Which patients are prone to undergo disproportionate recurrent CT imaging and should we worry?

Abstract

Purpose: To identify the spectrum of patients who undergo disproportionate recurrent computed tomography (CT) imaging, and to explore the cumulative effects of radiation exposure and intravenously injected contrast agents in these patients.

Methods: This retrospective study investigated all patients who had undergone 40 or more CT scans at a tertiary care center between 2007-2017.

Results: Fifty-six patients who had undergone a median of 47 (range: 40-92) CT scans were included. The main reason for CT scanning in all patients was oncological, and 55 patients (98.2 %) had metastatic disease. Twenty-six patients (45.6) had received chemotherapy, 35 (62.5 %) radiation therapy, 38 (67.9 %) targeted therapy, 12 (21.4 %) liver tumor microwave ablation, 44 (78.6 %) major surgery, and 34 (60.7 %) had participated in a therapeutic trial. Mean cumulative effective dose was 187.4 mSv (range: 120.7-278.4 mSv). Median estimated radiation-induced lifetime attributable risk (LAR) of cancer incidence was 1.0 % (range: 0.20-2.36 %). Mean estimated radiation-induced LAR of cancer mortality was 0.68 % (range: 0.18-1.37 %). Mean cumulative volume of intravenously injected iomeprol was 2339 mL (range: 540-3605 mL). Three patients (5.4 %) had developed severely decreased kidney function (estimated glomerular filtration rate between 15 and 29 mL/min per 1.73 m² for at least 3 months).

Conclusion: Patients with metastatic disease who experience a relatively long survival may be prone to undergo disproportionate recurrent CT imaging. The non-negligible CT radiation-induced cancer risk and mortality should be taken into account in these patients, while the effect of cumulatively administered CT contrast agents on kidney function requires further investigation.

Keywords: Computed tomography; Kidney failure; Medical oncology; Radiation exposure; Second cancer.