This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (175)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Oncology  • Radiation Therapy  • Radiologic Imaging  • Women's Health  • Women's Health, Other  • Angiology  • Computed Tomography  • Alert me on articles by topic  Social Bookmarking   What's this?

Andrew J. Einstein, MD, PhD; Milena J. Henzlova, MD, PhD; Sanjay Rajagopalan, MD

JAMA. 2007;298:317-323.

Context  Computed tomography coronary angiography (CTCA) has become a common diagnostic test, yet there are little data on its associated cancer risk. The recent Biological Effects of Ionizing Radiation (BEIR) VII Phase 2 report provides a framework for estimating lifetime attributable risk (LAR) of cancer incidence associated with radiation exposure from a CTCA study, using the most current data available on health effects of radiation.

Objectives  To determine the LAR of cancer incidence associated with radiation exposure from a 64-slice CTCA study and to evaluate the influence of age, sex, and scan protocol on cancer risk.

Design, Setting, and Patients  Organ doses from 64-slice CTCA to standardized phantom (computational model) male and female patients were estimated using Monte Carlo simulation methods, using standard spiral CT protocols. Age- and sex-specific LARs of individual cancers were estimated using the approach of BEIR VII and summed to obtain whole-body LARs.

Main Outcome Measures  Whole-body and organ LARs of cancer incidence.

Results  Organ doses ranged from 42 to 91 mSv for the lungs and 50 to 80 mSv for the female breast. Lifetime cancer risk estimates for standard cardiac scans varied from 1 in 143 for a 20-year-old woman to 1 in 3261 for an 80-year-old man. Use of simulated electrocardiographically controlled tube current modulation (ECTCM) decreased these risk estimates to 1 in 219 and 1 in 5017, respectively. Estimated cancer risks using ECTCM for a 60-year-old woman and a 60-year-old man were 1 in 715 and 1 in 1911, respectively. A combined scan of the heart and aorta had higher LARs, up to 1 in 114 for a 20-year-old woman. The highest organ LARs were for lung cancer and, in younger women, breast cancer.

Conclusions  These estimates derived from our simulation models suggest that use of 64-slice CTCA is associated with a nonnegligible LAR of cancer. This risk varies markedly and is considerably greater for women, younger patients, and for combined cardiac and aortic scans.

Author Affiliations: Department of Medicine, Division of Cardiology and Department of Radiology, Columbia University College of Physicians and Surgeons, New York, New York (Dr Einstein); Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, The Mount Sinai Medical Center, New York, New York (Dr Henzlova); and Department of Internal Medicine, The Ohio State University, Columbus (Dr Rajagopalan).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition
Achenbach et al.
Eur Heart J 2009;0:ehp470v1-ehp470.
ABSTRACT | FULL TEXT  

CT of Coronary Artery Disease
Bastarrika et al.
Radiology 2009;253:317-338.
ABSTRACT | FULL TEXT  

Accuracy and usefulness of fusion imaging between three-dimensional coronary sinus and coronary veins computed tomographic images with projection images obtained using fluoroscopy
Auricchio et al.
Europace 2009;11:1483-1490.
ABSTRACT | FULL TEXT  

Adoption And Spread Of New Imaging Technology: A Case Study
Ladapo et al.
Health Aff (Millwood) 2009;28:w1122-w1132.
ABSTRACT | FULL TEXT  

Impact of Heart Rate Frequency and Variability on Radiation Exposure, Image Quality, and Diagnostic Performance in Dual-Source Spiral CT Coronary Angiography
Weustink et al.
Radiology 2009;0:radiol.2533090358v1-radiol.2533090358.
ABSTRACT | FULL TEXT  

CT Coronary Angiography in Patients Suspected of Having Coronary Artery Disease: Decision Making from Various Perspectives in the Face of Uncertainty
Genders et al.
Radiology 2009;0:radiol.2533090507v1-radiol.2533090507.
ABSTRACT | FULL TEXT  

First head-to-head comparison of effective radiation dose from low-dose 64-slice CT with prospective ECG-triggering versus invasive coronary angiography
Herzog et al.
Heart 2009;95:1656-1661.
ABSTRACT | FULL TEXT  

