Abstract
Background
Patients with Ewing sarcoma are subject to various diagnostic procedures that incur exposure to ionising radiation.
Objective
To estimate the radiation doses received from all radiologic and nuclear imaging episodes during diagnosis and treatment, and to determine whether 18F-fluorodeoxyglucose positron emission tomography – computed tomography (18F-FDG PET-CT) is a major contributor of radiation.
Materials and methods
Twenty Ewing sarcoma patients diagnosed in Norway in 2005–2012 met the inclusion criteria (age <30 years, operable disease, uncomplicated chemotherapy and surgery, no metastasis or residual disease within a year of diagnosis). Radiation doses from all imaging during the first year were calculated for each patient.
Results
The mean estimated cumulative radiation dose for all patients was 34 mSv (range: 6–70), radiography accounting for 3 mSv (range: 0.2-12), CT for 13 mSv (range: 2–28) and nuclear medicine for 18 mSv (range: 2–47). For the patients examined with PET-CT, the mean estimated cumulative effective dose was 38 mSv, of which PET-CT accounted for 14 mSv (37%).
Conclusion
There was large variation in number and type of examinations performed and also in estimated cumulative radiation dose. The mean radiation dose for patients examined with PET-CT was 23% higher than for patients not examined with PET-CT.
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References
Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296
Krille L, Dreger S, Schindel R et al (2015) Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study. Radiat Environ Biophys 54:1–12
Huang WY, Muo CH, Lin CY et al (2014) Paediatric head CT scan and subsequent risk of malignancy and benign brain tumour: a nation-wide population-based cohort study. Br J Cancer 110:2354–2360
Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505
Scandinavian Sarcoma Group (1979). http://www.ssg-org.net/om. Accessed 28 July 2016
National Competence of Sarcomas, Annual report 2013-2014-2015. http://www.sarkom.no/uploads/Arsrapport2013-2015.pdf. Accessed 28 July 2016
ESMO/European Sarcoma Network Working Group (2014) Bone sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 25:iii113-123
Helsedirektoratet Avdeling sykehustjenester Oslo Norway (2015) Nasjonalt handlingsprogram med retningslinjer for utredning, behandling og oppfølging av sarkom [Directory of Health, Department of Hospital services, National guidelines for staging, treatment and follow-up of sarcoma]. http://www.helsebiblioteket.no/retningslinjer/sarkomer. Accessed 28 July 2016
Alessio AM, Kinahan PE, Manchanda V et al (2009) Weight-based, low-dose pediatric whole-body PET/CT protocols. J Nucl Med 50:1570–1577
Widmark A, Friberg EG Representative doser i Norge - 2006–2009. Resultater fra første nasjonale innrapportering. Revisjon av nasjonale referanseverdier. StrålevernRapport 2014:6. Norwegian Radiation Protection [Widmark A, Friberg EG Representative doses in Norway-2006-2009. Results from the first national survey. Revision of national reference values. Radiation Protection Report 2014:6. Norwegian Radiation Protection]. www.nrpa.no. Accessed 28 July 2016
Stamm G, Nagel HD (2002) CT-Expo - a novel program for dose evaluation in CT. Röfo 174:1570–1576
Siemens (2006) SOMATOM Sensation 40/64 Application Guide. http://www.healthcare.siemens.com/computed-tomography/ct-customer-information-portal/somatom-sensation-application-guides/somatom-sensation. Accessed 28 July 2016
Lassmann M, Treves ST (2014) Paediatric radiopharmaceutical administration: harmonization of the 2007 EANM paediatric dosage card (version 1.5.2008) and the 2010 North American consensus guidelines. Eur J Nucl Med Mol Imaging 41:1036–1041
