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Radiation exposure from diagnostic imaging in young patients with testicular cancer

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Abstract

Objectives

Risks associated with high cumulative effective dose (CED) from radiation are greater when imaging is performed on younger patients. Testicular cancer affects young patients and has a good prognosis. Regular imaging is standard for follow-up. This study quantifies CED from diagnostic imaging in these patients.

Methods

Radiological imaging of patients aged 18-39 years, diagnosed with testicular cancer between 2001 and 2011 in two tertiary care centres was examined. Age at diagnosis, cancer type, dose-length product (DLP), imaging type, and frequency were recorded. CED was calculated from DLP using conversion factors. Statistical analysis was performed with SPSS.

Results

In total, 120 patients with a mean age of 30.7 ± 5.2 years at diagnosis had 1,410 radiological investigations. Median (IQR) surveillance was 4.37 years (2.0–5.5). Median (IQR) CED was 125.1 mSv (81.3-177.5). Computed tomography accounted for 65.3 % of imaging studies and 98.3 % of CED. We found that 77.5 % (93/120) of patients received high CED (>75 mSv). Surveillance time was associated with high CED (OR 2.1, CI 1.5-2.8).

Conclusions

Survivors of testicular cancer frequently receive high CED from diagnostic imaging, mainly CT. Dose management software for accurate real-time monitoring of CED and low-dose CT protocols with maintained image quality should be used by specialist centres for surveillance imaging.

Key points

• CT accounted for 98.3 % of CED in patients with testicular cancer.

• Median CED in patients with testicular cancer was 125.1 mSv

• High CED (>75 mSv) was observed in 77.5 % (93/120) of patients.

• Dose tracking and development of low-dose CT protocols are recommended.

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Abbreviations

CED:

Cumulative effective dose

CT:

Computed tomography

ICRP:

International Commission on Radiological Protection

UICC:

Union for International Cancer Control

TNM:

Tumour nodes, metastases

PACS:

Picture Archiving and Communication System

DRLs:

Diagnostic reference levels

ESMO:

European Society for Medical Oncology

RPLND:

Retroperitoneal lymph node dissection

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Acknowledgments

The scientific guarantor of this publication is Prof Michael Maher. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. None of the study subjects or cohorts have been previously reported. Methodology: retrospective, observational, multicentre study.

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Correspondence to O. J. O’Connor.

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Sullivan, C.J., Murphy, K.P., McLaughlin, P.D. et al. Radiation exposure from diagnostic imaging in young patients with testicular cancer. Eur Radiol 25, 1005–1013 (2015). https://doi.org/10.1007/s00330-014-3507-0

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