利用复发性全身低剂量CT成像监测阴燃型多发性骨髓瘤患者的累积辐射负担及相关风险评估

IF 2.7 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Physica Medica-European Journal of Medical Physics Pub Date : 2025-10-01 DOI:10.1016/j.ejmp.2025.105173

Pascaline Wangechi Abissi , Georgia Lymperopoulou , Vasileios-Petros Agrokostas , Vassilis Koutoulidis , Panagiotis Grigoropoulos , Evangelos Terpos , Lia Angela Moulopoulos , Martin Fiebich , Ioannis Seimenis

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引用次数: 0

摘要

目的评估阴燃型多发性骨髓瘤（SMM）患者多次全身低剂量计算机断层扫描（WBLDCT）的累积辐射负担和癌症风险。方法对116例反复行WBLDCT检查的SMM患者（n = 2-7）进行队列研究。使用CT剂量测量软件（NCICT）估计患者特异性器官剂量，而通过NCICT和剂量长度乘积（DLP）估计有效剂量（ED）。使用BEIR VII方法计算每位患者癌症发病率的器官特异性和总终身归因风险（LAR）。结果对甲状腺的累积剂量达66 mGy，对唾液腺和眼晶状体/眼球的累积剂量超过50 mGy。使用NCICT/DLP，每次WBLDCT检查的平均ED为5.6/4.6 mSv（女性）和5.8/3.4 mSv（男性），最高累积ED （n = 7）为42.1 mSv。肺癌（女性）和白血病（女性/男性）与WBLDCT手术相关的最高风险相关，女性的总LAR比男性高44%。单次暴露的中位数LAR为每10万人36/25（女性/男性），累积的中位数LAR为每10万人85/58。结论：在现实生活中，多次WBLDCT检查与主动监测SMM队列相关的理论放射致癌风险似乎比10%的SMM患者低两个数量级，这些患者可能发展为需要治疗的症状性MM。建议对WBLDCT方案进行剂量优化，以及针对患者的主动SMM监测策略，但需要进一步研究来评估早期治疗干预措施的作用。

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Evaluation of cumulative radiation burden and associated risk in smouldering multiple myeloma patients monitored using recurrent whole-body low-dose CT imaging

Purpose

To assess the cumulative radiation burden and cancer risk associated with multiple whole-body low-dose computed tomography (WBLDCT) scans in patients with smouldering multiple myeloma (SMM).

Methods

A cohort of 116 SMM patients who underwent recurrent (n = 2–7) WBLDCT examinations was studied. Patient-specific organ doses were estimated using CT dosimetry software (NCICT) whereas effective doses (ED) were estimated from NCICT and the dose-length product (DLP). Organ-specific and total lifetime-attributable risks (LAR) of cancer incidence were calculated per patient using the BEIR VII methodology.

Results

Cumulative dose to the thyroid reached 66 mGy, whereas cumulative doses to salivary glands and eye lenses/balls exceeded 50 mGy. The median ED per WBLDCT examination was 5.6/4.6 mSv (female) and 5.8/3.4 mSv (male) using NCICT/DLP with the highest cumulative (n = 7) ED being 42.1 mSv. Lung cancer (female) and leukaemia (female/male) were associated with the highest risks related to WBLDCT procedures, with total LAR being 44 % higher in females compared to males. The median LAR per single exposure was 36/25 per 100,000 (female/male) with the median cumulative LAR being 85/58 per 100,000.

Conclusion

The theoretical radiogenic risk of cancer induction associated with multiple WBLDCT examinations for the active surveillance of a real-life SMM cohort appears to be two orders of magnitude lower than 10 % of SMM patients, which may progress to symptomatic MM requiring treatment. Dose optimisation is recommended for the WBLDCT protocol, as well as a patient-specific strategy for active SMM surveillance, but further research is needed to evaluate the role of early therapeutic interventions.

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来源期刊

Physica Medica-European Journal of Medical Physics 生物-生物物理

CiteScore

6.80

自引率

14.70%

发文量

493

审稿时长

78 days

期刊介绍： Physica Medica, European Journal of Medical Physics, publishing with Elsevier from 2007, provides an international forum for research and reviews on the following main topics: Medical Imaging Radiation Therapy Radiation Protection Measuring Systems and Signal Processing Education and training in Medical Physics Professional issues in Medical Physics.