Cumulative Effective Dose and Cancer Risk of Pediatric Population in Repetitive Whole-Body Scan Using Dual-Energy X-Ray Absorptiometry

Leixnering, M.; Ma, Wang-Kei; Chan, Eva; Mui, Candy; Ma, Vivian; Ho, Wai Yin; Yip, Lawrance; Lam, Wendy

doi:10.1016/j.jocd.2017.09.005

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…It can further increase the error of perceived and true risk of radiation dose from CT examinations. The combination of individual dose distributions and risk assessment has been presented for a few other examinations in literature, such as absorptiometry and spine radiographs, but not for spiral CT examinations 27 . Pairwise patient comparisons provide a comprehensive overview of the extent of error with regard to age, BMI and sex.…”

Section: Discussionmentioning

confidence: 99%

Individual Calculation of Effective Dose and Risk of Malignancy Based on Monte Carlo Simulations after Whole Body Computed Tomography

Kopp

Loewe

Wuest

et al. 2020

Sci Rep

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Detailed knowledge about radiation exposure is crucial for radiology professionals. The conventional calculation of effective dose (ED) for computed tomography (CT) is based on dose length product (DLP) and population-based conversion factors (k). This is often imprecise and unable to consider individual patient characteristics. We sought to provide more precise and individual radiation exposure calculation using image based Monte Carlo simulations (MC) in a heterogeneous patient collective and to compare it to phantom based MC provided from the National Cancer Institute (NCI) as academic reference. Dose distributions were simulated for 22 patients after whole-body CT during Positron Emission Tomography-CT. Based on MC we calculated individual Lifetime Attributable Risk (LAR) and Excess Relative Risk (ERR) of cancer mortality. ED MC was compared to ED DLp and eD nci. ED DLp (13.2 ± 4.5 mSv) was higher compared to ED nci (9.8 ± 2.1 mSv) and ED MC (11.6 ± 1.5 mSv). Relative individual differences were up to −48% for ED MC and −44% for ED nci compared to ED DLp. Matching pair analysis illustrates that young age and gender are affecting LAR and ERR significantly. Because of these uncertainties in radiation dose assessment automated individual dose and risk estimation would be desirable for dose monitoring in the future. The Euratom council directive (2013/59/Euratom) emphasizes the need for patient radiation dose monitoring in clinical routine 1. Computed tomography (CT) is indispensable for contemporary patient care, but many studies suggest a relation between low dose protracted radiation exposure and an increased incidence of malignancy based on the linear Non-threshold Dose-Response Model 2. Therefore, detailed knowledge of radiation exposure from CT examinations is crucial for radiology healthcare professionals in clinical routine to detect and address increased risks of malignancy. Widely used parameters for radiation exposure assessment like the volumetric CT dose index (CTDI vol) and the Dose Length Product (DLP) characterize scanner radiation output, but are unable to take individual patient characteristics into account 3. Conversion to effective dose (ED DLP) is feasible using population-based conversion factors (k) that take the averaged radiosensitivity in defined anatomic regions into account 4. A variety of different k-factors are recommended in the literature for different volumes (e.g. head, thorax, abdomen, pelvis) and different CT-scanners 5,6. These k-factors are mostly derived from phantom models that try to represent average patient anatomy in western populations, but are unable to respect individual anatomy like missing organs due to aplasia or resection, organ hypo-or hypertrophy, skeletal deformations and metal implants. Nevertheless, these programs, like e.g. the National Cancer Institute (NCI) dosimetry system for CT, can be considered as current academic reference (ED NCI) 7. However, the routinely performed calculation of ED DLP is imprecise and the degree of difference to the real ED in e...