Pre-Fontan cardiac magnetic resonance predicts post-Fontan length of stay and avoids ionizing radiation
Harris et al.
J. Thorac. Cardiovasc. Surg. 2009;138:941-947.
ABSTRACT | FULL TEXT  

ACCF/AHA/ACP 2009 competence and training statement: a curriculum on prevention of cardiovascular disease.
American College of Cardiology Foundation et al.
J Am Coll Cardiol 2009;54:1336-1363.
FULL TEXT  

ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Competence and Training (Writing Committee to Develop a Competence and Training Statement on Prevention of Cardiovascular Disease): Developed in Collaboration With the American Academy of Neurology; American Association of Cardiovascular and Pulmonary Rehabilitation; American College of Preventive Medicine; American College of Sports Medicine; American Diabetes Association; American Society of Hypertension; Association of Black Cardiologists; Centers for Disease Control and Prevention; National Heart, Lung, and Blood Institute; National Lipid Association; and Preventive Cardiovascular Nurses Association
WRITING COMMITTEE MEMBERS et al.
Circulation 2009;120:e100-e126.
FULL TEXT  

Noninvasive Coronary Angiography by 320-Row Computed Tomography With Lower Radiation Exposure and Maintained Diagnostic Accuracy: Comparison of Results With Cardiac Catheterization in a Head-to-Head Pilot Investigation
Dewey et al.
Circulation 2009;120:867-875.
ABSTRACT | FULL TEXT  

Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures
Fazel et al.
NEJM 2009;361:849-857.
ABSTRACT | FULL TEXT  

Screening for Asymptomatic Coronary Artery Disease in Patients With Type 2 Diabetes
Vidovich
JAMA 2009;302:736-736.
FULL TEXT  

Pediatric 64-MDCT Coronary Angiography With ECG-Modulated Tube Current: Radiation Dose and Cancer Risk
Huang et al.
Am. J. Roentgenol. 2009;193:539-544.
ABSTRACT | FULL TEXT  

Triple-Rule-Out CT Angiography for Evaluation of Acute Chest Pain and Possible Acute Coronary Syndrome
Halpern
Radiology 2009;252:332-345.
ABSTRACT | FULL TEXT  

Diagnostic accuracy of coronary computed tomography angiography: a comparison between prospective and retrospective electrocardiogram triggering.
Pontone et al.
J Am Coll Cardiol 2009;54:346-355.
ABSTRACT | FULL TEXT  

Calcium Scoring With Computed Tomography: What Is the Radiation Risk?
Gibbons and Gerber
Arch Intern Med 2009;169:1185-1187.
FULL TEXT  

Coronary Artery Calcification Screening: Estimated Radiation Dose and Cancer Risk
Kim et al.
Arch Intern Med 2009;169:1188-1194.
ABSTRACT | FULL TEXT  

Diagnostic Accuracy of Computed Tomography Angiography in Patients After Bypass Grafting: Comparison With Invasive Coronary Angiography
Weustink et al.
J Am Coll Cardiol Img 2009;2:816-824.
ABSTRACT | FULL TEXT  

Outcomes Research in Cardiovascular Imaging: Report of a Workshop Sponsored by the National Heart, Lung, and Blood Institute
Douglas et al.
J Am Coll Cardiol Img 2009;2:897-907.
ABSTRACT | FULL TEXT  

One More Step for Computed Tomography Coronary Angiography Before Heart Valve Surgery
O'Gara
Circ Cardiovasc Imaging 2009;2:279-281.
FULL TEXT  

Outcomes Research in Cardiovascular Imaging: Report of a Workshop Sponsored by the National Heart, Lung, and Blood Institute
Douglas et al.
Circ Cardiovasc Imaging 2009;2:339-348.
ABSTRACT | FULL TEXT  

Multislice Computed Tomography in the Exclusion of Coronary Artery Disease in Patients With Presurgical Valve Disease
Bettencourt et al.
Circ Cardiovasc Imaging 2009;2:306-313.
ABSTRACT | FULL TEXT  

