Assessing Radiation Exposure and Its Implications for Cancer Risk in Chest CT Scans: An Experimental Study
-
Saleh Salehi Zahabi
,
Saeed Bagherzadeh
,
Karim Khoshgard
,
Ali MohammadSharifi
,
Afsane Mir Derikvand
Abstract
Purpose: The rise in coronavirus cases has led to an increased reliance on CT scans, which are known for delivering higher radiation exposure. This study aims to estimate organ doses (ODs) and effective doses (EDs) to evaluate the lifetime attributable risks (LARs) of cancer occurrence and mortality among patients. A total of 600 patients, either confirmed or suspected to have COVID-19, were included in this investigation.
Materials and Methods: To assess patient doses and associated cancer risks, dosimetric parameters such as DLP, volumetric CTDI, and scan length were utilized. The ImPACT CT dosimetry software was employed to calculate ODs and EDs.
Results: For female patients, the mean ED was recorded as 2.36 ± 0.48 mSv based on ICRP Report 103 and 1.2 ± 0.28 mSv based on ICRP Report 60. In male patients, these values were 2.31 ± 0.53 mSv and 1.21 ± 0.45 mSv, respectively. The mean LAR for all cancer rates in males was found to be 14.79 ± 4.85 per 100,000 individuals, while for cancer mortality, it was 8.59 ± 2.42 per 100,000 individuals. For females, the LARs were higher, at 23.37 ± 9.59 for incidence and 12.61 ± 3.89 for mortality per 100,000 individuals.
Conclusion: The findings indicate that chest CT scans are associated with significant radiation exposure and potential cancer risks. Therefore, it is essential to optimize CT protocols according to the ALARA principle to minimize radiation-induced risks while maintaining diagnostic effectiveness during the ongoing pandemic.
1- Radhika H Pandya, Mayur Kiran Shinde, Viral B Patel, Ajay Gajanan Phatak, and Himanshu V Pandya, "Development and implementation of optimized chest CT protocol in COVID-19: A clinical audit." Journal of Family Medicine and Primary Care, Vol. 11 (No. 7), pp. 3705-10, (2022).
2- Mandeep Garg et al., "Radiation exposure and lifetime attributable risk of cancer incidence and mortality from low-and standard-dose CT chest: implications for COVID-19 pneumonia subjects." Diagnostics, Vol. 12 (No. 12), p. 3043, (2022).
3- Fatemeh Homayounieh et al., "Variations in CT utilization, protocols, and radiation doses in COVID-19 pneumonia: results from 28 countries in the IAEA study." Radiology, Vol. 298 (No. 3), pp. E141-E51, (2021).
4- Zhen Kang, Xu Li, and Shuchang Zhou, "Recommendation of low-dose CT in the detection and management of COVID-2019." European Radiology, Vol. 30 (No. 8), pp. 4356-57, (2020).
5- Lane F Donnelly et al., "Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large children's hospital." American Journal of Roentgenology, Vol. 176 (No. 2), pp. 303-06, (2001).
6- Choonsik Lee, "Managing radiation dose from chest CT in patients with COVID-19." Vol. 298, ed: Radiological Society of North America, (2021), pp. E158-E59.
7- Eric J Hall and Amato J Giaccia, Radiobiology for the Radiologist. Philadelphia, (2006).
8- David J Brenner et al., "Cancer risks attributable to low doses of ionizing radiation: assessing what we really know." Proceedings of the National Academy of Sciences, Vol. 100 (No. 24), pp. 13761-66, (2003).
9- Lawrence T Dauer, Antone L Brooks, David G Hoel, William F Morgan, Daniel Stram, and Phung Tran, "Review and evaluation of updated research on the health effects associated with low-dose ionising radiation." Radiation Protection Dosimetry, Vol. 140 (No. 2), pp. 103-36, (2010).
