title: Monitoring Ionizing Radiation Exposure for Cardiotoxic Effects of Breast Cancer Treatment.
abstract: Serial assessments of left ventricular ejection fraction (LVEF) are customary in patients with breast cancer receiving trastuzumab. Radionuclide angiography (RNA) is often used; however, a typical monitoring schedule could include 5 scans in a year. We evaluated the proportion of imaging-related ionizing radiation attributable to RNA in 115 patients with breast cancer, from 3 medical centers in the United States, Ireland, and Japan, who completed 12 months of trastuzumab treatment. Estimated radiation dose (ERD) was used to calculate exposure associated with imaging procedures spanning the 18 months before and after trastuzumab therapy. In addition, 20 cardiologists and oncologists from participating centers were surveyed for their opinions regarding the contribution of RNA to overall radiation exposure during trastuzumab treatment. When RNA was used to monitor LVEF, the mean ERD from imaging was substantial (34 ± 24.3 mSv), with the majority attributable solely to RNA (24.7 ± 14.8 mSv, 72.6%). Actual ERD associated with RNA in this population differed significantly from the perception in surveyed cardiologists and oncologists; 70% of respondents believed that RNA typically accounted for 0% to 20% of overall radiation exposure from imaging; RNA actually accounted for more than 70% of ERD. In conclusion, RNA was used to monitor LVEF in most patients in this cohort during and after trastuzumab therapy. This significantly increased ERD and accounted for a greater proportion of radiation than that perceived by surveyed physicians. ERD should be taken into account when choosing a method of LVEF surveillance. Alternative techniques that do not use radiation should be strongly considered.
authors.affiliation: Department of Medicine, University of Chicago, Chicago.
authors.forename: Gillian
authors.initials: G
authors.lastname: Murtagh
authors.affiliation: Department of Medicine, University of Chicago, Chicago.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Yu
authors.affiliation: Department of Hematology and Oncology, St James's Hospital, Dublin, Ireland.
authors.forename: Emily
authors.initials: E
authors.lastname: Harrold
authors.affiliation: Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland.
authors.forename: Jennie
authors.initials: J
authors.lastname: Cooke
authors.affiliation: Department of Hematology and Oncology, St James's Hospital, Dublin, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Keegan
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Fukuda
authors.affiliation: Department of Medicine, University of Chicago, Chicago.
authors.forename: Karima
authors.initials: K
authors.lastname: Addetia
authors.affiliation: Department of Medicine, University of Chicago, Chicago.
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Medicine, University of Chicago, Chicago.
authors.forename: Kirk T
authors.initials: KT
authors.lastname: Spencer
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Department of Hematology and Oncology, St James's Hospital, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Kennedy
authors.affiliation: Department of Medicine, University of Chicago, Chicago.
authors.forename: R Parker
authors.initials: RP
authors.lastname: Ward
authors.affiliation: Department of Medicine, University of Chicago, Chicago; Department of Radiology, University of Chicago, Chicago.
authors.forename: Amit R
authors.initials: AR
authors.lastname: Patel
authors.affiliation: Department of Medicine, University of Chicago, Chicago; Department of Radiology, University of Chicago, Chicago.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
authors.affiliation: Department of Medicine, University of Chicago, Chicago. Electronic address: jdecara@medicine.bsd.uchicago.edu.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: DeCara
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D009202:Cardiomyopathies / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D019028:Magnetic Resonance Imaging, Cine; D008875:Middle Aged; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011839:Radiation, Ionizing; D011877:Radionuclide Imaging / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000009:adverse effects; D000068878:Trastuzumab / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000528:radiation effects
chemical_list: D000970:Antineoplastic Agents; D000068878:Trastuzumab