Preserved Diagnostic Performance of Dual-Source CT Coronary Angiography with Reduced Radiation Exposure and Cancer Risk
Weustink et al.
Radiology 2009;252:53-60.
ABSTRACT | FULL TEXT  

Will 3.0-T make coronary magnetic resonance angiography competitive with computed tomography angiography?
Sibley and Bluemke
J Am Coll Cardiol 2009;54:77-78.
FULL TEXT  

Radiation Dose From Cardiac Computed Tomography Before and After Implementation of Radiation Dose-Reduction Techniques
Raff et al.
JAMA 2009;301:2340-2348.
ABSTRACT | FULL TEXT  

Medical Decision Making Regarding Computed Tomographic Radiation Dose and Associated Risk: The Patient's Perspective
Caoili et al.
Arch Intern Med 2009;169:1069-1071.
FULL TEXT  

The Year in Coronary Artery Disease
Achenbach et al.
J Am Coll Cardiol Img 2009;2:774-786.
ABSTRACT | FULL TEXT  

Computed tomography to analyze mitral valve an answer in search of a question.
Flachskampf and Ropers
J Am Coll Cardiol Img 2009;2:566-568.
FULL TEXT  

Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: Preprocedural assessment with multidetector computed tomography.
Kurra et al.
J. Thorac. Cardiovasc. Surg. 2009;137:1258-1264.
ABSTRACT | FULL TEXT  

Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department
Hoffmann and Bamberg
Circ Cardiovasc Imaging 2009;2:251-263.
FULL TEXT  

Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department: Antagonist Viewpoint
Hendel
Circ Cardiovasc Imaging 2009;2:264-275.
FULL TEXT  

End of the Road for Delayed Hyperenhancement Cardiac Magnetic Resonance?
Desai and Flamm
J Am Coll Cardiol Img 2009;2:421-423.
FULL TEXT  

Radiation Dose in a "Triple Rule-Out" Coronary CT Angiography Protocol of Emergency Department Patients Using 64-MDCT: The Impact of ECG-Based Tube Current Modulation on Age, Sex, and Body Mass Index
Takakuwa et al.
Am. J. Roentgenol. 2009;192:866-872.
ABSTRACT | FULL TEXT  

Cumulative Radiation Exposure and Cancer Risk Estimates in Emergency Department Patients Undergoing Repeat or Multiple CT
Griffey and Sodickson
Am. J. Roentgenol. 2009;192:887-892.
ABSTRACT | FULL TEXT  

Recurrent CT, Cumulative Radiation Exposure, and Associated Radiation-induced Cancer Risks from CT of Adults
Sodickson et al.
Radiology 2009;251:175-184.
ABSTRACT | FULL TEXT  

Image Quality in a Low Radiation Exposure Protocol for Retrospectively ECG-Gated Coronary CT Angiography
Pflederer et al.
Am. J. Roentgenol. 2009;192:1045-1050.
ABSTRACT | FULL TEXT  

Whole-Body PET/CT Scanning: Estimation of Radiation Dose and Cancer Risk
Huang et al.
Radiology 2009;251:166-174.
ABSTRACT | FULL TEXT  

The evolving role of molecular imaging for coronary artery disease: where do we stand today?
Chua
Heart Asia 2009;2009:1-5.
ABSTRACT | FULL TEXT  

Radiation Dose in Cardiac CT
Mayo and Leipsic
Am. J. Roentgenol. 2009;192:646-653.
ABSTRACT | FULL TEXT  

Ionizing Radiation in Cardiac Imaging: A Science Advisory From the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention
Gerber et al.
Circulation 2009;119:1056-1065.
FULL TEXT  

Estimated Radiation Dose Associated With Cardiac CT Angiography
Hausleiter et al.
JAMA 2009;301:500-507.
ABSTRACT | FULL TEXT  

Radiation Protection of Patients Undergoing Cardiac Computed Tomographic Angiography
Einstein
JAMA 2009;301:545-547.
FULL TEXT  

Prognostic utility of 64-slice computed tomography in patients with suspected but no documented coronary artery disease
Carrigan et al.
Eur Heart J 2009;30:362-371.
ABSTRACT | FULL TEXT  

CT Venography: A Necessary Adjunct to CT Pulmonary Angiography or a Waste of Time, Money, and Radiation?
Goodman et al.
Radiology 2009;250:327-330.
FULL TEXT  

The year in cardiac imaging.
Gibbons et al.
J Am Coll Cardiol 2009;53:54-70.
FULL TEXT  

Cardiac MRI and Pulmonary MR Angiography of Sinus Venosus Defect and Partial Anomalous Pulmonary Venous Connection in Cause of Right Undiagnosed Ventricular Enlargement
Kafka and Mohiaddin
Am. J. Roentgenol. 2009;192:259-266.
ABSTRACT | FULL TEXT  

CHAPTER 6 Cardiovascular Computed Tomography
de Feyter et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT | FULL TEXT  

Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study.
Meijboom et al.
J Am Coll Cardiol 2008;52:2135-2144.
ABSTRACT | FULL TEXT  

Limitations of computed tomography coronary angiography.
Nissen
J Am Coll Cardiol 2008;52:2145-2147.
FULL TEXT  

Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram-triggering: first clinical experience
Herzog et al.
Eur Heart J 2008;29:3037-3042.
ABSTRACT | FULL TEXT  

Non-invasive CT coronary angiography: can high diagnostic image quality be achieved with less radiation exposure?
Schmermund et al.
Eur Heart J 2008;29:2955-2956.
FULL TEXT  

Radiation risk from coronary artery disease imaging: how do different diagnostic tests compare?
Einstein
Heart 2008;94:1519-1521.
FULL TEXT  

Diagnostic Performance of Coronary Angiography by 64-Row CT
Miller et al.
NEJM 2008;359:2324-2336.
ABSTRACT | FULL TEXT  

Screening for Colorectal Cancer: A Targeted, Updated Systematic Review for the U.S. Preventive Services Task Force
Whitlock et al.
ANN INTERN MED 2008;149:638-658.
ABSTRACT | FULL TEXT  

Quantitative Analysis of Intraventricular Dyssynchrony Using Wall Thickness by Multidetector Computed Tomography.
Truong et al.
J Am Coll Cardiol Img 2008;1:772-781.
ABSTRACT | FULL TEXT  

Noninvasive Diagnosis and Prognosis Assessment in Chronic Coronary Artery Disease: Stress Testing With and Without Imaging Perspective
Gibbons
Circ Cardiovasc Imaging 2008;1:257-269.
FULL TEXT  

Routine Diagnostic X-ray Examinations and Increased Frequency of Chromosome Translocations among U.S. Radiologic Technologists
Sigurdson et al.
Cancer Res. 2008;68:8825-8831.
ABSTRACT | FULL TEXT  

Sensitivity and Specificity of Perfusion Scintigraphy Combined with Chest Radiography for Acute Pulmonary Embolism in PIOPED II
Sostman et al.
JNM 2008;49:1741-1748.
ABSTRACT | FULL TEXT  

64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis
Mowatt et al.
Heart 2008;94:1386-1393.
ABSTRACT | FULL TEXT  

Radiation Dose Reduction and Coronary Assessability of Prospective Electrocardiogram-Gated Computed Tomography Coronary Angiography: Comparison With Retrospective Electrocardiogram-Gated Helical Scan
Maruyama et al.
J Am Coll Cardiol 2008;52:1450-1455.
ABSTRACT | FULL TEXT  

Combined coronary and late-enhanced multidetector-computed tomography for delineation of the etiology of left ventricular dysfunction: comparison with coronary angiography and contrast-enhanced cardiac magnetic resonance imaging
le Polain de Waroux et al.
Eur Heart J 2008;29:2544-2551.
ABSTRACT | FULL TEXT  

Optimal Electrocardiographic Pulsing Windows and Heart Rate: Effect on Image Quality and Radiation Exposure at Dual-Source Coronary CT Angiography
Weustink et al.
Radiology 2008;248:792-798.
ABSTRACT | FULL TEXT  