10- Donald A Pierce and Dale L Preston, "Radiation-related cancer risks at low doses among atomic bomb survivors." Radiation research, Vol. 154 (No. 2), pp. 178-86, (2000).
11- DL Preston et al., "Solid cancer incidence in atomic bomb survivors: 1958–1998." Radiation research, Vol. 168 (No. 1), pp. 1-64, (2007).
12- Amy Berrington De González et al., "Projected cancer risks from computed tomographic scans performed in the United States in 2007." Archives of internal medicine, Vol. 169 (No. 22), pp. 2071-77, (2009).
13- United Nations Scientific Committee on the Effects of Atomic Radiation, "UNSCEAR 2000 Report to the General Assembly with Scientific Annexes, Vol. II: Effects." http://www. unscear. org/unscear/publications/2000_2. html, (2000).
14- Marie-Odile Bernier et al., "Cohort profile: the EPI-CT study: a European pooled epidemiological study to quantify the risk of radiation-induced cancer from paediatric CT." International Journal of Epidemiology, Vol. 48 (No. 2), pp. 379-81g, (2019).
15- DM Parkin and SC Darby, "12. Cancers in 2010 attributable to ionising radiation exposure in the UK." British journal of cancer, Vol. 105 (No. 2), pp. S57-S65, (2011).
16- Amy Berrington de Gonzalez and Sarah Darby, "Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries." The lancet, Vol. 363 (No. 9406), pp. 345-51, (2004).
17- Zoe Brady, F Ramanauskas, TM Cain, and PN Johnston, "Assessment of paediatric CT dose indicators for the purpose of optimisation." The British journal of radiology, Vol. 85 (No. 1019), pp. 1488-98, (2012).
18- Willi A Kalender, "X-ray computed tomography." Physics in medicine & Biology, Vol. 51 (No. 13), p. R29, (2006).
19- Cynthia McCollough et al., "The measurement, reporting, and management of radiation dose in CT." (No Title), (2008).
20- Adam M Alessio and Grace S Phillips, "A pediatric CT dose and risk estimator." Pediatric radiology, Vol. 40pp. 1816-21, (2010).
21- Marijke C Jansen-van der Weide, Marcel JW Greuter, Liesbeth Jansen, Jan C Oosterwijk, Ruud M Pijnappel, and Geertruida H de Bock, "Exposure to low-dose radiation and the risk of breast cancer among women with a familial or genetic predisposition: a meta-analysis." European radiology, Vol. 20pp. 2547-56, (2010).
22- Walter Huda, U Joseph Schoepf, Joseph A Abro, Eugene Mah, and Philip Costello, "Radiation-related cancer risks in a clinical patient population undergoing cardiac CT." American Journal of Roentgenology, Vol. 196 (No. 2), pp. W159-W65, (2011).
23- KA Jessen et al., "EUR 16262: European guidelines on quality criteria for computed tomography." Luxembourg: Office for Official Publications of the European Communities, (2000).
24- BV Phase, "Health risks from exposure to low levels of ionizing radiation." Washington, DC: The British Institute of Radiology, (2006).
25- Saeed Bagherzadeh, Nasrollah Jabbari, and Hamid Reza Khalkhali, "Estimation of lifetime attributable risks (LARs) of cancer associated with abdominopelvic radiotherapy treatment planning computed tomography (CT) simulations." International Journal of Radiation Biology, Vol. 94 (No. 5), pp. 454-61, (2018).
26- Parinaz Mehnati, Ayoub Amirnia, and Nasrollah Jabbari, "Estimating cancer induction risk from abdominopelvic scanning with 6-and 16-slice computed tomography." International Journal of Radiation Biology, Vol. 93 (No. 4), pp. 416-25, (2017).
27- C Ghetti, O Ortenzia, M Maddalo, L Altabella, and N Sverzellati, "Dosimetric and radiation cancer risk evaluation of high resolution thorax CT during COVID-19 outbreak." Physica Medica, Vol. 80pp. 119-24, (2020).
