Cumulative Radiation Exposure from Radiological Imaging in Patients with Hodgkin and Diffuse Large B-cell Lymphoma Not Submitted to Radiotherapy

Overview

Journal Br J Radiol

Publisher Oxford University Press

Specialty Radiology

Date 2023 Jul 26

PMID 37493259

Authors

Marco Brambilla

Roberta Matheoud

Gloria Margiotta-Casaluci

Barbara Cannillo

Andrea DAlessio

Chiara Siciliano

Alessandro Carriero

Gianluca Gaidano

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the cumulated exposure to radiation due to imaging in Hodgkin (HL) and diffuse large B-cell (DLBCL) lymphoma patients who were not submitted to radiotherapy.

Methods: The study population included 51 and 83 adult patients with HL and DLBCL, with a follow-up duration >1 year. The cumulated exposure was expressed using patient-specific data as cumulated effective dose (CED).

Results: Fifty-one HL patients (median age 47 years) were followed for a median of 3.5 years. The median total CED per subject was 104 mSv. CT and PET/CT examinations accounted for 75 and 25% of the total CED, respectively. 26 patients (49%) had a total CED ≥ 100 mSv and the maximum CED was 302 mSv. Eighty-three DLBCL patients (median age 66 years) were followed for a median of 3.7 years. The median total CED per subject over the study period was 134 mSv. CT and PET/CT for 86% and 13% of the total CED, respectively. 56 patients (67%) had a total CED ≥100 mSv. The maximum CED was 557 mSv.

Conclusion: Our study demonstrated the large number of imaging procedures performed for patients with lymphoma. Overall, 61% of the patients accrued a CED ≥ 100 mSv. Imaging policies were only in a partial agreement with current international guidelines.

Advances In Knowledge: The cumulated exposure radiation exposure may be of concern in HL patients and the contribution of CT procedures to the total CED is significant. The standardisation of clinical guidelines for managing patients with lymphoma is warranted.

Citing Articles

Recurrent medical imaging exposures for the care of patients: one way forward.

Frush D, Vassileva J, Brambilla M, Mahesh M, Rehani M, Samei E Eur Radiol. 2024; 34(10):6475-6487.

PMID: 38592419 DOI: 10.1007/s00330-024-10659-x.

References

Postorino M, Lizio D, Andreana De Mauri , Marino C, Tripepi G, Zoccali C . Radiation dose from medical imaging in end stage renal disease patients: a Nationwide Italian Survey. J Nephrol. 2021; 34(3):791-799. DOI: 10.1007/s40620-020-00911-0. View

Harrison J, Balonov M, Bochud F, Martin C, Menzel H, Ortiz-Lopez P . ICRP Publication 147: Use of Dose Quantities in Radiological Protection. Ann ICRP. 2021; 50(1):9-82. DOI: 10.1177/0146645320911864. View

Nguyen G, Low D, Chong R, Diong C, Chawla T . Utilization of Diagnostic Imaging and Ionization Radiation Exposure Among an Inflammatory Bowel Disease Inception Cohort. Inflamm Bowel Dis. 2019; 26(6):898-906. DOI: 10.1093/ibd/izz219. View

Indrakanti S, Li X, Rehani M . Patients undergoing multiple F-FDG PET/CT exams: Assessment of frequency, dose and disease classification. Br J Radiol. 2022; 95(1135):20211225. PMC: 10996321. DOI: 10.1259/bjr.20211225. View

Crowley M, ONeill S, Kevane B, ONeill D, Eustace J, Cahill M . Ionizing radiation exposure as a result of diagnostic imaging in patients with lymphoma. Clin Transl Oncol. 2015; 18(5):533-6. DOI: 10.1007/s12094-015-1394-8. View

Rehani M, Yang K, Melick E, Heil J, Salat D, Sensakovic W . Patients undergoing recurrent CT scans: assessing the magnitude. Eur Radiol. 2019; 30(4):1828-1836. DOI: 10.1007/s00330-019-06523-y. View

Brambilla M, Vassileva J, Kuchcinska A, Rehani M . Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action. Eur Radiol. 2019; 30(5):2493-2501. DOI: 10.1007/s00330-019-06528-7. View

