Estimated cumulative radiation dose from PET/CT in children with malignancies: a 5-year retrospective review

Abstract

BackgroundThe increasing use of serial PET/CT scans in the management of pediatric malignancies raises the important consideration of radiation exposure in children.ObjectiveTo estimate the cumulative radiation dose from PET/CT studies to children with malignancy and to compare with the data in literature.Materials and methodsTwo hundred forty-eight clinical PET/CT studies performed on 78 patients (50 boys/28 girls, 1.3 to 18 years old from December 2002 to October 2007) were retrospectively reviewed under IRB approval. The whole-body effective dose (ED) estimates for each child were obtained by estimating the effective dose from each PET/CT exam performed using the ImPACT Patient Dosimetry Calculator for CT and OLINDA for PET.ResultsThe average number of PET/CT studies was 3.2 per child (range: 1 to 14 studies). The average ED of an individual CT study was 20.3 mSv (range: 2.7 to 54.2), of PET study was 4.6 mSv (range: 0.4 to 7.7) and of PET/CT study was 24.8 mSv (range: 6.2 to 60.7). The average cumulative radiation dose per patient from CT studies was 64.4 mSv (range: 2.7 to 326), from PET studies was 14.5 mSv (range: 2.8 to 73) and from PET/CT studies was 78.9 mSv (range: 6.2 to 399).ConclusionThe radiation exposure from serial PET/CT studies performed in pediatric malignancies was considerable; however, lower doses can be used for both PET and CT studies. The ALARA principle must be applied without sacrificing diagnostic information.

Comparison of effective radiation doses from X-ray, CT, and PET/CT in pediatric patients with neuroblastoma using a dose monitoring program

“…However, the dose from PET alone contributed to less than a quarter of the total dose from PET/ CT (3). A retrospective review of 78 pediatric patients with cancer also demonstrated that the average effective doses from CT, PET, and PET/CT were 20.3 mSv, 4.6 mSv, and 24.8 mSv, respectively (18). In this study, the average effective dose from PET was 3.44 mSv, comparable with previous results.…”

“…The reported radiation dose from standard PET/ CT with diagnostic contrast-enhanced CT and CT topography was 21 mSv for a 55 kg 15-year-old, 18 mSv for a 20 kg five-yearold, and 15 mSv for a 10 kg one-year-old child (17). Moreover, the cumulative radiation dose from PET/CT per patient has been reported to be up to 399 mSv (18). However, the dose from PET alone contributed to less than a quarter of the total dose from PET/ CT (3).…”

Positron Emission Tomographic Scans in Lymphoma: Convention and Controversy

“…55 Furthermore, repeated PET scans increase the radiation exposure and thereby increase the risk for malignancy. 56 The high rate of false-positive results highlights the importance of a confirmatory tissue biopsy. Even in patients with positive findings on interim PET, histologic confirmation plays an important role in identifying true relapse.…”

Pediatric Oncologic Imaging: A Key Application of Combined PET/MRI

“…Recent studies suggest that radiation exposure in childhood, especially by CT, bears the risk of negative long-term effects including secondary malignancies [40,41]. In contrast to adult oncologic patients, pediatric patients often have an excellent long-term prognosis [42] and receive numerous follow-up examinations with significant cumulative radiation exposure [43]. In this context, the use of PET/ MRI enables a significant reduction of cumulative doses.…”