28- E Manssor et al., "Radiation doses in chest, abdomen and pelvis CT procedures." Radiation protection dosimetry, Vol. 165 (No. 1-4), pp. 194-98, (2015).
29- Masashi Takahashi et al., "Low-dose spiral computed tomography of the thorax: comparison with the standard-dose technique." Investigative radiology, Vol. 33 (No. 2), pp. 68-73, (1998).
30- David P Naidich, Christopher H Marshall, Christopher Gribbin, Ronald S Arams, and Dorothy I McCauley, "Low-dose CT of the lungs: preliminary observations." Radiology, Vol. 175 (No. 3), pp. 729-31, (1990).
31- Mohamed Khaldoun Badawy, Michael Galea, Kam Shan Mong, and Paul U, "Computed tomography overexposure as a consequence of extended scan length." Journal of medical imaging and radiation oncology, Vol. 59 (No. 5), pp. 586-89, (2015).
32- Hamidreza Masjedi, Reza Omidi, Hamed Zamani, Ghazale Perota, and Mohammad Hosein Zare, "Radiation dose and risk of exposure-induced death associated with common computed tomography procedures in Yazd Province." European journal of radiology, Vol. 126p. 108932, (2020).
33- Elena Ivanovna Matkevich and Ivan Vasilievich Ivanov, "Radiation Doses and Risk Assessment during Computed Tomography of the Chest in COVID-19 Patients." Computed-Tomography (CT) Scan, pp. 1-13, (2021).
34- Nyathi Mpumelelo, "Estimation of effective dose using the dose length product in chest computed tomography procedures." International Journal of Radiation Research, Vol. 19 (No. 4), pp. 979-86, (2021).
35- Tony M Svahn, Tommy Sjöberg, and Jennifer C Ast, "Dose estimation of ultra-low-dose chest CT to different sized adult patients." European Radiology, Vol. 29pp. 4315-23, (2019).
36- Radiological Protection, "ICRP publication 103." Ann ICRP, Vol. 37 (No. 2.4), p. 2, (2007).
37- International Commission on Radiological Protection, Recommendations of the International Commission on Radiological Protection: Adopted January 17, 1977. (No. 3). International Commission on Radiological Protection, (1977).
38- Masayoshi Tokunaga et al., "Incidence of female breast cancer among atomic bomb survivors, Hiroshima and Nagasaki, 1950-1980." Radiation research, Vol. 112 (No. 2), pp. 243-72, (1987).
39- Mehmet Halit Yilmaz et al., "Female breast radiation exposure during thorax multidetector computed tomography and the effectiveness of bismuth breast shield to reduce breast radiation dose." Journal of computer assisted tomography, Vol. 31 (No. 1), pp. 138-42, (2007).
2- Mandeep Garg et al., "Radiation exposure and lifetime attributable risk of cancer incidence and mortality from low-and standard-dose CT chest: implications for COVID-19 pneumonia subjects." Diagnostics, Vol. 12 (No. 12), p. 3043, (2022).
3- Fatemeh Homayounieh et al., "Variations in CT utilization, protocols, and radiation doses in COVID-19 pneumonia: results from 28 countries in the IAEA study." Radiology, Vol. 298 (No. 3), pp. E141-E51, (2021).
4- Zhen Kang, Xu Li, and Shuchang Zhou, "Recommendation of low-dose CT in the detection and management of COVID-2019." European Radiology, Vol. 30 (No. 8), pp. 4356-57, (2020).
5- Lane F Donnelly et al., "Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large children's hospital." American Journal of Roentgenology, Vol. 176 (No. 2), pp. 303-06, (2001).
6- Choonsik Lee, "Managing radiation dose from chest CT in patients with COVID-19." Vol. 298, ed: Radiological Society of North America, (2021), pp. E158-E59.
7- Eric J Hall and Amato J Giaccia, Radiobiology for the Radiologist. Philadelphia, (2006).