Brambilla M, Cannillo B, Guzzardi G, DAlessio A, Galbiati A, Matheoud R . Conversion factors for effective dose and organ doses with the air kerma area product in patients undergoing percutaneous transhepatic biliary drainage and trans arterial chemoembolization. Phys Med. 2020; 72:7-15. DOI: 10.1016/j.ejmp.2020.03.003. View

Guttikonda R, Herts B, Dong F, Baker M, Fenner K, Pohlman B . Estimated radiation exposure and cancer risk from CT and PET/CT scans in patients with lymphoma. Eur J Radiol. 2014; 83(6):1011-1015. DOI: 10.1016/j.ejrad.2014.02.015. View

10.

Brambilla M, Andreana De Mauri , Leva L, Carriero A, Picano E . Cumulative radiation dose from medical imaging in chronic adult patients. Am J Med. 2013; 126(6):480-6. DOI: 10.1016/j.amjmed.2012.10.025. View

11.

Li X, Hirsch J, Rehani M, Ganguli S, Yang K, Liu B . Radiation Effective Dose Above 100 mSv From Fluoroscopically Guided Intervention: Frequency and Patient Medical Condition. AJR Am J Roentgenol. 2020; 215(2):433-440. DOI: 10.2214/AJR.19.22227. View

12.

Frija G, Damilakis J, Paulo G, Loose R, Vano E . Cumulative effective dose from recurrent CT examinations in Europe: proposal for clinical guidance based on an ESR EuroSafe Imaging survey. Eur Radiol. 2021; 31(8):5514-5523. PMC: 8270793. DOI: 10.1007/s00330-021-07696-1. View

13.

Tilly H, Gomes Da Silva M, Vitolo U, Jack A, Meignan M, Lopez-Guillermo A . Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015; 26 Suppl 5:v116-25. DOI: 10.1093/annonc/mdv304. View

14.

Howard A, West R, Iball G, Panteli M, Pandit H, Giannoudis P . An Estimation of Lifetime Fatal Carcinogenesis Risk Attributable to Radiation Exposure in the First Year Following Polytrauma: A Major Trauma Center's Experience Over 10 Years. J Bone Joint Surg Am. 2019; 101(15):1375-1380. DOI: 10.2106/JBJS.18.01334. View

15.

Eichenauer D, Aleman B, Andre M, Federico M, Hutchings M, Illidge T . Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018; 29(Suppl 4):iv19-iv29. DOI: 10.1093/annonc/mdy080. View

16.

Andreana De Mauri , Matheoud R, Guzzardi G, Vaccarone V, David P, Brambilla M . Ionizing radiation exposure from dialysis tunneled catheters procedures: European directive and legal implications. J Vasc Access. 2021; 23(4):500-507. DOI: 10.1177/11297298211001141. View

17.

Elstrom R, Leonard J, Coleman M, Brown R . Combined PET and low-dose, noncontrast CT scanning obviates the need for additional diagnostic contrast-enhanced CT scans in patients undergoing staging or restaging for lymphoma. Ann Oncol. 2008; 19(10):1770-3. PMC: 2735066. DOI: 10.1093/annonc/mdn282. View

18.

Gandikota N, Hartridge-Lambert S, Migliacci J, Yahalom J, Portlock C, Schoder H . Very low utility of surveillance imaging in early-stage classic Hodgkin lymphoma treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy. Cancer. 2015; 121(12):1985-92. PMC: 4972450. DOI: 10.1002/cncr.29277. View

19.

Brambilla M, DAlessio A, Kuchcinska A, Segota D, Sukupova L . A systematic review of conversion factors between kerma-area product and effective/organ dose for cardiac interventional fluoroscopy procedures performed in adult and paediatric patients. Phys Med Biol. 2022; 67(6). DOI: 10.1088/1361-6560/ac5670. View

20.

ICRP . Radiation dose to patients from radiopharmaceuticals. Addendum 3 to ICRP Publication 53. ICRP Publication 106. Approved by the Commission in October 2007. Ann ICRP. 2009; 38(1-2):1-197. DOI: 10.1016/j.icrp.2008.08.003. View