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CT-guided cryoablation of renal cancer: radiation burden and the associated risk of secondary cancer from procedural- and follow-up imaging

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  • Jens Borgbjerg
  • ,
  • Thóra Bylling, Aarhus University Hospital
  • ,
  • Gratien Andersen
  • Jesper Thygesen
  • ,
  • Anders Mikkelsen, Medico/Technical Department, Aarhus University Hospital
  • ,
  • Tommy K. Nielsen

Objectives: To estimate radiation dose and the associated risk of secondary cancer risk related to percutaneous cryoablation (PCA) and follow-up imaging in a cohort of patients treated for small renal masses (SRMs). Methods: A total of 149 patients underwent PCA for a SRM at our institution. Based on CT dose reports, we calculated the mean effective dose for a CT-guided PCA procedure and post-ablative follow-up CT. Applying follow-up recommendations by a multidisciplinary expert panel, we calculated the total radiation dose for the PCA procedure and the CT surveillance program corresponding to a minimal and preferable follow-up regime (5-year vs 10-year). Estimates of the lifetime attributable cancer risk for different age groups were calculated based on the cumulative effective dose based on the latest BEIR VII report. Results: Total dose for the PCA treatment and follow-up CTs amounted to 174 and 294 mSv for a minimal and preferable protocol, respectively. Follow-up CTs accounted for the majority of the total effective dose for the minimal and preferable protocol (89% vs 94%). CT fluoroscopy contributed only to a limited amount of the total radiation dose for the minimal and preferable protocol (1.8% vs 1.1%). A 70-year-old male undergoing PCA treatment has a lifetime attributable cancer risk of 0.8% (1 in 131) when completing the preferable follow-up protocol. The same regimen in a 30-year-old female results in a lifetime attributable risk of cancer of 3.4% (1 in 29). Conclusion: Radiation dose and the associated risk of secondary cancer are high for patients with SRMs undergoing PCA and post-ablative follow-up imaging in particular in younger patients. Radiation exposure in the PCA procedure itself accounts for only a limited amount of the total radiation. Radiologists and clinicians must strive to implement radiation dose saving measures especially with respect to the follow-up regime.

TidsskriftAbdominal Radiology
Antal sider8
StatusE-pub ahead of print - 2020

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