Radiation burden and associated cancer risk for a typical population to be screened for lung cancer with low-dose CT: A phantom study
To estimate (a) organ doses and organ-specific radiation-induced cancer risk from a single low-dose CT (LDCT) for lung cancer screening (LCS) and (b) the theoretical cumulative risk of radiation-induced cancer for a typical cohort to be subjected to repeated annual LCS LDCT.
Sex- and body size-specific organ dose data from scan projection radiography (SPR) and helical CT exposures involved in LCS 256-slice LDCT were determined using Monte Carlo methods. Theoretical life attributable risk (LAR) of radiogenic cancer from a single 256-slice chest LDCT at age 55–80 years and the cumulative LAR of cancer from repeated annual LDCT studies up to age 80 years were estimated and compared to corresponding nominal lifetime intrinsic risks (LIRs) of being diagnosed with cancer.
The effective dose from LCS 256-slice LDCT was estimated to be 0.71 mSv. SPR was found to contribute 6–12 % to the total effective dose from chest LDCT. The radiation-cancer LAR from a single LDCT study was found to increase the nominal LIR of cancer in average-size 55-year-old males and females by 0.008 % and 0.018 %, respectively. Cumulative radiogenic risk of cancer from repeated annual scans from the age of 55–80 years was found to increase the nominal LIR of cancer by 0.13 % in males and 0.30 % in females.
Modern scanners may offer sub-millisievert LCS LDCT. Cumulative radiation risk from repeated annual 256-slice LDCT LCS examinations was found to minimally aggravate the lifetime intrinsic cancer risk of a typical screening population.
• Effective dose from lung cancer screening low-dose CT may be <1 mSv.
• Screening with modern low-dose CT minimally aggravates lifetime cancer induction intrinsic risk.
• Dosimetry of lung cancer screening low-dose CT should encounter the radiation burden from the localizing scan projection radiography.
• DLP method may underestimate effective dose from low-dose chest CT by 27 %.
KeywordsLung cancer Cancer screening Multidetector computed tomography Radiation exposure Radiation-induced cancer
Body mass index
Computed tomography dose index
International Commission on Radiological Protection
Lung cancer screening
Life intrinsic risk
Scan projection radiograph
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Kostas Perisinakis.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was not required since the study was not on human subjects
• performed at one institution
- 5.American Lung Association (2015) Providing guidance on lung cancer screening to patients and physicians. An update from the American Lung Association Screening CommitteeGoogle Scholar
- 6.National Comprehensive Cancer Network (2007) NCCN Guidelines for Patients: Lung Cancer Screening, Version 1Google Scholar
- 15.American Association of Physicists in Medicine (2011) Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations. Report of AAPM Task Group 204, College Park, MA, USAGoogle Scholar
- 17.International Commission on Radiological Protection (2007) Managing Patient Dose in Multi-Detector Computed Tomography (MDCT). ICRP Publication 102. Ann ICRP 37(1)Google Scholar
- 20.Committee to Assess Health Risks from Exposure to Low levels of Ionizing Radiation (2006) Health Risks from Exposure to low Levels of Ionizing Radiation: BEIR VII Phase 2. The National Academy Press, Washington, DCGoogle Scholar
- 21.International Commission on Radiological Protection (2007) The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 37Google Scholar
- 22.American Association of Physicists in Medicine (2008) The measurement, reporting and management of radiation dose in CT. Report of AAPM task group 23, College Park, MA, USAGoogle Scholar
- 29.National Heart, Lung, and Blood Institute (2000) The Practical guide for identification, evaluation and treatment of overweight and obesity in adults, NIH Publication No. 00-4084Google Scholar
- 30.International Commission on Radiological Protection (1996) Conversion coefficients for use in radiological protection against external radiation. ICRP publication 74. In Ann ICRP 26Google Scholar
- 31.Howlader N, Noone AM, Krapcho M et al (2017) SEER Cancer Statistics Review, 1975-2014. National Cancer Institute, Bethesda, MDGoogle Scholar
- 36.Miao Z, Weiwei Q, Ye S, Yan J, Xiaoyi L, Hong N (2017) Screening for Lung cancer using sub-millisievert chest CT with iterative reconstruction algorithm: image quality and nodule detectability. Br J Radiol 20170658. lGoogle Scholar