shrimpton, P.C., Lewis, M.A. and Dunn, M. (2005) Doses from Computed Tomography Examinations in the UK—2003 Review. NRPB W67 Report.
[9]
McCollough, C.H. and Schueler, B.A. (2000) Calculation of Effective Dose. Medical Physics, 27, 828-837. https://doi.org/10.1118/1.598948
[10]
Shrimpton, P.C. and Wall, B.F. (1992) Assessment of Patient Dose from Computed Tomography. Radiation Protection Dosimetry, 43, 205-205. https://doi.org/10.1093/rpd/43.1-4.205
[11]
McCollough, C., Cody, D., Edyvean, S., Geise, R., Gould, B., Keat, N., et al. (2008) The Measurement, Reporting, and Management of Radiation Dose in CT. Report of AAPM Task Group, 23, 1-28.
[12]
Thomas, K.E. and Wang, B. (2008) Age-Specific Effective Doses for Pediatric MSCT Examinations at a Large Children’s Hospital Using DLP Conversion Coefficients: A Simple Estimation Method. Pediatric Radiology, 38, 645-656. https://doi.org/10.1007/s00247-008-0794-0
[13]
Deak, P.D., Smal, Y. and Kalender, W.A. (2010) Multisection CT Protocols: Sex-and Age-Specific Conversion Factors Used to Determine Effective Dose from Dose-Length Product. Radiology, 257, 158-166. https://doi.org/10.1148/radiol.10100047
[14]
Huda, W., Magill, D. and He, W. (2011) CT Effective Dose Per Dose Length Product Using ICRP 103 Weighting Factors. Medical Physics, 38, 1261-1265. https://doi.org/10.1118/1.3544350
[15]
Linet, M.S., Slovis, T.L., Miller, D.L., Kleinerman, R., Lee, C., Rajaraman, P., et al. (2012) Cancer Risks Associated with External Radiation from Diagnostic Imaging Procedures. CA: A Cancer Journal for Clinicians, 62, 75-100. https://doi.org/10.3322/caac.21132
[16]
Uushona, V., Boadu, M., Nyabanda, R., Diagne, M., Inkoom, S., Issahaku, S., et al. (2022) Establishment of Regional Diagnostic Reference Levels in Adult Computed Tomography for Four African Countries: A Preliminary Survey. Radiation Protection Dosimetry, 198, 414-422. https://doi.org/10.1093/rpd/ncac074
[17]
Kanal, K.M., Butler, P.F., Sengupta, D., Bharga-Chatfield, M., Coombs, L.P. and Morin, R.L. (2017) U.S. Diagnostic Reference Levels and Achievable Doses for 10 Adult CT Examinations. Radiology, 284, 120-133. https://doi.org/10.1148/radiol.2017161911
[18]
Treier, R., Aroua, A., Verdun, F.R., Samara, E., Stuessi, A. and Trueb, P.R. (2010) Patient Doses in CT Examinations in Switzerland: Implementation of National Diagnostic Reference Levels. Radiation Protection Dosimetry, 142, 244-254. https://doi.org/10.1093/rpd/ncq279
[19]
Khoramian, D., Sistani, S. and Hejazi, P. (2019) Establishment of Diagnostic Reference Levels Arising from Common CT Examinations in Semnan County, Iran. Polish Journal of Medical Physics and Engineering, 25, 51-55. https://doi.org/10.2478/pjmpe-2019-0008
[20]
de Oliveira, C.M., Turcati Accorsi, A., Vinicius de Moura, L., Bacelar, A. and Anés. M. (2019) CT DRL Value for Adult Patients in a University Hospital from Brazil. European Society of Radiology EuroSafe Imaging 2019, ESI-0052. https://dx.doi.org/10.26044/esi2019/ESI-0052
[21]
Smith-Bindman, R. (2009) Radiation Dose Associated with Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer. Archives of Internal Medicine, 169, 2078-2086. https://doi.org/10.1001/archinternmed.2009.427
[22]
McCollough, C.H., Guimarães, L. and Fletcher, J.G. (2009) In Defense of Body CT. American Journal of Roentgenology, 193, 28-39. http://www.ncbi.nlm.nih.gov/pubmed/19542392 https://doi.org/10.2214/ajr.09.2754
[23]
Einstein, A.J., Henzlova, M.J. and Rajagopalan, S. (2007) Estimating Risk of Cancer Associated with Radiation Exposure from 64-Slice Computed Tomography Coronary Angiography. JAMA, 298, 317-323. https://doi.org/10.1001/jama.298.3.317
[24]
Conference of Radiation Control Program Directors (2007) Nationwide Evaluation of X-Ray Trends (NEXT): Tabulation and Graphical Summary of 2000 Survey of Computed Tomography. Conference of Radiation Control Program Directors Inc.
[25]
Kobayashi, M., Ootsuka, T. and Suzuki, S. (2013) Evaluation and Examination of Accuracy for the Conversion Factors of Effective Dose Per Dose-Length Product. Japanese Journal of Radiological Technology, 69, 19-27. https://doi.org/10.6009/jjrt.2013_jsrt_69.1.19