CT-guided cryoablation of renal cancer: radiation burden and the associated risk of secondary cancer from procedural- an
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INTERVENTIONAL RADIOLOGY
CT‑guided cryoablation of renal cancer: radiation burden and the associated risk of secondary cancer from procedural‑ and follow‑up imaging Jens Borgbjerg1 · Thóra Bylling1 · Gratien Andersen1 · Jesper Thygesen2 · Anders Mikkelsen2 · Tommy K. Nielsen3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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. Keywords Radiation · Tomography · X-ray computed · Cryoablation · Renal cell carcinoma Abbreviations SRM Small renal mass PTA Percutaneous thermal ablation Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00261-020-02527-1) contains supplementary material, which is available to authorized users. * Jens Borgbjerg [email protected] 1
Department of Radiology, Aarhus University Hospital, Palle Juul‑Jensens Boulevard 99, 8200 Aarhus N, Denmark
2
Medico/Technical Department, Aarhus University Hospital, Aarhus, Denmark
3
Department of Urology, Aarhus University Hospital, Aarhus, Denmark
PCA Percutaneous cryoablation RM Renal mass DLP Dose-length product LAR Lifetime attributable risk ALARA As low as reasonabl
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