Sains Malaysiana 50(11)(2021): 3365-3372

http://doi.org/10.17576/jsm-2021-5011-20

Estimated Effective Lifetime Risks of Radiation-Induced Thyroid Cancer in Computed Tomography (CT) Brain Examination

(Anggaran Keberkesanan Risiko Sepanjang Hayat Kanser Tiroid Disebabkan Radiasi dalam Pemeriksaan Tomografi Berkomputer Otak)

REKHA GANESAN¹, MUHAMMAD IKHMAL NAIM MOHD HILAL¹, IZA NURZAWANI CHE ISA¹*, NORHASHIMAH NORSUDDIN¹, KHADIJAH MOHD NASSIR¹, SAID MOHD SHAFFIQ SAID RAHMAT² & MUHAMMAD KHALIS ABD KARIM³

¹Diagnostic Imaging and Radiotherapy Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Federal Territory, Malaysia

²Department of Radiology, National Cancer Institute, 62250 Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia

³Department of Physics, Faculty of Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia

Received: 19 June 2020/Accepted: 7 March 2021

ABSTRACT

Thyroid is one of the most radiosensitive organs in the human body. Although the scanning range of brain computed tomography (CT) does not include lower neck region, there is possibility for thyroid to be irradiated due to scattered radiation because of its location near to the external beam collimation. The objective of this study was to evaluate effective lifetime risk of radiation-induced thyroid cancer in young adults following brain CT examination. A total of 306 patient data within the age range between 18 and 39 years old were retrospectively analysed. Absorbed dose of the thyroid organ was obtained through the input of data using WAZA- ARI v2. Effective lifetime risk was calculated by multiplying equivalent dose of the thyroid organ with the lifetime attributable cancer risk adapted from Biological Effects in Ionising Radiation (BEIR) Report V11. The effective lifetime risks were recorded as 0.45 ± 0.70 per 100 000 and 0.93 ± 1.52 per 100 000 for single and multiple exposures, respectively. In terms of gender, woman data (0.99 ± 0.76; 1.95 ± 2.15) were found higher as compared to man data (0.13 ± 0.39; 0.35 ± 0.45) for both single and multiple exposure. The percentage difference of effective lifetime risks between single and multiple exposures was up to 107%. The effective lifetime risk noted in this study may be low, however, the long-term risk of cancer development should be considered. This study serves as preliminary reference when revising clinical protocol especially in those involving repeated exposures in young adult patients. Future study should include other radiosensitive organs exploring the effective lifetime risk of radiation induced cancer following CT procedure.

Keywords: CT brain; effective lifetime risk; radiation risk; thyroid cancer; young adult

ABSTRAK

Tiroid ialah organ badan manusia yang sangat sensitif terhadap radiasi. Walaupun kawasan dedahan kepada radiasi semasa prosedur tomografi berkomputer (CT) otak tidak meliputi kawasan leher, namun begitu masih terdapat risiko radiasi yang diterima oleh tiroid kerana kedudukannya terletak berhampiran dengan kawasan kolimasi. Objektif kajian ini adalah untuk mengkaji risiko berkesan radiasi kanser tiroid sepanjang hayat dalam kalangan pesakit bagi peringkat awal dewasa yang menjalani pemeriksaan CT otak. Sebanyak 306 data pesakit antara umur 18 dan 39 tahun telah dianalisis secara retrospektif. Dos serapan tiroid dihitung menggunakan WAZA-ARI v2. Risiko berkesan sepanjang hayat dihitung menggunakan data tiroid dos setara dan data risiko pembentukan kanser yang diambil daripada Laporan V11, Biological Effects in Ionising Radiation (BEIR). Risiko berkesan sepanjang hayat telah dicatatkan sebagai 0.45 ± 0.70 bagi dedahan tunggal dan 0.93 ± 1.52 bagi dedahan berulang. Dari segi perbandingan antara jantina, data pesakit wanita (0.99 ± 0.76; 1.95 ± 2.15) mencatatkan risiko berkesan yang lebih tinggi berbanding dengan data pesakit lelaki (0.13 ± 0.39; 0.35 ± 0.45) bagi dedahan tunggal dan berulang. Peratusan perbezaan risiko yang dicatatkan adalah sehingga 107%. Risiko berkesan sepanjang hayat yang dicatatkan dalam kajian ini mungkin rendah, namun begitu risiko jangka panjang perkembangan kanser perlu diambil kira. Kajian ini menunjukkan bahawa protokol untuk peperiksaan CT perlu disemak terutamanya kepada pesakit peringkat awal dewasa yang perlu menjalani prosedur CT secara berulang. Kajian pada masa hadapan perlu dilakukan merangkumi organ lain yang sensitif terhadap radiasi seperti bahagian peranakan dan mata.

