The risk index as a basis for risk/benefit analyses and protocol optimization in diagnostic nuclear imaging Journal Article
| Authors: | Ocampo Ramos, J. C.; Carter, L. M.; Brown, J. L.; Marquis, H.; Uribe, C. F.; Zanzonico, P. B.; Bolch, W. E.; Kesner, A. L. |
| Article Title: | The risk index as a basis for risk/benefit analyses and protocol optimization in diagnostic nuclear imaging |
| Abstract: | Background: Potential risk associated with low-dose radiation exposures is often expressed using the effective dose (E) quantity. Other risk-related quantities have been proposed as alternatives. The recently introduced risk index (RI) shares similarities with E but expands the metric to incorporate medical imaging-appropriate risks factors including patient-specific size, age, and sex. Purpose: The aim of this work is to examine the RI metric for quantifying stochastic radiation risk and demonstrate its applications in nuclear imaging. The advantages in this improved metric may help the field progress toward stratified risk consideration in the course of patient management, improve efforts for procedure optimization, and support an evolution in the science of radiation risk assessment. Methods: In this study we describe, implement, and calculate RI for various diagnostic nuclear imaging scenarios using reference biokinetics published in ICRP Publication 128 for commonly utilized radiopharmaceuticals. All absorbed dose, E and RI calculations were performed using the freely available MIRDcalc nuclear medicine dosimetry software; the organ specific risk parameters used in the software are also benchmarked in this text. The resulting RI and E values are compared and various trends in RI values identified. Results: E and RI coefficients were calculated for 3016 use cases. Notably RI values vary depending on patient characteristics. Overall, across the population, global trends in RI values can be identified. In general, RI values were 2.15 times higher for females than males, due to higher risk coefficients and activities being distributed in smaller reference masses. The pediatric patients showed higher RIs than adults, as younger patients generally receive higher absorbed doses per administered activity, and are more radiosensitive, and have a longer projected lifespan at risk. A compendium of E and RI values is also provided in table format to serve as a reference for the community. Conclusions: RI is a rational quantity that could be used for justification, risk communication and protocol optimization in medical imaging. It has some advantages when compared to the long-utilized E value with respect to personalization, since accounts for patient size, age, sex, and natural incidence of cancer risk. © 2023 American Association of Physicists in Medicine. |
| Keywords: | adult; child; controlled study; major clinical study; cancer risk; risk benefit analysis; radiation dose; cancer incidence; radiopharmaceuticals; radiation exposure; risk assessment; radiation dosage; patient care; electron therapy; medical imaging; dosimetry; diagnosis; fluorodeoxyglucose f 18; radiopharmaceutical agent; ionizing radiation; radiography; nuclear medicine; sex difference; drug absorption; radiation hazard; radiometry; photon therapy; phantoms, imaging; software; lifespan; attributable risk; optimization; effective dose; alpha radiation; proton therapy; procedures; radiation risk; neutron therapy; nuclear imaging; humans; human; male; female; article; protocol optimization; stochastic systems; pediatric patient; optimisations; risks assessments; radiation induced cancer; lifetime attributable risk; technetium phosphate tc 99m; attributable risks; index values; risk indices |
| Journal Title: | Medical Physics |
| Volume: | 50 |
| Issue: | 12 |
| ISSN: | 0094-2405 |
| Publisher: | American Association of Physicists in Medicine |
| Date Published: | 2023-12-01 |
| Start Page: | 7390 |
| End Page: | 7399 |
| Language: | English |
| DOI: | 10.1002/mp.16696 |
| PUBMED: | 37656137 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Juan Ocampo -- Source: Scopus |
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79Carter -
27Ocampo Ramos -
17Marquis
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