Radiologists back judicious use of CT pulmonary angio in women because of radiation dose to breast

Radiologists are encouraging their colleagues to think twice and consider alternatives before using CT in the diagnosis of pulmonary embolism in women under the age of 55 because of the radiation dose of these examinations.

Chest CT plays a critical role in the diagnosis and management of most patients with complex thoracic and cardiopulmonary disease, and has become the gold standard for imaging pulmonary emboli, said Mark S. Parker, MD, associate professor of thoracic imaging at the Medical College of Virginia Hospitals, Virginia Commonwealth University Medical Center. However, the potential carcinogenic effects of ionizing radiation on radiosensitive tissues such as the female breast are often not deemed relevant to acute patient care. The latency period for potential cancer induction is estimated to be 10-30 years in the dose ranges used in CT pulmonary angiography. Thus, the younger the patient is at the time of exposure, the more radiosensitive the fibroglandular tissue, and the more time the patient has to develop potential nonfatal and fatal cancers, Dr. Parker said.

"We recently studied 1,325 patients who had undergone CT pulmonary angiograms; 60% of the patients were women--some of them as young as 15 years old," said Dr. Parker. The mean age of the female patients was 52.5 years. "We found that the calculated dose to the breast tissue of an average-sized woman during a CT pulmonary angiography examination was at least 2.0 rads per breast. The radiation dose to the breast from these examinations is equivalent to10-25, two view mammograms, or 100-400 chest radiographs. The estimated radiation dose is two to three times greater with techniques that employ overlapped scanned regions of interest (i.e., nonenhanced and enhanced scans), and 30-50% greater with the newer multidetector CT (MDCT) scanners, Dr. Parker added. One millisievert (mSv) of radiation exposure may be associated with five additional cancers in 100,000 exposed patients, he

Contact: Keri Sperry
American Roentgen Ray Society

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