Kata kunci: Awal dewasa; CT otak; kanser tiroid; risiko berkesan sepanjang hayat; risiko radiasi

REFERENCES

Abdulkadir, M.K., Mat Rahim, N.A.Y., Mazlan, N.S., Daud, N.M., Shuaib, I.L. & Osman, N.D. 2020. Dose optimisation in paediatric CT examination: Assessment on current scanning protocols associated with radiation dose. Radiation Physics and Chemistry 171: 108740. https://doi.org/10.1016/j.radphyschem.2020.108740.

Albi, E., Cataldi, S., Lazzarini, A., Codini, M., Beccari, T., Ambesi-Impiombato, F.S. & Curcio, F. 2017. Radiation and thyroid cancer. International Journal of Molecular Sciences 18(5): 911. https://doi.org/10.3390/ijms18050911.

Ali, A.H.A., Al-Ghamdi, S., Karrar, M.H., Alajmi, S.A., Almutairi, O.S., Aldalbahi, A.M., Alotaibi, Y.M., Alruwaili, S.A. & Elamin, A.Y. 2018. Is there a misuse of computed tomography in the diagnostic workup of headache? A restrospective record-based study in secondary health-care facility in Saudi Arabia. Journal of Family Medicine and Primary Care 7(2): 357-361.

Asselin, B.L. 2011. Epidemiology of childhood and adolescent cancer. In Nelson Textbook of Pediatrics, edited by Kliegman, R.M., Behrman, R.E., Stanton, B.F., Schor, N. & St. Geme, J. Philadelphia: Saunders W.B. pp. 1725-1727e1. https://doi.org/10.1016/b978-1-4377-0755-7.00485-1.

Azmi, M.Y., Junidah, R., Siti Mariam, A., Safiah, M.Y., Fatimah, S., Norimah, A.K., Poh, B.K., Kandiah, M., Zalilah, M.S., Wan Abdul Manan, W.M., Siti Haslinda, M.D. & Tahir, A. 2009. Body mass index (BMI) of adults: Findings of the Malaysian Adult Nutrition Survey (MANS). Malaysian Journal of Nutrition 15(2): 97-119.

Bleyer, A. 2007. Young adult oncology: The Patients and their survival challenges. CA: A Cancer Journal for Clinicians 57(4): 242-255. https://doi.org/10.3322/canjclin.57.4.242.

Bleyer, A., Barr, R., Hayes-Lattin, B., Thomas, D., Ellis, C. & Anderson, B. 2008. The distinctive biology of cancer in adolescents and young adults. In Nature Reviews Cancer 8(4): 288-298. https://doi.org/10.1038/nrc2349.

Brenner, D.J. 2012. We can do better than effective dose for estimating or comparing low-dose radiation risks. Annals of the ICRP 41(3-4): 124-128. https://doi.org/10.1016/j.icrp.2012.07.001.

Chen, A.Y., Jemal, A. & Ward, E.M. 2009. Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005. Cancer 115(16): 3801-3807. https://doi.org/10.1002/cncr.24416.

Chen, J.X., Kachniarz, B., Gilani, S. & Shin, J.J. 2014. Risk of malignancy associated with head and neck ct in children: A systematic review. In Otolaryngology - Head and Neck Surgery (United States) 151(4): 554-566. https://doi.org/10.1177/0194599814542588.

Cunha, L.L., Ferreira, R.C., Marcello, M.A., Vassallo, J. & Ward, L.S. 2011. Clinical and pathological implications of concurrent autoimmune thyroid disorders and papillary thyroid cancer. Journal of Thyroid Research 2011: 387062. https://doi.org/10.4061/2011/387062.

Edgren, G., Liang, L., Adami, H.O. & Chang, E.T. 2012. Enigmatic sex disparities in cancer incidence. European Journal of Epidemiology 27(3): 187-196. https://doi.org/10.1007/s10654-011-9647-5.

Fidler, M.M., Gupta, S., Soerjomataram, I., Ferlay, J., Steliarova-Foucher, E. & Bray, F. 2017. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: A population-based study. The Lancet Oncology 18(12): 1579-1589. https://doi.org/10.1016/S1470-2045(17)30677-0.

Ghaznavi, H. 2020. Thyroid cancer risk in patients undergoing 64 slice brain and paranasal sinuses computed tomography. Frontiers in Biomedical Technologies 7(2): 100-104. https://doi.org/10.18502/fbt.v7i2.3855.

Hernández, L., Terradas, M., Camps, J., Martín, M., Tusell, L. & Genescà, A. 2015. Aging and radiation: Bad companions. In Aging Cell 14(2): 153-161. https://doi.org/10.1111/acel.12306.

Ivanov, V.K., Kashcheev, V.V., Chekin, S.Y., Menyaylo, A.N., Pryakhin, E.A., Tsyb, A.F. & Mettler, F.A. 2014. Estimating the lifetime risk of cancer associated with multiple CT scans. Journal of Radiological Protection 34(4): 825-841. https://doi.org/10.1088/0952-4746/34/4/825.

