title: Comparison of radiation exposure and cost between dynamic computed tomography and sestamibi scintigraphy for preoperative localization of parathyroid lesions.
abstract: OBJECTIVE
  Dynamic computed tomography (CT) is emerging as a first-line alternative to sestamibi scintigraphy for preoperative localization of parathyroid lesions. In recent years, there has been increased concern over the impact of radiation exposure from medical imaging, as well as on the cost of diagnostic medical procedures. An ideal diagnostic procedure would be cost effective while minimizing hazardous exposures and complication rates.
  
  
  OBJECTIVE
  To compare the radiation dose and financial cost of dynamic CT with sestamibi scintigraphy.
  
  
  METHODS
  A retrospective review of 263 patients at a large, urban, tertiary referral center who underwent either dynamic parathyroid CT or sestamibi scintigraphy for any etiology of hyperparathyroidism from 2006 through 2010.
  
  
  METHODS
  The 2 primary study outcomes were radiation exposure measured in millisieverts (mSv) and medical charges for the respective diagnostic procedures. The study was conducted with the hypothesis that dynamic parathyroid CT would have slightly greater radiation exposure with similar cost to sestamibi scintigraphy.
  
  
  RESULTS
  Dynamic parathyroid CT and sestamibi scintigraphy delivered mean radiation doses of 5.56 and 3.33 mSv, respectively (P < .05). Charges totaled $1296 for thin-cut dynamic parathyroid CT and a mean of $1112 for sestamibi scintigraphy, depending on the type and amount of radiotracer injected. Although multiphase CT scanning took less than 5 minutes, sestamibi scintigraphy lasted a mean time of 306 minutes. A total of 62 of 119 patients (52%) in the CT group have undergone operative treatment to date, whereas all patients in the sestamibi arm underwent operative treatment of their hyperparathyroidism. Of the patients who underwent a surgical procedure, CT correctly identified the side of the parathyroid adenoma in 54 of 62 patients (87%), while sestamibi scintigraphy only correctly lateralized 90 of 122 adenomas (74%) as confirmed by exploratory surgery, intraoperative parathyroid hormone levels, and pathologic features. A dynamic parathyroid CT correctly predicted multiglandular disease in 1 of 7 patients (14%), while sestamibi scintigraphy correctly predicted multiglandular disease in 8 of 23 patients (35%).
  
  
  CONCLUSIONS
  In patients who underwent directed parathyroid surgery, dynamic CT is comparable to sestamibi scintigraphy in patients with hyperparathyroidism. Although CT delivers a higher dose of radiation, the average background radiation exposure in the United States is 3 mSv/y, and added exposures of less than 15 mSv are considered low risk for carcinogenesis. Overall, dynamic parathyroid CT is a safe, cost-effective alternative to sestamibi scintigraphy.
authors.affiliation: Department of Surgery, Mount SinaiMedical Center, New York, New York, USA.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Madorin
authors.forename: Randall
authors.initials: R
authors.lastname: Owen
authors.forename: Brian
authors.initials: B
authors.lastname: Coakley
authors.forename: Hannah
authors.initials: H
authors.lastname: Lowe
authors.forename: Kee-Hyun
authors.initials: KH
authors.lastname: Nam
authors.forename: Kaare
authors.initials: K
authors.lastname: Weber
authors.forename: Leon
authors.initials: L
authors.lastname: Kushnir
authors.forename: Jose
authors.initials: J
authors.lastname: Rios
authors.forename: Eric
authors.initials: E
authors.lastname: Genden
authors.forename: Puneet S
authors.initials: PS
authors.lastname: Pawha
authors.forename: William B
authors.initials: WB
authors.lastname: Inabnet
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics; D011300:Preoperative Care; D011829:Radiation Dosage; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000191:economics; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi / Q000191:economics; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi