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Projected lifetime cancer risk from cone-beam computed tomography for orthodontic treatment

  • Jha, Nayansi (Department of Dentistry, University of Ulsan College of Medicine) ;
  • Kim, Yoon-Ji (Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Youngjun ;
  • Lee, Ju Young ;
  • Lee, Won Jin (Department of Preventive Medicine, Korea University College of Medicine) ;
  • Sung, Sang-Jin (Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2020.08.18
  • Accepted : 2020.12.09
  • Published : 2021.05.25

Abstract

Objective: To estimate the projected cancer risk attributable to diagnostic cone-beam computed tomography (CBCT) performed under different exposure settings for orthodontic purposes in children and adults. Methods: We collected a list of CBCT machines and their specifications from 38 orthodontists. Organ doses were estimated using median and maximum exposure settings of 105 kVp/156.8 mAs and 130 kVp/200 mAs, respectively. The projected cancer risk attributable to CBCT procedures performed 1-3 times within 2 years was calculated for children (aged 5 and 10 years) and adult (aged 20, 30, and 40 years) male and female patients. Results: For maximum exposure settings, the mean lifetime fractional ratio (LFR) was 14.28% for children and 0.91% for adults; this indicated that the risk to children was 16 times the risk to adults. For median exposure settings, the mean LFR was 5.25% and 0.58% for children and adults, respectively. The risk of cancer decreased with increasing age. For both median and maximum exposure settings, females showed a higher risk of cancer than did males in all age groups. Cancer risk increased with an increase in the frequency of CBCT procedures within a given period. Conclusions: The projected dental CBCT-associated cancer risk spans over a wide range depending on the machine parameters and image acquisition settings. Children and female patients are at a higher risk of developing cancer associated with diagnostic CBCT. Therefore, the use of diagnostic CBCT should be justified, and protective measures should be taken to minimize the harmful biological effects of radiation.

Keywords

Acknowledgement

We would like to thank the members of the Korean Society of Digital Orthodontists for their support with the questionnaires for this study.

References

  1. Adams GL, Gansky SA, Miller AJ, Harrell WE Jr, Hatcher DC. Comparison between traditional 2-dimensional cephalometry and a 3-dimensional approach on human dry skulls. Am J Orthod Dentofacial Orthop 2004;126:397-409. https://doi.org/10.1016/j.ajodo.2004.03.023
  2. Tronje G, Welander U, McDavid WD, Morris CR. Image distortion in rotational panoramic radiography. I. General considerations. Acta Radiol Diagn (Stockh) 1981;22(3A):295-9. https://doi.org/10.1177/028418518102203A14
  3. Loubele M, Bogaerts R, Van Dijck E, Pauwels R, Vanheusden S, Suetens P, et al. Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications. Eur J Radiol 2009;71:461-8. https://doi.org/10.1016/j.ejrad.2008.06.002
  4. Suomalainen A, Vehmas T, Kortesniemi M, Robinson S, Peltola J. Accuracy of linear measurements using dental cone beam and conventional multislice computed tomography. Dentomaxillofac Radiol 2008;37:10-7. https://doi.org/10.1259/dmfr/14140281
  5. Kapila SD, Nervina JM. CBCT in orthodontics: assessment of treatment outcomes and indications for its use. Dentomaxillofac Radiol 2015;44:20140282. https://doi.org/10.1259/dmfr.20140282
  6. Wrzesien M, Olszewski J. Absorbed doses for patients undergoing panoramic radiography, cephalometric radiography and CBCT. Int J Occup Med Environ Health 2017;30:705-13.
  7. Ludlow JB, Timothy R, Walker C, Hunter R, Benavides E, Samuelson DB, et al. Effective dose of dental CBCT-a meta analysis of published data and additional data for nine CBCT units. Dentomaxillofac Radiol 2015;44:20140197. https://doi.org/10.1259/dmfr.20140197
  8. Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:106-14. https://doi.org/10.1016/j.tripleo.2008.03.018
  9. Sezgin OS, Kayipmaz S, Yasar D, Yilmaz AB, Ozturk MH. Comparative dosimetry of dental cone beam computed tomography, panoramic radiography, and multislice computed tomography. Oral Radiol 2012;28:32-7. https://doi.org/10.1007/s11282-011-0078-5
  10. United Nations. UNSCEAR 2013 Report to the general assembly, with scientific annexes. Effect of ionizing radiations. New York: United Nations Publications; 2013.
  11. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012;380:499-505. https://doi.org/10.1016/S0140-6736(12)60815-0
  12. Hong JY, Han K, Jung JH, Kim JS. Association of exposure to diagnostic low-dose ionizing radiation with risk of cancer among youths in South Korea. JAMA Netw Open 2019;2:e1910584. https://doi.org/10.1001/jamanetworkopen.2019.10584
  13. Kim HJ, Lee JY, Lee HK, Kim KP. Public health weekly report. Computer programs (ALARA) for calculation of diagnostic radiation dose. Cheongju: Korea Disease Control and Prevention Agency; 2020. p. 1023-6.
  14. Lee C, Kim KP, Long DJ, Bolch WE. Organ doses for reference pediatric and adolescent patients undergoing computed tomography estimated by Monte Carlo simulation. Med Phys 2012;39:2129-46. https://doi.org/10.1118/1.3693052
  15. Servomaa A, Tapiovaara M. Organ dose calculation in medical X-ray examinations by the program PCXMC. Radiat Protect Dosim 1998;80:213-9. https://doi.org/10.1093/oxfordjournals.rpd.a032509
  16. Solberg TD, DeMarco JJ, Chetty IJ, Mesa AV, Cagnon CH, Li AN, et al. A review of radiation dosimetry applications using the MCNP Monte Carlo code. Radiochim Acta 2001;89:337-55. https://doi.org/10.1524/ract.2001.89.4-5.337
  17. Long DJ, Lee C, Tien C, Fisher R, Hoerner MR, Hintenlang D, et al. Monte Carlo simulations of adult and pediatric computed tomography exams: validation studies of organ doses with physical phantoms. Med Phys 2013;40:013901. https://doi.org/10.1118/1.4771934
  18. Berrington de Gonzalez A, Iulian Apostoaei A, Veiga LH, Rajaraman P, Thomas BA, Owen Hoffman F, et al. RadRAT: a radiation risk assessment tool for lifetime cancer risk projection. J Radiol Prot 2012;32:205-22. https://doi.org/10.1088/0952-4746/32/3/205
  19. National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Washington, D.C.: National Academies Press; 2006.
  20. Kellerer AM, Nekolla EA, Walsh L. On the conversion of solid cancer excess relative risk into lifetime attributable risk. Radiat Environ Biophys 2001;40:249-57. https://doi.org/10.1007/s004110100106
  21. Journy NM, Lee C, Harbron RW, McHugh K, Pearce MS, Berrington de Gonzalez A. Projected cancer risks potentially related to past, current, and future practices in paediatric CT in the United Kingdom, 1990-2020. Br J Cancer 2017;116:109-16. https://doi.org/10.1038/bjc.2016.351
  22. Lee WJ, Choi Y, Ko S, Cha ES, Kim J, Kim YM, et al. Projected lifetime cancer risks from occupational radiation exposure among diagnostic medical radiation workers in South Korea. BMC Cancer 2018;18:1206. https://doi.org/10.1186/s12885-018-5107-x
  23. Walsh L, Zhang W, Shore RE, Auvinen A, Laurier D, Wakeford R, et al. A framework for estimating radiation-related cancer risks in Japan from the 2011 Fukushima nuclear accident. Radiat Res 2014;182:556-72. https://doi.org/10.1667/RR13779.1
  24. Douple EB, Mabuchi K, Cullings HM, Preston DL, Kodama K, Shimizu Y, et al. Long-term radiation-related health effects in a unique human population: lessons learned from the atomic bomb survivors of Hiroshima and Nagasaki. Disaster Med Public Health Prep 2011;5 Suppl 1:S122-33. https://doi.org/10.1001/dmp.2011.21
  25. Pauwels R, Cockmartin L, Ivanauskaite D, Urboniene A, Gavala S, Donta C, et al. Estimating cancer risk from dental cone-beam CT exposures based on skin dosimetry. Phys Med Biol 2014;59:3877-91. https://doi.org/10.1088/0031-9155/59/14/3877
  26. Yeh JK, Chen CH. Estimated radiation risk of cancer from dental cone-beam computed tomography imaging in orthodontics patients. BMC Oral Health 2018;18:131. https://doi.org/10.1186/s12903-018-0592-5
  27. Stratis A, Zhang G, Jacobs R, Bogaerts R, Bosmans H. The growing concern of radiation dose in paediatric dental and maxillofacial CBCT: an easy guide for daily practice. Eur Radiol 2019;29:7009-18. https://doi.org/10.1007/s00330-019-06287-5
  28. Wu TH, Lin WC, Chen WK, Chang YC, Hwang JJ. Predicting cancer risks from dental computed tomography. J Dent Res 2015;94:27-35. https://doi.org/10.1177/0022034514554226
  29. Peterson E, De P, Nuttall R. BMI, diet and female reproductive factors as risks for thyroid cancer: a systematic review. PLoS One 2012;7:e29177. https://doi.org/10.1371/journal.pone.0029177
  30. Shore RE, Beck HL, Boice JD, Caffrey EA, Davis S, Grogan HA, et al. Implications of recent epidemiologic studies for the linear nonthreshold model and radiation protection. J Radiol Prot 2018;38:1217-33. https://doi.org/10.1088/0952-4746/38/3/1217