Ann ICRP (1987) Radiation dose to patients from radiopharmaceuticals. A report of a Task Group of Committee 2 of the International Commission on Radiological Protection. Ann ICRP 18:1–377. doi:10.1016/0146-6453(87)90003-0
Ann ICRP (1998) Radiation dose to patients from radiopharmaceuticals: (Addendum 2 to ICRP Publication 53) ICRP Publication 80 Approved by the Commission in September 1997. Ann ICRP 28:1. doi:10.1016/s0146-6453(99)00006-8
ICRP (2008) ICRP publication 106. Ann ICRP 38:7–33
Swedish Radiation Safety Authority Doskatalog. http://www.stralsakerhetsmyndigheten.se/Yrkesverksam/Vard/Doskatalog/. Accessed 28 July 2016
Júliusson PB, Roelants M, Eide GE et al (2009) Vekstkurver for norske barn. [Growth references for Norwegian children]. Tidsskr Nor Laegeforen 129:281–286
Italian Sarcoma Group (Bologna Italy), Scandinavian Sarcoma Group (Oncologic Center Lund Sweden) (1999) ISG/SSG III An Italian – Scandinavian treatment protocol for nonmetastatic Ewing’s family tumors. http://www.ocsyd.se/VP-verksamhet/Hud%20mjukdel%20skelett/ISGSSG3-1999.pdf. Accessed 28 July 2016
Italian Sarcoma Group (Bologna Italy), Scandinavian Sarcoma Group (Oncologic Center Lund Sweden) (1999) An Italian – Scandinavian treatment protocol for high-risk Ewing’s family tumors. http://www.ssg-org.net/wp-content/uploads/2011/05/Protocol_ISGSSGIV.pdf. Accessed 28 July 2016
Directorate-General for Energy Directorate D — Nuclear Safety & Fuel Cycle Unit D3 — Radiation Protection (2015) Medical radiation exposure of the European population, part 1/2. http://ddmed.eu/. Accessed 28 July 2016
Norwegian Radiation Protection Authority (2012) Strålevernsinfo 11.12. Felles nordisk uttalelsefra strålevernmyndighetene om økt bruk av CT [Norwegian Radiation Protection Authority (2012) Radiatin Protection Information 11.12. Joint nordic statement from the radiation protection authorities regarding increasing use of CT]. http://www.nrpa.no/dav/4d6907bf7d.pdf. Accessed 28 July 2016
Chawla SC, Federman N, Zhang D et al (2010) Estimated cumulative radiation dose from PET/CT in children with malignancies: a 5-year retrospective review. Pediatr Radiol 40:681–686
Gelfand MJ, Sharp SE, Treves ST et al (2010) Estimated cumulative radiation dose from PET/CT in children with malignancies. Pediatr Radiol 40:1712–1713, author reply 1714–1715
Guttikonda R, Herts BR, Dong F et al (2014) Estimated radiation exposure and cancer risk from CT and PET/CT scans in patients with lymphoma. Eur J Radiol 83:1011–1015
Johnsen B, Boye K, Rosendahl K et al (2015) F-18-FDG PET-CT in children and young adults with Ewing sarcoma diagnosed in Norway during 2005–2012: a national population-based study. Clin Physiol Funct Imaging. doi:10.1111/cpf.12247
Grant FD, Gelfand MJ, Drubach LA et al (2015) Radiation doses for pediatric nuclear medicine studies: comparing the North American consensus guidelines and the pediatric dosage card of the European Association of Nuclear Medicine. Pediatr Radiol 45:706–713
Fahey FH, Treves ST, Adelstein SJ (2012) Minimizing and communicating radiation risk in pediatric nuclear medicine. J Nucl Med Technol 40:13–24
Acknowledgments
The research group has received funding from the Norwegian Society of Radiology, Competence Centre of Solid Tumours in Children (KSSB) and the National Competence Service Centre of Sarcomas in Norway.
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Johnsen, B., Fasmer, K.E., Boye, K. et al. Estimated cumulative radiation dose received by diagnostic imaging during staging and treatment of operable Ewing sarcoma 2005–2012. Pediatr Radiol 47, 82–88 (2017). https://doi.org/10.1007/s00247-016-3720-x
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DOI: https://doi.org/10.1007/s00247-016-3720-x