8- David J Brenner et al., "Cancer risks attributable to low doses of ionizing radiation: assessing what we really know." Proceedings of the National Academy of Sciences, Vol. 100 (No. 24), pp. 13761-66, (2003).
9- Lawrence T Dauer, Antone L Brooks, David G Hoel, William F Morgan, Daniel Stram, and Phung Tran, "Review and evaluation of updated research on the health effects associated with low-dose ionising radiation." Radiation Protection Dosimetry, Vol. 140 (No. 2), pp. 103-36, (2010).
10- Donald A Pierce and Dale L Preston, "Radiation-related cancer risks at low doses among atomic bomb survivors." Radiation research, Vol. 154 (No. 2), pp. 178-86, (2000).
11- DL Preston et al., "Solid cancer incidence in atomic bomb survivors: 1958–1998." Radiation research, Vol. 168 (No. 1), pp. 1-64, (2007).
12- Amy Berrington De González et al., "Projected cancer risks from computed tomographic scans performed in the United States in 2007." Archives of internal medicine, Vol. 169 (No. 22), pp. 2071-77, (2009).
13- United Nations Scientific Committee on the Effects of Atomic Radiation, "UNSCEAR 2000 Report to the General Assembly with Scientific Annexes, Vol. II: Effects." http://www. unscear. org/unscear/publications/2000_2. html, (2000).
14- Marie-Odile Bernier et al., "Cohort profile: the EPI-CT study: a European pooled epidemiological study to quantify the risk of radiation-induced cancer from paediatric CT." International Journal of Epidemiology, Vol. 48 (No. 2), pp. 379-81g, (2019).
15- DM Parkin and SC Darby, "12. Cancers in 2010 attributable to ionising radiation exposure in the UK." British journal of cancer, Vol. 105 (No. 2), pp. S57-S65, (2011).
16- Amy Berrington de Gonzalez and Sarah Darby, "Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries." The lancet, Vol. 363 (No. 9406), pp. 345-51, (2004).
17- Zoe Brady, F Ramanauskas, TM Cain, and PN Johnston, "Assessment of paediatric CT dose indicators for the purpose of optimisation." The British journal of radiology, Vol. 85 (No. 1019), pp. 1488-98, (2012).
18- Willi A Kalender, "X-ray computed tomography." Physics in medicine & Biology, Vol. 51 (No. 13), p. R29, (2006).
19- Cynthia McCollough et al., "The measurement, reporting, and management of radiation dose in CT." (No Title), (2008).
20- Adam M Alessio and Grace S Phillips, "A pediatric CT dose and risk estimator." Pediatric radiology, Vol. 40pp. 1816-21, (2010).
21- Marijke C Jansen-van der Weide, Marcel JW Greuter, Liesbeth Jansen, Jan C Oosterwijk, Ruud M Pijnappel, and Geertruida H de Bock, "Exposure to low-dose radiation and the risk of breast cancer among women with a familial or genetic predisposition: a meta-analysis." European radiology, Vol. 20pp. 2547-56, (2010).
22- Walter Huda, U Joseph Schoepf, Joseph A Abro, Eugene Mah, and Philip Costello, "Radiation-related cancer risks in a clinical patient population undergoing cardiac CT." American Journal of Roentgenology, Vol. 196 (No. 2), pp. W159-W65, (2011).
23- KA Jessen et al., "EUR 16262: European guidelines on quality criteria for computed tomography." Luxembourg: Office for Official Publications of the European Communities, (2000).
24- BV Phase, "Health risks from exposure to low levels of ionizing radiation." Washington, DC: The British Institute of Radiology, (2006).
25- Saeed Bagherzadeh, Nasrollah Jabbari, and Hamid Reza Khalkhali, "Estimation of lifetime attributable risks (LARs) of cancer associated with abdominopelvic radiotherapy treatment planning computed tomography (CT) simulations." International Journal of Radiation Biology, Vol. 94 (No. 5), pp. 454-61, (2018).
