Radiation burden and associated cancer risk for a typical population to be screened for lung cancer with low-dose CT: A phantom study

Abstract

Objectives: To estimate (a) organ doses and organ-specific radiation-induced cancer risk from a single low-dose CT (LDCT) for lung cancer screening (LCS) and (b) the theoretical cumulative risk of radiation-induced cancer for a typical cohort to be subjected to repeated annual LCS LDCT.

Methods: Sex- and body size-specific organ dose data from scan projection radiography (SPR) and helical CT exposures involved in LCS 256-slice LDCT were determined using Monte Carlo methods. Theoretical life attributable risk (LAR) of radiogenic cancer from a single 256-slice chest LDCT at age 55-80 years and the cumulative LAR of cancer from repeated annual LDCT studies up to age 80 years were estimated and compared to corresponding nominal lifetime intrinsic risks (LIRs) of being diagnosed with cancer.

Results: The effective dose from LCS 256-slice LDCT was estimated to be 0.71 mSv. SPR was found to contribute 6-12 % to the total effective dose from chest LDCT. The radiation-cancer LAR from a single LDCT study was found to increase the nominal LIR of cancer in average-size 55-year-old males and females by 0.008 % and 0.018 %, respectively. Cumulative radiogenic risk of cancer from repeated annual scans from the age of 55-80 years was found to increase the nominal LIR of cancer by 0.13 % in males and 0.30 % in females.

Conclusion: Modern scanners may offer sub-millisievert LCS LDCT. Cumulative radiation risk from repeated annual 256-slice LDCT LCS examinations was found to minimally aggravate the lifetime intrinsic cancer risk of a typical screening population.

Key points: • Effective dose from lung cancer screening low-dose CT may be <1 mSv. • Screening with modern low-dose CT minimally aggravates lifetime cancer induction intrinsic risk. • Dosimetry of lung cancer screening low-dose CT should encounter the radiation burden from the localizing scan projection radiography. • DLP method may underestimate effective dose from low-dose chest CT by 27 %.

Keywords: Cancer screening; Lung cancer; Multidetector computed tomography; Radiation exposure; Radiation-induced cancer.