Evaluation of the radiation dose exposure and associated cancer risks in patients having preoperative parathyroid localization

Ann R Coll Surg Engl. 2017 May;99(5):363-368. doi: 10.1308/rcsann.2017.0014.

Abstract

OBJECTIVE The study aimed to evaluate the total effective and organ absorbed radiation doses associated with three- and four-phase parathyroid computed tomography (CT) and sestamibi scans used for the preoperative localisation of parathyroid adenomas in a cohort of patients with primary hyperparathyroidism at a single institution. We aimed to assess the risk of cancer incidence for the organs demonstrating the highest absorbed doses for the different imaging techniques, and more specifically determine the risk for our cohort of patients. METHODS Fifty patients with primary hyperparathyroidism had both multiphase CT and sestamibi scans. The Imaging Performance Assessment of CT Scanners (ImPACT) calculator was used to estimate the patient-effective and organ-absorbed radiations doses for all the CT examinations. For sestamibi scans, the US Nuclear Regulatory Commission NUREG/CR-6345 publication was used to estimate the dose for each patient. The attributable risks of cancer were calculated using the Health Protection Agency HPA-CRCE-028 publication. RESULTS The mean patient total effective doses were 15.9% ± 2.8 mSv, 20.2% ± 2.8 mSv and 5.6 ± 0.24 mSv for three-phase CT, four-phase CT and sestamibi examinations, respectively. In our cohort, the highest attributable lifetime risk was for lung cancer (0.03%) after multiphase CT. This compared with a tenfold lower risk for thyroid cancer (0.003%). After sestamibi, the highest risk was for colon cancer (0.06%). CONCLUSIONS Multiphase CT is associated with a higher radiation dose and thus a higher potential risk of cancer, but this risk is low in the older population that constituted the majority of our cohort.

Keywords: 4D CT; Primary hyperparathyroidism; parathyroidectomy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Humans
  • Hyperparathyroidism, Primary / diagnostic imaging*
  • Hyperparathyroidism, Primary / epidemiology*
  • Hyperparathyroidism, Primary / surgery
  • Male
  • Middle Aged
  • Neoplasms / epidemiology*
  • Parathyroid Glands / diagnostic imaging*
  • Parathyroid Glands / surgery
  • Parathyroidectomy / methods
  • Preoperative Care / adverse effects*
  • Preoperative Care / statistics & numerical data
  • Radiation Dosage
  • Radionuclide Imaging / adverse effects
  • Radionuclide Imaging / statistics & numerical data
  • Risk Factors
  • Tomography, X-Ray Computed / adverse effects
  • Tomography, X-Ray Computed / statistics & numerical data