Cumulative radiation exposures from CT screening and surveillance strategies for von hippel-lindau-associated solid pancreatic tumors

Amit Tirosh, Neige Journy, Les R. Folio, Choonsik Lee, Christiane Leite, Jianhua Yao, William Kovacs, W. Marston Linehan, Ashkan Malayeri, Electron Kebebew, Amy Berrington De González

Research output: Contribution to journalArticle

Abstract

Purpose: To assess the potential ionizing radiation exposure from CT scans for both screening and surveillance of patients with von Hippel-Lindau (VHL) syndrome. Materials and Methods: For this retrospective study, abdomen-pelvic (AP) and chest-abdomen-pelvic (CAP) CT scans were performed with either a three-phase (n = 1242) or a dual-energy virtual noncontrast protocol (VNC; n = 149) in 747 patients with VHL syndrome in the National Institutes of Health Clinical Center between 2009 and 2015 (mean age, 47.6 years ± 14.6 [standard deviation]; age range, 12-83 years; 320 women [42.8%]). CT scanning parameters for patients with pancreatic neuroendocrine tumors (PNETs; 124 patients and 381 scans) were compared between a tumor diameter-based surveillance protocol and a VHL genotype and tumor diameter-based algorithm (a tailored algorithm) developed by three VHL clinicians. Organ and lifetime radiation doses were estimated by two radiologists and five radiation scientists. Cumulative radiation doses were compared between the PNET surveillance algorithms by analyses of variance, and a two-tailed P value less than .05 indicated statistical significance. Results: Median cumulative colon doses for annual CAP and AP CT scans from age 15 to 40 years ranged from 0.34 Gy (5th- 95th percentiles, 0.18-0.75; dual-energy VNC CT) to 0.89 Gy (5th-95th percentiles, 0.42-1.0; three-phase CT). For the current PNET surveillance protocol, the cumulative effective radiation dose from age 40 to 65 years was 682 mSv (tumors < 1.2 cm) and 2125 mSv (tumors . 3 cm). The tailored algorithm could halve these doses for patients with initial tumor diameter less than 1.2 cm (P < .001). Conclusion: CT screening of patients with von Hippel-Lindau syndrome can lead to substantial radiation exposures, even with dualenergy virtual noncontrast CT. A genome and tumor diameter-based algorithm for pancreatic neuroendocrine tumor surveillance may potentially reduce lifetime radiation exposure.

Original languageEnglish (US)
Pages (from-to)116-124
Number of pages9
JournalRadiology
Volume290
Issue number1
DOIs
StatePublished - Jan 2019
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Tirosh, A., Journy, N., Folio, L. R., Lee, C., Leite, C., Yao, J., Kovacs, W., Linehan, W. M., Malayeri, A., Kebebew, E., & De González, A. B. (2019). Cumulative radiation exposures from CT screening and surveillance strategies for von hippel-lindau-associated solid pancreatic tumors. Radiology, 290(1), 116-124. https://doi.org/10.1148/radiol.2018180687