Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) · 2025
Evaluation of cumulative radiation burden and associated risk in smouldering multiple myeloma patients monitored using recurrent whole-body low-dose CT imaging.
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Abissi Pascaline Wangechi, Lymperopoulou Georgia, Agrokostas Vasileios-Petros, Koutoulidis Vassilis, Grigoropoulos Panagiotis, Terpos Evangelos, Moulopoulos Lia Angela, Fiebich Martin, Seimenis Ioannis
Аннотация
PURPOSE: To assess the cumulative radiation burden and cancer risk associated with multiple whole-body low-dose computed tomography (WBLDCT) scans in patients with smouldering multiple myeloma (SMM).
METHODS: A cohort of 116 SMM patients who underwent recurrent (n = 2-7) WBLDCT examinations was studied. Patient-specific organ doses were estimated using CT dosimetry software (NCICT) whereas effective doses (ED) were estimated from NCICT and the dose-length product (DLP). Organ-specific and total lifetime-attributable risks (LAR) of cancer incidence were calculated per patient using the BEIR VII methodology.
RESULTS: Cumulative dose to the thyroid reached 66 mGy, whereas cumulative doses to salivary glands and eye lenses/balls exceeded 50 mGy. The median ED per WBLDCT examination was 5.6/4.6 mSv (female) and 5.8/3.4 mSv (male) using NCICT/DLP with the highest cumulative (n = 7) ED being 42.1 mSv. Lung cancer (female) and leukaemia (female/male) were associated with the highest risks related to WBLDCT procedures, with total LAR being 44 % higher in females compared to males. The median LAR per single exposure was 36/25 per 100,000 (female/male) with the median cumulative LAR being 85/58 per 100,000.
CONCLUSION: The theoretical radiogenic risk of cancer induction associated with multiple WBLDCT examinations for the active surveillance of a real-life SMM cohort appears to be two orders of magnitude lower than 10 % of SMM patients, which may progress to symptomatic MM requiring treatment. Dose optimisation is recommended for the WBLDCT protocol, as well as a patient-specific strategy for active SMM surveillance, but further research is needed to evaluate the role of early therapeutic interventions.
METHODS: A cohort of 116 SMM patients who underwent recurrent (n = 2-7) WBLDCT examinations was studied. Patient-specific organ doses were estimated using CT dosimetry software (NCICT) whereas effective doses (ED) were estimated from NCICT and the dose-length product (DLP). Organ-specific and total lifetime-attributable risks (LAR) of cancer incidence were calculated per patient using the BEIR VII methodology.
RESULTS: Cumulative dose to the thyroid reached 66 mGy, whereas cumulative doses to salivary glands and eye lenses/balls exceeded 50 mGy. The median ED per WBLDCT examination was 5.6/4.6 mSv (female) and 5.8/3.4 mSv (male) using NCICT/DLP with the highest cumulative (n = 7) ED being 42.1 mSv. Lung cancer (female) and leukaemia (female/male) were associated with the highest risks related to WBLDCT procedures, with total LAR being 44 % higher in females compared to males. The median LAR per single exposure was 36/25 per 100,000 (female/male) with the median cumulative LAR being 85/58 per 100,000.
CONCLUSION: The theoretical radiogenic risk of cancer induction associated with multiple WBLDCT examinations for the active surveillance of a real-life SMM cohort appears to be two orders of magnitude lower than 10 % of SMM patients, which may progress to symptomatic MM requiring treatment. Dose optimisation is recommended for the WBLDCT protocol, as well as a patient-specific strategy for active SMM surveillance, but further research is needed to evaluate the role of early therapeutic interventions.