Cancer Risk due to Diagnostic Radiology

1. Epidemiology
   1. Cummulative risk increases after age 40
   2. Radiology may cause 1% of U.S. Cancers
2. Adverse Effects: Highest risk procedures (in descending order of risk)
   1. CT Scan (expecially CT Neck, CT Lung, CT Pelvis)
   2. Barium Enema
   3. Hip XRay
   4. Pelvis XRay
3. Adverse Effects: Cancers associated with Radiography
   1. Colon Cancer
   2. Bladder Cancer
   3. Breast Cancer
   4. Leukemia
4. Adverse Effects: Radiation Exposure from coronary procedures (under fluoroscopy)
   1. Coronary Angiography with stent placement: 13 mSv
   2. Electrophysiology study alone: 3.2 mSv
   3. Cardiac Catheter Ablation
      1. Atrial Tachycardia Ablation: 4.4 mSv
      2. Atrioventricular nodal reentrant Tachycardia (AVNRT) ablation: 4.8 mSv
      3. Atrial Flutter Ablation: 12.1 mSv
      4. Atrioventricular Reciprocating Tachycardia (AVRT) ablation: 12.8 mSv
      5. Atrial Fibrillation Ablation: 16.6 mSv
   4. References
      1. Efstathopoulos (2006) Europace 8(6): 443-8
      2. Perisinakis (2001) Circulation 104(1): 58-62
      3. Shapira (2009) Am Fam Physician 80(10): 1089-94
5. Adverse Effects: CT-related Radiation Exposure
   1. CT Radiation Exposure (average, in MilliSieverts)
      1. High dose protocols: 3-27 mSv
      2. Low dose protocols: 0.3-0.55 mSv
   2. CT radiation exposure varies by CT type
      1. CT Electron beam (EBT): 11 mSv Chest, 26 mSv Abdomen
      2. CT Sequential: 4 mSv Chest, 20 mSv Abdomen
      3. CT Spiral: 2 mSv Chest, 7 mSv Abdomen
      4. Becker (1998) Radiologe 38:726-9
   3. CT radiation exposure during episodic care
      1. Average radiation exposure during a trauma admission: 22.7 mSv
      2. Tien (2007) j Trauma 62:151-6
   4. CT Chest Radiation Exposures (in milliSieverts)
      1. Newborn: 1.7 mSv
      2. Five year old (on low dose CF protocol): 0.55 mSv
      3. Adults: 5.4 mSv
         1. Equivalent of 20 to 90 Chest XRays
      4. Huda (2007) Proc Am Thorac Surg 4:316-20
   5. Comparisons
      1. Standard Chest XRay (2 view) Radiation Exposure: 0.06 to 0.25 mSv
      2. Radiation from natural sources in an entire year (Germany): 2.4 mSv/year
      3. Survivors of Hiroshima and Nagasaki Atomic bombings: 50 to 150 mSv
   6. Interpretation
      1. Each 1 mSv increase in exposure leads to 5 extra malignancies per 100,000 people
      2. Thyroid radiation exposure is proportionally much higher in Chest CT
      3. Diederich (2000) Cancer 89:2457-60
6. References
   1. Berrington de Gonzalez (2004) Lancet 363:345-51