Medical imaging professionals have an accountability for both quality and safety in the care of patients that have unexpected or anticipated repeated imaging examinations that use ionizing radiatio...

The cumulative radiation dose paradigm in pediatric imaging.

OBJECTIVE
To analyse the frequency, demographics, primary disease, and cumulative effective dose of patients undergoing two or more 18F-FDGPET/CT examinations in a year.


METHODS
In a retrospective study performed at a tertiary care hospital, patients who underwent ≥2 18F-FDGPET/CT scans in a calendar year were identified for two consecutive years. The CT radiation dose was calculated using dose-length-product and sex-specific conversion factors. The primary malignancy of patients was retrieved from electronic medical records.


RESULTS
10,714 18F-FDG PET/CT exams were performed for 6,831 unique patients in 2 years, yielding an average of 1.6 exams per patient. The maximum number of 18F-FDG PET/CT examinations any patient underwent in a single year was seven. 20.9% patients had ≥2 18F-FDG PET/CT exams in any single year. Thirty nine percent patients in the cohort were below 60 years age. The median dose for 18F-FDG PET/CT examination was 25.1 mSv and maximum value reaching 1.7 to 2.9 times the median value. Cumulative effective dose (CED) was ≥100 mSv in 12-13% of the patients. The cumulative dose for both years combined demonstrated the 25th percentile, 50th percentile and 75th percentile as well as the mean to be over 100 mSv, with the 25th percentile being 109 mSv. The dominant primary malignancies contributing to serial 18F-FDG PET/CTs in decreasing frequency were melanoma, non-Hodgkin's lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin's lymphoma.


CONCLUSIONS
A sizeable number of patients undergo ≥2 18F-FDG PET/CT exams with one out of every 8 patients receiving cumulative dose ≥100 mSv and that includes patients with long life expectancy.


ADVANCES IN KNOWLEDGE
The study found that 1 of 5 patients had ≥2 18F-FDG PET/CT exams in a calendar year, 1 of 4 patients in two years and 1 of 8 patients received cumulative dose ≥100 mSv. Top malignancies associated with serial imaging in decreasing order of frequency included melanoma, non-Hodgkin's lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin's lymphoma.

Patients undergoing multiple 18F-FDG PET/CT exams: Assessment of frequency, dose, and disease classification.

To assess the cumulated exposure to radiation due to imaging in Hodgkin (HL) and diffuse large B-cell (DLBCL) lymphoma patients who were not submitted to radiotherapy.The study population included 51 and 83 adult patients with HL and DLBCL, with a follow-up duration >1 year. The cumulated exposure was expressed using patient-specific data as cumulated effective dose (CED).Fifty-one HL patients (median age 47 years) were followed for a median of 3.5 years. The median total CED per subject was 104 mSv. CT and PET/CT examinations accounted for 75 and 25% of the total CED, respectively. 26 patients (49%) had a total CED ≥ 100 mSv and the maximum CED was 302 mSv. Eighty-three DLBCL patients (median age 66 years) were followed for a median of 3.7 years. The median total CED per subject over the study period was 134 mSv. CT and PET/CT for 86% and 13% of the total CED, respectively. 56 patients (67%) had a total CED ≥100 mSv. The maximum CED was 557 mSv.Our study demonstrated the large number of imaging procedures performed for patients with lymphoma. Overall, 61% of the patients accrued a CED ≥ 100 mSv. Imaging policies were only in a partial agreement with current international guidelines.The cumulated exposure radiation exposure may be of concern in HL patients and the contribution of CT procedures to the total CED is significant. The standardisation of clinical guidelines for managing patients with lymphoma is warranted. 

Cumulative radiation exposure from radiological imaging in patients with Hodgkin and diffuse large b-cell lymphoma not submitted to radiotherapy.

BACKGROUND
How to reduce the radiation dose received from full-body CT scans during the follow-up of lymphoma patients is a concern.


OBJECTIVE
To investigate the image quality and radiation dose of reduced-dose full-body computerized tomography [CT] in lymphoma patients during follow-up.


