Lifetime Attributable Risk of Cancer from Computed Tomography in Patients with Severe Traumatic Brain Injury

Keywords: cancer, traumatic brain injury, computed tomography, natural history, risk factor

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     There is concern about the potential cancer risk inflicted by frequent radiographic evaluation with modalities utilizing ionizing radiation. This is especially true in patients suffering severe traumatic brain injury (TBI) whose injuries frequently necessitate serial computed topographic (CT) scans.
     The purpose of this study was to calculate lifetime attributable risk (LAR) of cancer from CT scan use in the severe TBI population.
     Cumulative radiation exposure was calculated in a consecutive series of 67 patients =14 years of age admitted with a GCS=8 (severe TBI) to UPMC who survived a minimum of one year. Mean age of the study population was 34yrs.
     Radiation exposure was quantified using the effective dose of each scan. Risk models based on the Biological Effects of Ionizing Radiation VII report and cumulative effective dose incurred by each patient from time of injury to 1-year follow-up were used to estimate LAR of cancer and cancer-related mortality.
     Mean number of CT exams per patient in the first year following injury was 23 (IQR 8) mean cumulative radiation dose was 87.2±45 mSv. This resulted in a mean LAR of cancer of 0.81% ± 0.53 and a mean LAR of cancer-related mortality of 0.44% ± 0.27 related to computed tomography.
     This is a retrospective study.
     The use of computed tomography in the evaluation and management of severe TBI is associated with a negligible lifetime attributable risk of cancer.
     Treating physicians should not allow the concern for future risk of cancer to impact decisions regarding radiographic evaluation.


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