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Triple-Rule-Out Computed Tomography Angiography With 256-Slice Computed Tomography Scanners: Patient-Specific Assessment of Radiation Burden and Associated Cancer Risk

Perisinakis, Kostas PhD*; Seimenis, Ioannis PhD; Tzedakis, Antonis PhD; Papadakis, Antonios E. PhD; Damilakis, John PhD*

Investigative Radiology:
doi: 10.1097/RLI.0b013e31822d0cf3
Original Articles

Objectives: Risk-benefit analysis of triple-rule-out 256-slice computed tomography angiography (TRO-CTA) requires data on associated cancer risks, currently not available. The aim of the current study was to provide estimates of patient radiation burden and lifetime attributable risk (LAR) of radiation-induced cancer in patients undergoing typical 256-slice TRO-CTA.

Materials and Methods: Standard step-and-shoot 256-slice TRO-CTA exposures were simulated on 31 male and 31 female individual-specific voxelized phantoms using a Monte Carlo CT dosimetry software. Dose images were generated depicting the dose deposition on the exposed body region of the patient. Organ doses were obtained for all primarily irradiated radiosensitive organs. Organ doses were correlated to patient body size. TRO-CTA effective dose was estimated from (a) organ doses and (b) dose-length product data. Recently published sex-, age-, and organ-specific cancer risk factors were used to estimate the total LAR of radiation-induced cancer. The theoretical risks of radiation-induced cancer to the lung and breast following a 256-slice TRO-CTA were compared with the corresponding nominal risks for each of the studied patients.

Results: The highest organ doses were observed for the breast, heart, esophagus, and lung. Mean effective dose estimated using organ dose data was found to be 6.5 ± 1.0 mSv for female and 3.8 ± 0.7 mSv for male individuals subjected to 256-slice TRO-CTA. The associated mean LARs of cancer was found to be 41 per 105 female and 17 per 105 male patients. The total radiation-induced cancer risk was found to markedly decrease with patient age. TRO-CTA exposure was found to increase the intrinsic risks of developing lung or breast cancer during the remaining lifetime by less than 0.5% and 0.1%, respectively.

Conclusions: The mean theoretical risk of radiation-induced cancer for a patient cohort subjected to step-and-shoot 256-slice TRO-CTA may be considered to be low compared with the intrinsic risk of developing cancer.

Author Information

From the *Department of Medical Physics, University of Crete, Crete, Greece; †Medical Diagnostic Center “Ayios Therissos,” Nicosia, Cyprus; and ‡Department of Medical Physics, University Hospital of Heraklion, Crete, Greece.

Received January 14, 2011, and accepted for publication, after revision, July 9, 2011.

Conflicts of interest and sources of funding: none declared.

Reprints: Kostas Perisinakis, PhD, Faculty of Medicine, Medical Physics Department, University of Crete, P. O. Box 2208, 71003 Heraklion, Crete, Greece. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.