26- Parinaz Mehnati, Ayoub Amirnia, and Nasrollah Jabbari, "Estimating cancer induction risk from abdominopelvic scanning with 6-and 16-slice computed tomography." International Journal of Radiation Biology, Vol. 93 (No. 4), pp. 416-25, (2017).
27- C Ghetti, O Ortenzia, M Maddalo, L Altabella, and N Sverzellati, "Dosimetric and radiation cancer risk evaluation of high resolution thorax CT during COVID-19 outbreak." Physica Medica, Vol. 80pp. 119-24, (2020).
28- E Manssor et al., "Radiation doses in chest, abdomen and pelvis CT procedures." Radiation protection dosimetry, Vol. 165 (No. 1-4), pp. 194-98, (2015).
29- Masashi Takahashi et al., "Low-dose spiral computed tomography of the thorax: comparison with the standard-dose technique." Investigative radiology, Vol. 33 (No. 2), pp. 68-73, (1998).
30- David P Naidich, Christopher H Marshall, Christopher Gribbin, Ronald S Arams, and Dorothy I McCauley, "Low-dose CT of the lungs: preliminary observations." Radiology, Vol. 175 (No. 3), pp. 729-31, (1990).
31- Mohamed Khaldoun Badawy, Michael Galea, Kam Shan Mong, and Paul U, "Computed tomography overexposure as a consequence of extended scan length." Journal of medical imaging and radiation oncology, Vol. 59 (No. 5), pp. 586-89, (2015).
32- Hamidreza Masjedi, Reza Omidi, Hamed Zamani, Ghazale Perota, and Mohammad Hosein Zare, "Radiation dose and risk of exposure-induced death associated with common computed tomography procedures in Yazd Province." European journal of radiology, Vol. 126p. 108932, (2020).
33- Elena Ivanovna Matkevich and Ivan Vasilievich Ivanov, "Radiation Doses and Risk Assessment during Computed Tomography of the Chest in COVID-19 Patients." Computed-Tomography (CT) Scan, pp. 1-13, (2021).
34- Nyathi Mpumelelo, "Estimation of effective dose using the dose length product in chest computed tomography procedures." International Journal of Radiation Research, Vol. 19 (No. 4), pp. 979-86, (2021).
35- Tony M Svahn, Tommy Sjöberg, and Jennifer C Ast, "Dose estimation of ultra-low-dose chest CT to different sized adult patients." European Radiology, Vol. 29pp. 4315-23, (2019).
36- Radiological Protection, "ICRP publication 103." Ann ICRP, Vol. 37 (No. 2.4), p. 2, (2007).
37- International Commission on Radiological Protection, Recommendations of the International Commission on Radiological Protection: Adopted January 17, 1977. (No. 3). International Commission on Radiological Protection, (1977).
38- Masayoshi Tokunaga et al., "Incidence of female breast cancer among atomic bomb survivors, Hiroshima and Nagasaki, 1950-1980." Radiation research, Vol. 112 (No. 2), pp. 243-72, (1987).
39- Mehmet Halit Yilmaz et al., "Female breast radiation exposure during thorax multidetector computed tomography and the effectiveness of bismuth breast shield to reduce breast radiation dose." Journal of computer assisted tomography, Vol. 31 (No. 1), pp. 138-42, (2007).
| Files | ||
| Issue | Vol 13 No 3 (2026) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/fbt.v13i3.22743 | |
| Keywords | ||
| Radiation dose; Dosimetry; CT Scan; Cancer risk lung | ||
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How to Cite
1.
Salehi Zahabi S, Bagherzadeh S, Khoshgard K, MohammadSharifi A, Mir Derikvand A. Assessing Radiation Exposure and Its Implications for Cancer Risk in Chest CT Scans: An Experimental Study. Frontiers Biomed Technol. 2026;13(3):709-719.