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Section: Discussionmentioning

confidence: 99%

Individual Calculation of Effective Dose and Risk of Malignancy Based on Monte Carlo Simulations after Whole Body Computed Tomography

Kopp

Loewe

Wuest

et al. 2020

Sci Rep

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“…DXA is the most frequently used method of assessment of bone mass because of its availability, diagnostic accuracy, and because of its use of a low dose of radiation (5–6 mSv for the lumbar spine, hip, and whole body) [ 42 ]. DXA measures BMC and calculates areal BMD (aBMD) by dividing BMC by the area of the region scanned.…”

Section: Paediatric Osteoporosismentioning

confidence: 99%

Bone Health in Children with Rheumatic Disorders: Focus on Molecular Mechanisms, Diagnosis, and Management

Marcello

Donato

d’Angelo

et al. 2022

IJMS

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Bone is an extremely dynamic and adaptive tissue, whose metabolism and homeostasis is influenced by many different hormonal, mechanical, nutritional, immunological and pharmacological stimuli. Genetic factors significantly affect bone health, through their influence on bone cells function, cartilage quality, calcium and vitamin D homeostasis, sex hormone metabolism and pubertal timing. In addition, optimal nutrition and physical activity contribute to bone mass acquisition in the growing age. All these factors influence the attainment of peak bone mass, a critical determinant of bone health and fracture risk in adulthood. Secondary osteoporosis is an important issue of clinical care in children with acute and chronic diseases. Systemic autoimmune disorders, like juvenile idiopathic arthritis, can affect the skeletal system, causing reduced bone mineral density and high risk of fragility fractures during childhood. In these patients, multiple factors contribute to reduce bone strength, including systemic inflammation with elevated cytokines, reduced physical activity, malabsorption and nutritional deficiency, inadequate daily calcium and vitamin D intake, use of glucocorticoids, poor growth and pubertal delay. In juvenile arthritis, osteoporosis is more prominent at the femoral neck and radius compared to the lumbar spine. Nevertheless, vertebral fractures are an important, often asymptomatic manifestation, especially in glucocorticoid-treated patients. A standardized diagnostic approach to the musculoskeletal system, including prophylaxis, therapy and follow up, is therefore mandatory in at risk children. Here we discuss the molecular mechanisms involved in skeletal homeostasis and the influence of inflammation and chronic disease on bone metabolism.

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“…Despite this, most of the imaging equipment has been traditionally developed and manufactured without specific indications for pediatric use. This is particularly important in relation to the use of ionizing radiation as younger patients are at greater risk of complications secondary to radiation exposure [71,72]. Modern dual energy techniques have reduced exposure but still have a quantifiable risk of cancer induction when use is frequent in the pediatric population [73].…”

Section: Diagnostic Imaging Devices For Cypmentioning

confidence: 99%

Medical Device Development for Children and Young People—Reviewing the Challenges and Opportunities

et al. 2021

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Development of specific medical devices (MDs) is required to meet the healthcare needs of children and young people (CYP). In this context, MD development should address changes in growth and psychosocial maturation, physiology, and pathophysiology, and avoid inappropriate repurposing of adult technologies. Underpinning the development of MD for CYP is the need to ensure MD safety and effectiveness through pediatric MD-specific regulations. Contrary to current perceptions of limited market potential, the global pediatric healthcare market is expected to generate around USD 15,984 million by 2025. There are 1.8 billion young people in the world today; 40% of the global population is under 24, creating significant future healthcare market opportunities. This review highlights a number of technology areas that have led to successful pediatric MD, including 3D printing, advanced materials, drug delivery, and diagnostic imaging. To ensure the targeted development of MD for CYP, collaboration across multiple professional disciplines is required, facilitated by a platform to foster collaboration and drive innovation. The European Pediatric Translational Research Infrastructure (EPTRI) will be established as the European platform to support collaboration, including the life sciences industrial sector, to identify unmet needs in child health and support the development, adoption, and commercialization of pediatric MDs.

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Cumulative Effective Dose and Cancer Risk of Pediatric Population in Repetitive Whole-Body Scan Using Dual-Energy X-Ray Absorptiometry

Cited by 7 publications

References 13 publications

Individual Calculation of Effective Dose and Risk of Malignancy Based on Monte Carlo Simulations after Whole Body Computed Tomography

Individual Calculation of Effective Dose and Risk of Malignancy Based on Monte Carlo Simulations after Whole Body Computed Tomography

Bone Health in Children with Rheumatic Disorders: Focus on Molecular Mechanisms, Diagnosis, and Management

Medical Device Development for Children and Young People—Reviewing the Challenges and Opportunities

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