title: Lifetime Attributable Risk of Cancer From Radiation Exposure During Parathyroid Imaging: Comparison of 4D CT and Parathyroid Scintigraphy.
abstract: OBJECTIVE
  The purpose of this study is to measure the organ doses and effective dose (ED) for parathyroid 4D CT and scintigraphy and to estimate the lifetime attributable risk of cancer incidence associated with imaging.
  
  
  METHODS
  Organ radiation doses for 4D CT and scintigraphy were measured on the basis of imaging with our institution's protocols. An anthropomorphic phantom with metal oxide semiconductor field effect transistor detectors was scanned to measure CT organ dose. Organ doses from the radionuclide were based on International Commission for Radiological Protection report 80. ED was calculated for 4D CT and scintigraphy and was used to estimate the lifetime attributable risk of cancer incidence for patients differing in age and sex with the approach established by the Biologic Effects of Ionizing Radiation VII report. A 55-year-old woman was selected as the standard patient according to the demographics of patients with primary hyperparathyroidism.
  
  
  RESULTS
  Organs receiving the highest radiation dose from 4D CT were the thyroid (150.6 mGy) and salivary glands (137.8 mGy). For scintigraphy, the highest organ doses were to the colon (41.5 mGy), gallbladder (39.8 mGy), and kidneys (32.3 mGy). The ED was 28 mSv for 4D CT, compared with 12 mSv for scintigraphy. In the exposed standard patient, the lifetime attributable risk for cancer incidence was 193 cancers/100,000 patients for 4D CT and 68 cancers/100,000 patients for scintigraphy. Given a baseline lifetime incidence of cancer of 46,300 cancers/100,000 patients, imaging results in an increase in lifetime incidence of cancer over baseline of 0.52% for 4D CT and 0.19% for scintigraphy.
  
  
  CONCLUSIONS
  The ED of 4D CT is more than double that of scintigraphy, but both studies cause negligible increases in lifetime risk of cancer. Clinicians should not allow concern for radiation-induced cancer to influence decisions regarding workup in older patients.
authors.affiliation: 1 Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC 27710.
authors.forename: Jenny K
authors.initials: JK
authors.lastname: Hoang
authors.forename: Robert E
authors.initials: RE
authors.lastname: Reiman
authors.forename: Giao B
authors.initials: GB
authors.lastname: Nguyen
authors.forename: Natalie
authors.initials: N
authors.lastname: Januzis
authors.forename: Bennett B
authors.initials: BB
authors.lastname: Chin
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lowry
authors.forename: Terry T
authors.initials: TT
authors.lastname: Yoshizumi
mesh_terms: D005260:Female; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D015994:Incidence; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology*; D010279:Parathyroid Diseases / Q000000981:diagnostic imaging*; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011877:Radionuclide Imaging; D018570:Risk Assessment; D012307:Risk Factors
keywords: 4D CT; parathyroid; radiation dose; scintigraphy; stochastic effect