Radioprotection 2025, 60( 1), 65 – 75 © H. Murat et al., Published by EDP Sciences, 2025 https:// doi. org / 10.1051 / radiopro / 2024034
Available online at: www. radioprotection. org
ARTICLE
Assessment of lifetime attributable risk( LAR) of cancer incidence from whole-body 18 F-FDG PET / CT examinations using established polynomial fittings
H. Murat 1, 2, M. M. A. Kechik 1, M. T. Chew 1, I. Kamal 1, M. A. Said 3 and M. K. A. Karim 1,*
1 Department of Physics, Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia. 2 Department of Nuclear Medicine, Hospital Sultanah Aminah, 80100 Johor Bahru, Johor, Malaysia. 3 Department of Nuclear Medicine, Institut Kanser Negara, 62250, W. P. Putrajaya, Malaysia.
Received: 21 February 2024 / Accepted: 5 August 2024
Abstract – The advent of PET / CT examinations has revolutionized cancer treatment, offering greater precision in diagnosis. Nonetheless, the ionizing radiation exposure during the examination could cause radiation cancer risk. Hence, this study aimed to evaluate the radiation dose and radiation-induced risk associated of whole-body PET / CT examinations that includes the 18 F-FDG radionuclides. For this retrospective study, 40 participants were studied, with 20 men and 20 women. The average age and weight of the participants were 53.77 ± 15.78 years and 66.59 ± 16.94 kg respectively, and they were administered 424.64 ± 121.19 MBq of 18 F-FDG before the PET / CT commenced. The IDAC-Dose 2.1 program was employed to calculate the absorbed dose and effective dose in organs such as the bladder, brain, lung, kidneys, colon, red bone marrow( RBM), stomach, liver, and thyroid. In this study, polynomial regression was used to fit the Lifetime Attributable Risk( LAR) values derived from the BEIR VII phase II report. The effective dose from the 18 F-FDG PET / CT examination was 20.1 ± 7.9 mSv, with a ratio of E to the administered activity of 1.612 10 �2 mSv / MBq, in accordance with ICRP standards. The related risk of cancer in the second part of the work did not include CT component. The estimated average cancer incidence from the PET alone was 7 and 8 cases per 100,000 persons exposed to 0.1Gy for men and women respectively, with PET-related effective doses ranging between 3.2 mSv to 27.3 mSv. In summary, the risk of cancer associated with current whole-body 18 F-FDG PET / CT examinations is low, but it is essential to mitigate radiation exposure during these examinations and utilize suitable techniques to prevent stochastic effects from low-dose radiation exposure.
Keywords: Whole-body 18 F-FDG PET / CT / lifetime attributable risk( LAR) / cancer risks / organ absorbed dose
1 Introduction
A PET / CT combines the functional imaging of PET with the anatomical resolution of CT through the detection of transmitted and attenuated ionizing radiation. The level of radiation exposure to the patient resulting from PET / CT examinations is subject to various influencing factors, including the injected activity of the radiotracer, the CT acquisition parameters, the patient’ s size and weight( Alashban et al., 2023; Choi et al., 2020; Lim et al., 2018). For instance, a nationwide survey in Korea estimated the average effective dose from injected 18 F-FDG and CT scans was estimated to be 7.6 mSv and 5.2 mSv, respectively( Adeleye & Chetty, 2018; Kwon et al., 2016). Nonetheless, it should be taken into
* Corresponding author: mkhalis @ upm. edu. my consideration that the values could be subject to variation, depending on the imaging protocols and practices of distinct institutions( Alessio et al., 2015; Li et al., 2019; Masoomi et al., 2021; Velo et al., 2023). Furthermore, the utilization of PET / CT examinations has become indispensable in the care of individuals with cancer, and it has been widely acknowledged as the established norm for diagnosing and monitoring various forms of cancer( Berberoglu, 2019; El-Galaly et al., 2018; Murat et al., 2024).
Investigating potential long-term cancer risks associated with radiation exposure is a continuing concern within low levels of ionizing radiation related to gamma radiation and X-ray in PET / CT examinations. This should be performed in order to weigh the potential radiation risk of the examinations against the other medical risk of not performing the examinations. It is crucial for medical staff and medical physicists to comprehend the amount of radiation a patient is
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