Converting Dose-Length Product to Effective Dose at CT
Huda et al.
Radiology 2008;248:995-1003.
ABSTRACT | FULL TEXT  

Cumulative patient effective dose in cardiology
BEDETTI et al.
Br. J. Radiol. 2008;81:699-705.
ABSTRACT | FULL TEXT  

Limitations of multidetector computed tomography (MDCT)
Nicol and Stirrup
BMJ 2008;337:a1402-a1402.
FULL TEXT  

Perspective: The Case Against Radioiodine Remnant Ablation in Patients with Well-Differentiated Thyroid Carcinoma
Hay et al.
JNM 2008;49:1395-1397.
ABSTRACT | FULL TEXT  

Prospective versus Retrospective ECG Gating for 64-Detector CT of the Coronary Arteries: Comparison of Image Quality and Patient Radiation Dose
Shuman et al.
Radiology 2008;248:431-437.
ABSTRACT | FULL TEXT  

Coronary Computed Tomography Angiography as a Screening Tool for the Detection of Occult Coronary Artery Disease in Asymptomatic Individuals
Choi et al.
J Am Coll Cardiol 2008;52:357-365.
ABSTRACT | FULL TEXT  

Noninvasive evaluation with multislice computed tomography in suspected acute coronary syndrome plaque morphology on multislice computed tomography versus coronary calcium score.
Henneman et al.
J Am Coll Cardiol 2008;52:216-222.
ABSTRACT | FULL TEXT  

Effective Doses in Radiology and Diagnostic Nuclear Medicine: A Catalog
Mettler et al.
Radiology 2008;248:254-263.
ABSTRACT | FULL TEXT  

SPECT/CT Imaging: Clinical Utility of an Emerging Technology1
Bybel et al.
RadioGraphics 2008;28:1097-1113.
ABSTRACT | FULL TEXT  

Screening patients with multi-detector computed axial tomography (MDCT): when will we inform patients about the risk of radiation?
Baskerville
Emerg. Med. J. 2008;25:323-324.
FULL TEXT  

Cancer risks from diagnostic radiology
HALL and BRENNER
Br. J. Radiol. 2008;81:362-378.
ABSTRACT | FULL TEXT  

Reducing Radiation Dose in Rest-Stress Cardiac PET/CT by Single Poststress Cine CT for Attenuation Correction: Quantitative Validation
Gould et al.
JNM 2008;49:738-745.
ABSTRACT | FULL TEXT  

RADIATION DOSIMETRY FOR DIAGNOSTIC MEDICAL EXPOSURES
Martin
Radiat Prot Dosimetry 2008;0:ncm495v1-24.
ABSTRACT | FULL TEXT  

Screening High-Risk Patients With Computed Tomography Angiography
Gottlieb and Lima
Circulation 2008;117:1318-1332.
FULL TEXT  

All High-Risk Patients Should Not Be Screened With Computed Tomographic Angiography
Kramer
Circulation 2008;117:1333-1339.
FULL TEXT  

Another Step Forward in CT Angiography.
Lima
J Am Coll Cardiol Img 2008;1:187-189.
FULL TEXT  

Prospectively Gated Transverse Coronary CT Angiography versus Retrospectively Gated Helical Technique: Improved Image Quality and Reduced Radiation Dose
Earls et al.
Radiology 2008;246:742-753.
ABSTRACT | FULL TEXT  

Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology
Schroeder et al.
Eur Heart J 2008;29:531-556.
ABSTRACT | FULL TEXT  

Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating
Husmann et al.
Eur Heart J 2008;29:191-197.
ABSTRACT | FULL TEXT  

Back to the future: coronary CT angiography using prospective ECG triggering
Schoenhagen
Eur Heart J 2008;29:153-154.
FULL TEXT  

Business aspects of cardiovascular computed tomography: tackling the challenges.
Bateman
J Am Coll Cardiol Img 2008;1:111-118.
ABSTRACT | FULL TEXT  

Don't Bury the V/Q Scan: It's as Good as Multidetector CT Angiograms with a Lot Less Radiation Exposure
Freeman
JNM 2008;49:5-8.
FULL TEXT