Abdominal pediatric cancer surveillance using serial computed tomography: evaluation of organ absorbed dose and effective dose

Computed tomography (CT) is used extensively in cancer diagnosis, staging, evaluation of response to treatment, and in active surveillance for cancer reoccurrence. A review of CT technology is provided, at a level of detail appropriate for a busy clinician to review. The basis of x-ray CT dosimetry is also discussed, and concepts of absorbed dose and effective dose (ED) are distinguished. Absorbed dose is a physical quantity (measured in milligray mGy]) equal to the x-ray energy deposited in a mass of tissue, whereas ED uses an organ-specific weighting method that converts organ doses to ED measured in millisieverts (mSv). The organ weighting values carry with them a measure of radiation risk, and so ED (in mSv) is not a physical dose metric but rather is one that conveys radiation risk. The use of CT in a cancer surveillance protocol was used as an example of a pediatric patient who had kidney cancer, with surgery and radiation therapy. The active use of CT for cancer surveillance along with diagnostic CT scans led to a total of 50 CT scans performed on this child in a 7-year period. It was estimated that the patient received an average organ dose of 431 mGy from these CT scans. By comparison, the radiation therapy was performed and delivered 50.4 Gy to the patient's abdomen. Thus, the total dose from CT represented only 0.8% of the patient's radiation dose.