Estimation of potential excess cancer incidence in pediatric ²⁰¹Tl imaging

OBJECTIVE. Little information is available regarding doses of ionizing radiation from medical imaging in the growing population of children undergoing therapy for cancer who are at risk of developing second cancers. The purpose of our study was to estimate the potential excess lifetime cancer incidence and mortality associated with thallium bone imging in pediatric patients. MATERIALS AND METHODS. We retrospectively reviewed the medical records of pediatric patients treated between August 1991 and December 2003 for newly diagnosed osteosarcoma who underwent ²⁰¹Tl imaging as part of the treatment protocol. According to age at diagnosis and doses of ²⁰¹Tl, we estimated the excess cancer incidence and cancer mortality for boys and girls at 5 and 15 years old. RESULTS. The study cohort consisted of 73 patients, 32 males (median age at diagnosis, 14.8 years; age range, 8.1-20.1 years) and 41 females (median age at diagnosis, 13.3 years; age range, 6.0-20.7 years). Patients underwent a total of three ²⁰¹Tl studies with a median dose of 4.4 mCi (162.8 MBq) (range, 2.2-8.4 mCi [81.4-310.8 MBq]) per study. Total median cumulative patient radiation dose for ²⁰¹Tl studies was 18.6 rem (186 mSv) (range, 8.4-44.2 rem [84-442 mSv]) for males and 21.5 rem (215 mSv) (range, 7.0-43.8 rem [70-438 mSv]) for females. Estimated excess cancer incidence was 6.0 per 100 (male) and 13.0 per 100 (female) if exposed by 5 years of age; 2.0 per 100 (male) and 3.1 per 100 (female) by 15 years of age. Estimated excess cancer mortality was 3.0 per 100 for males and 5.2 per 100 for females at 5 years of age; 1.0 per 100 (male) and 1.4 per 100 (female) exposed at 15 years of age. CONCLUSION. Further reduction of doses in younger patients is needed to consider ²⁰¹Tl a viable option for imaging osteosarcoma.