METHODS
121 patients were included and divided into conventional CT group [group 1, 120-kVp, n = 61] or reduced-dose CT group [group 2, 100-kVp combined dual-energy CT [DECT], n = 60]. 140-kVp polychromatic images and 70-keV monochromatic images were reconstructed from DECT. The abdominal virtual non-enhanced [VNE] images were reconstructed from monochromatic images. Two radiologists rated the overall image quality with a five-point scale and graded the depiction of lesions using a four-point scale. The objective image quality was evaluated using image noise, signal-to-noise ratio, contrast-to-noise ratio. The radiation dose and image quality were compared between groups.


RESULTS
The comparable subjective image quality was observed between 70-keV and 120-kVp images in the neck, while 120-kVp images showed better objective image quality. 70-keV images showed better objective image quality in the chest. While the subjective image quality of abdominal VNE images was inferior to that of true non-enhanced images, the improved objective image quality was observed in VNE images. In the abdominal arterial phase, similar subjective image quality was observed between groups. Abdominal 70-keV images in the arterial phase showed improved objective image quality. Similar image quality was obtained in the abdominal venous phase between groups. The effevtive radiation dose in group 2 showed a significant reduction.


CONCLUSION
The application of reduced-dose full-body CT can significantly reduce the radiation dose for lymphoma patients during follow-up while maintaining or improving image quality.

Reduced-dose Full-body CT in Lymphoma Follow-up: A Pilot Study.

Purpose Radiological examinations are critical in the evaluation of patients with haematological malignancies for diagnosis and treatment. Any dose of radiation has been shown in studies to be harmful. In this regard, we assessed the radiation exposure of 3 types of haematological malignancies (diffuse large B-cell lymphoma [DLBCL], acute myeloid leukaemia [AML], and multiple myeloma [MM]) in our centre during the first year after diagnosis. Material and methods In the first year after diagnosis we retrospectively reviewed the radiation exposure data of 3 types of haematological malignancies (DLBCL, AML, and MM). The total and median CED value (cumulative effective radiation dose in millisieverts [mSv]) of each patient was used. Each patient’s total and median estimated CED value was calculated using a web-based calculator and recorded in millisieverts (mSv). Results The total radiation doses in one year after diagnosis (CED value) were 46.54 ± 37.12 (median dose: 36.2) in the AML group; 63.00 ± 42.05 (median dose: 66.4) in the DLBCL group; and 28.04 ± 19.81 (median dose: 26.0) in the MM group (p = 0.0001). There was a significant difference between DLBCL and MM groups. Conclusions In all 3 haematological malignancies, the radiation exposure was significant, especially in the DBLCL group, within the first year of diagnosis. It is critical to seek methods to reduce these dosage levels. In diagnostic radiology, reference values must be established to increase awareness and self-control and reduce patient radiation exposure. This paper is also the first to offer thorough details on the subject at hand, and we think it can serve as a guide for further investigation.

/pdf/radiation-exposure-in-acute-myeloid-leukaemia-diffuse-large-fsjzbn7i.pdf

Radiation exposure in acute myeloid leukaemia, diffuse large B-cell lymphoma, and multiple myeloma patients in the first year following diagnosis

Survival rates among patients with lymphoma continue to improve. Strategies aimed at reducing potential 
treatment-related toxicity are increasingly prioritized. While radiological procedures play an important role, ionizing radiation exposure has been linked to an increased risk of malignancy, particularly among individuals whose cumulative radiation exposure exceeds a specific threshold (75 millisieverts). Within this retrospective study, the cumulative radiation exposure dose was quantified for 486 consecutive patients with lymphoma. The median estimated total cumulative effective dose (CED) of ionizing radiation per subject was 69 mSv (42–118). However, younger patients (under 40 years) had a median CED of 89 mSv (55–124). This study highlights the considerable radiation exposure occurring among patients with lymphoma as a result of diagnostic imaging. To limit the risk of secondary carcinogenesis, consideration should be given to monitoring cumulative radiation exposure in individual patients as well as considering imaging modalities, which do not impart an ionizing radiation dose.

Ionizing radiation exposure as a result of diagnostic imaging in patients with lymphoma.

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Ionizing radiation exposure as a result of diagnostic imaging in patients with lymphoma.