Karim, M.K.A., Hashim, S., Sabarudin, A., Bradley, D.A. & Bahruddin, N.A. 2016. Evaluating organ dose and radiation risk of routine CT examinations in Johor Malaysia. Sains Malaysiana 45(4): 567-573.

Li, X., Samei, E., Segars, W.P., Sturgeon, G.M., Colsher, J.G., Toncheva, G., Yoshizumi, T.T. & Frush, D.P. 2011. Patient-specific radiation dose and cancer risk estimation in CT: Part II. Application to patients. Medical Physics 38(1): 408-419. https://doi.org/10.1118/1.3515864.

Mazonakis, M., Tzedakis, A., Damilakis, J. & Gourtsoyiannis, N. 2007. Thyroid dose from common head and neck CT examinations in children: Is there an excess risk for thyroid cancer induction? European Radiology 17(5): 1352-1357. https://doi.org/10.1007/s00330-006-0417-9.

National Cancer Institute. 2019. Malaysia National Cancer Registry Report (MNCRR) 2012-2016. In National Cancer Registry. http://nci.moh.gov.my/index.php/ms/list-penerbitan/35-laporan/398-summary-of-malaysian-national-cancer-registry-report-2007-2011.

Russo, M.M. & Sundaramurthi, T. 2019. An overview of cancer pain: Epidemiology and pathophysiology. In Seminars in Oncology Nursing 35(3): 223-228. https://doi.org/10.1016/j.soncn.2019.04.002.

Sabarudin, A., Siong, T.W., Chin, A.W., Hoong, N.K. & Karim, M.K.A. 2019. A comparison study of radiation effective dose in ECG-Gated coronary CT angiography and calcium scoring examinations performed with a dual-source CT scanner. Scientific Reports 9(1): 4374. https://doi.org/10.1038/s41598-019-40758-5.

Schonfeld, S.J., Lee, C. & Berrington de González, A. 2011. Medical exposure to radiation and thyroid cancer. Clinical Oncology 23(4): 244-250. https://doi.org/10.1016/j.clon.2011.01.159.

Su, Y.P., Niu, H.W., Chen, J.B., Fu, Y.H., Xiao, G.B. & Sun, Q.F. 2014. Radiation dose in the thyroid and the thyroid cancer risk attributable to CT scans for pediatric patients in one general hospital of China. International Journal of Environmental Research and Public Health 11(3): 2793-2803. https://doi.org/10.3390/ijerph110302793.

Takahashi, F., Sato, K., Endo, A., Ono, K., Yoshitake, T., Hasegawa, T., Katsunuma, Y., Ban, N. & Kai, M. 2011. WAZA-ARI: Computational dosimetry system for x-ray CT examinations. I. radiation transport calculation for organ and tissue doses evaluation using JM phantom. Radiation Protection Dosimetry 146(1-3): 241-243. https://doi.org/10.1093/rpd/ncr160.

Tevfik Dorak, M. & Karpuzoglu, E. 2012. Gender differences in cancer susceptibility: An inadequately addressed issue. Frontiers in Genetics 3(NOV): 1-11. https://doi.org/10.3389/fgene.2012.00268.

Trama, A., Botta, L. & Steliarova-Foucher, E. 2018. Cancer burden in adolescents and young adults. The Cancer Journal 24(6): 256-266. https://doi.org/10.1097/ppo.0000000000000346.

Trevisi, G., Scerrati, A., Peppucci, E., DeWaure, C., Anile, C. & Mangiola, A. 2018. What is the best timing of repeated CT scan in mild head trauma with an initially positive CT scan? World Neurosurgery 118: e316-e322. https://doi.org/10.1016/j.wneu.2018.06.185.

Watanabe, H., Noto, K., Shohji, T., Ogawa, Y., Fujibuchi, T., Yamaguchi, I., Hiraki, H., Kida, T., Sasanuma, K., Katsunuma, Y., Nakano, T., Horitsugi, G. & Hosono, M. 2017. A new shielding calculation method for X-ray computed tomography regarding scattered radiation. Radiological Physics and Technology 10(2): 213-226. https://doi.org/10.1007/s12194-016-0387-9.

Zondervan, R.L., Hahn, P.F., Sadow, C.A., Liu, B. & Lee, S.I. 2011. Frequent body CT scanning of young adults: Indications, outcomes, and risk for radiation-induced cancer. Journal of the American College of Radiology 8(7): 501-507. https://doi.org/10.1016/j.jacr.2010.12.025.

Zondervan, R.L., Hahn, P.F., Sadow, C.A., Liu, B. & Lee, S.I. 2013. Body CT scanning in young adults: Examination indications, patient outcomes, and risk of radiation-induced cancer. Radiology 267(2): 460-469. https://doi.org/10.1148/radiol.12121324.

*Corresponding author; email: zawaniisa@ukm.edu.my