Estimated cancer risks attributable to radiation dose in ureteral stenting procedures
DOI:
https://doi.org/10.25758/set.44Keywords:
Ureteral stenting, X-ray, Dose, Risk, CancerAbstract
Introduction: Double-J ureteral stenting is a frequent interventional urological procedure that implicates the use of x-ray fluoroscopy, with considerable exposure times, incident in an anatomic region with several organs. This fact raises doubts about the patient risks attributed to radiation dose. The purpose of this study was to clarify these doubts in estimating the cancer risk inherent to the patient's effective dose. Method: We studied specific data of 146 patients submitted to ureteral stenting procedures in the Urologic Department of Hospital Santa Maria. Effective doses were determined with a computational Monte Carlo-based program. Cancer risks were estimated with probability coefficients considering the linear non-threshold dose-effect relation (LNT) of the low doses of radiation. Results: A patient submitted to a ureteral stent insertion followed by a removal procedure, develops an increased cancer risk of 0,012%. This means that 1 in 8330 patients develops radiation-induced cancer. Also, a patient submitted to a ureteral stent insertion followed by 1 substitution, and a removal procedure is submitted to a mean effective dose of 4,47 mSv. This value is similar to the effective dose of an abdominal TC. Conclusion: When we compare the radiation risks with the clinical benefit, of “saving” renal function, we can conclude that benefits are greatly more important than risks. Furthermore, we verify that, although low, there is always some risk attributed to radiation dose. Thus, dose optimization and clinical justification should always be considered in these procedures.
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References
Martins MB. Efeitos biológicos das radiações ionizantes. 1. Curso de formação em protecção radiológica, Departamento de Protecção Radiológica e Segurança Nuclear, Instituto Tecnológico e Nuclear, Ministério da Ciência e do Ensino Superior. 2003.
Huda W, Slone R. Review of Radiologic Physics. 2nd ed. 2. Philadelphia: Lippincott Williams & Wilkins; 2003.
ICRP, International Commission on Radiological Protection. 3. Biological and Epidemiological information on Health Risks Attributable to Ionizing Radiation: A Summary of Judgements for the purposes of Radiological Protection Humans. FD-C1. 2005.
Tubiana M, Aurengo A, Averbeck D, Masse R. Recent 4. reports on the effect of low doses of ionizing radiation and its dose-effect relationship. Radiat Environ Biophys. 2006; 44: 245–251.
Chadwick KH, Leenhouts HP. Radiation risk is linear with 5. dose at low doses. Br J Radiology. 2005; 78: 8–10
Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks 6. attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA. 2003; 100:13761–13766.
Brenner DJ, Sachs RK. Estimating radiation-induced cancer 7. risks at very low doses: rationale for using a linear no-‑threshold approach. Radiat Environ Biophys. 2006; 44: 253–256.
BEIR VII, Committee on Health Effects of Exposure to Low 8. Levels of Ionizing Radiations, National Research Council. Health Risks from Exposure to Low Levels of Ionizing Radiation: Phase 2. National Academy Press, Washington DC. 2005.
Amis E, Butler PF, Applegate KE, Birnbaum SB, et al. 9. American College of Radiology White Paper on Radiation Dose in Medicine. J Am Coll Radiol. 2007; 4: 272–284.
Brenner DJ, Elliston CD. Estimated Radiation Risks 10. Potentially Associated with Full-Body CT Screening. Radiology RSNA Journals. 2004; 232: 735–738.
STUK, Radiation and Nuclear Safety Authority. PCXMC, 11. A PC-based Monte Carlo program for calculating patient doses in medical x-ray examinations. Helsinki. 2005. Available from: http://ww.stuk.fi/sateilyn_kayttajille/ohjelmat/PCXMC/en_GB/pcxmc/
Bor D, Sancak T, Olgar T, Elcim Y, et al. Comparison of 12. effective doses obtained from dose-area-product and air kerma measurements in interventional radiology. Br J Radiology. 2004; 77: 315–322.
Larrazet F, Dibie A, Philippe F, Palau R, et al. Factors 13. influencing fluoroscopy time and dose-area product values during ad hoc one vessel percutaneous coronary angioplasty. Br J Radiology. 2003; 76: 473–477.
Kotre CJ, Charlton S, Robson KJ, Birch IP, et al. Aplication 14. of low dose rate pulsed fluoroscopy in cardiac pacing and electrophysiology: patient dose and image quality implications. Br J Radiology. 2004; 77: 597–599.
Zweers D, Geleijns J, Aarts NJM, Hardam LJ, et al. Patient and 15. staff radiation dose in fluoroscopy-guided TIPS procedures and dose reduction, using dedicated fluoroscopy exposure settings. Br J Radiology. 1998; 71: 672–676.
McParland BJ. A Study of Patient Radiation Doses in 16. Interventional Radiological Procedures. Br J Radiology. 1998; 71; 175–185
Kim PK, Gracias VH, Maidment AD, O´Shea M, et al. 17. Cumulative Radiation Dose Caused By Radiologic Studies in Critically Ill Trauma Patients. The Journal of Trauma Injury, Infection and Critical Care. 2004; 57:510–514.
Hart D, Wall BF. The UK National Patient Dose Database: 18. now and in the future. Br J Radiology. 2005; 76: 361–365.
Fortin MF. O Processo de Investigação – da concepção à 19. realização. Lusociência. 1999.
Philips Medical Systems. Philips BV Pulsera: Instrucciones 20. de Uso, Realease 1.1, Nederland, 2001.
Mahesh M. Fluoroscopy: Patient Radiation Exposure Issues. 21. Radiographics RSNA Journals. 2001; 21:1033–1045.
Miller DL, Balter S, Noonan PT, Georgia JD. Minimizing 22. Radiation-induced Skin Injury in Interventional Radiology Procedures. Radiology RSNA Journals. 2002 Set; 225 (2): 329–336.
Carlson SK, Bender CE, Classic KL, Zink FE, et al. Benefits 23. and Safety of CT Fluoroscopy in Interventional Radiologic Procedures. Radiology RSNA Journals. 2001; 219: 515–520.
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