{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T15:11:40Z","timestamp":1767625900535,"version":"3.40.5"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T00:00:00Z","timestamp":1649635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>We estimate the lifetime attributable risk (LAR) of lung cancer incidence in symptomatic Coronary Artery Disease (CAD) patients receiving enhanced Coronary Computed Tomography Angiography (CCTA) and the unenhanced Computed Tomography Calcium Scoring (CTCS) examination. Retrospective analysis has been made of CCTA and CTCS data collected for 87 confirmed CAD adult patients. Patient effective dose (E) and organ doses (ODs) were calculated using CT-EXPO. Statistical correlation and the differences between E and ODs in enhanced CCTA and unenhanced CTCS were calculated using the Pearson coefficient and Wilcoxon unpaired t-test. Following BEIR VII report guidance, organ-specific LARs for the cohort were estimated using the organ-equivalent dose-to-risk conversion factor for numbers of cases per 100,000 patients exposed to low doses of 0.1 Gy. Significant statistical difference (p&lt;0.0001) is found between E obtained for CTCS and that of CCTA. The scan length was found to be greater in CCTA (17.5 \u00b1 2.9 cm) compared to that for CTCS (15 \u00b1 2 cm). More elevated values of dose were noted for the esophagus (4.2 \u00b1 2.15 mSv) and thymus (9.6 \u00b1 2.54 mSv) for both CTCS and CCTA. CTCS organ doses were lower than that of CCTA. Per 100,000 patients, female cumulative doses are seen to give rise to greater lung cancer LARs compared to that for males, albeit with risk varying significantly, noticeably greater for females, younger patients and combined CCTA and CTCS scans. While scan parameters and tube-modulation methods clearly contribute to patient dose, mAs offers by far the greater contribution.<\/jats:p>","DOI":"10.1371\/journal.pone.0265609","type":"journal-article","created":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T17:30:24Z","timestamp":1649698224000},"page":"e0265609","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Gender based lung cancer risks for symptomatic coronary artery disease patients undergone cardiac CT"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4485-4775","authenticated-orcid":true,"given":"Entesar Zawam","family":"Dalah","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulmunhem","family":"Obaideen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabaa","family":"Anam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid","family":"Alzimami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Layal Khalid","family":"Jambi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Bradley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,4,11]]},"reference":[{"key":"pone.0265609.ref001","doi-asserted-by":"crossref","first-page":"108535","DOI":"10.1016\/j.radphyschem.2019.108535","article-title":"Estimation of equivalent organ and effective doses to patients undergoing coronary angiography and percutaneous coronary intervention procedures using Monte Carlo simulation","volume":"168","author":"J Ngaile","year":"2020","journal-title":"Radiation Physics and Chemistry"},{"issue":"5","key":"pone.0265609.ref002","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1001\/jama.2009.54","article-title":"Estimated Radiation Dose Associated With Cardiac CT Angiography","volume":"301","author":"J. Hausleiter","year":"2009","journal-title":"JAMA"},{"issue":"1","key":"pone.0265609.ref003","article-title":"The proper use of coronary calcium score and coronary computed tomography angiography for screening asymptomatic patients with cardiovascular risk factors","volume":"7","author":"S Tay","year":"2017","journal-title":"Scientific Reports"},{"issue":"5","key":"pone.0265609.ref004","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1161\/01.CIR.94.5.1175","article-title":"Coronary Artery Calcification: Pathophysiology, Epidemiology, Imaging Methods, and Clinical Implications","volume":"94","author":"L Wexler","year":"1996","journal-title":"Circulation"},{"key":"pone.0265609.ref005","first-page":"1","article-title":"Correlation between multi-detector CT findings and angiography reported stenosis in symptomatic coronary artery disease patients: Pilot study","author":"E. Z. Dalah","year":"2018","journal-title":"2018 Advances in Science and Engineering Technology International Conferences (ASET)"},{"issue":"13","key":"pone.0265609.ref006","doi-asserted-by":"crossref","first-page":"3675","DOI":"10.1088\/0031-9155\/55\/13\/007","article-title":"Computing effective dose in cardiac CT","volume":"55","author":"W Huda","year":"2010","journal-title":"Physics in Medicine and Biology"},{"issue":"12","key":"pone.0265609.ref007","doi-asserted-by":"crossref","first-page":"465","DOI":"10.4330\/wjc.v5.i12.465","article-title":"Coronary CT angiography: Dose reduction strategies","volume":"5","author":"A Sabarudin","year":"2013","journal-title":"World Journal of Cardiology"},{"issue":"4","key":"pone.0265609.ref008","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1017\/S1460396906000343","article-title":"Radiobiology for the Radiologist: 6th edition, Eric J. Hall, Amato J. Giaccia, Lippincott Williams and Wilkins Publishing; ISBN 0-7817-4151-3; 656 pages; 2006; Hardback; \u00a353","volume":"5","author":"A. Fleet","year":"2006","journal-title":"Journal of Radiotherapy in Practice"},{"key":"pone.0265609.ref009","doi-asserted-by":"crossref","first-page":"108932","DOI":"10.1016\/j.ejrad.2020.108932","article-title":"Radiation dose and risk of exposure-induced death associated with common computed tomography procedures in Yazd Province","volume":"126","author":"H Masjedi","year":"2020","journal-title":"European Journal of Radiology"},{"issue":"22","key":"pone.0265609.ref010","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1056\/NEJMra072149","article-title":"Computed Tomography\u2014An Increasing Source of Radiation Exposure","volume":"357","author":"D Brenner","year":"2007","journal-title":"New England Journal of Medicine"},{"issue":"16","key":"pone.0265609.ref011","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1161\/CIRCULATIONAHA.106.178458","article-title":"Assessment of Coronary Artery Disease by Cardiac Computed Tomography","volume":"114","author":"M Budoff","year":"2006","journal-title":"Circulation"},{"volume-title":"Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2","year":"2006","author":"BEIR VII Council NR","key":"pone.0265609.ref012"},{"issue":"3","key":"pone.0265609.ref013","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1001\/jama.298.3.317","article-title":"Estimating Risk of Cancer Associated With Radiation Exposure From 64-Slice Computed Tomography Coronary Angiography","volume":"298","author":"A Einstein","year":"2007","journal-title":"JAMA"},{"issue":"4","key":"pone.0265609.ref014","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1097\/01.HP.0000324200.73903.5b","article-title":"ICRP Publication 103, The Recommendations of the International Commission on Radiological Protection","volume":"95","author":"R. Vetter","year":"2008","journal-title":"Health Physics"},{"issue":"1","key":"pone.0265609.ref015","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1148\/rg.281075024","article-title":"CT Dosimetry: Comparison of Measurement Techniques and Devices","volume":"28","author":"J Bauhs","year":"2008","journal-title":"RadioGraphics"},{"issue":"4","key":"pone.0265609.ref016","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/RTI.0b013e3181eebc49","article-title":"Dose Reduction Strategies for Thoracic Multidetector Computed Tomography","volume":"25","author":"A Bankier","year":"2010","journal-title":"Journal of Thoracic Imaging"},{"issue":"4","key":"pone.0265609.ref017","doi-asserted-by":"crossref","first-page":"881","DOI":"10.2214\/AJR.09.3462","article-title":"Estimating Effective Dose for CT Using Dose\u2013Length Product Compared With Using Organ Doses: Consequences of Adopting International Commission on Radiological Protection Publication 103 or Dual-Energy Scanning","volume":"194","author":"J Christner","year":"2010","journal-title":"American Journal of Roentgenology"},{"key":"pone.0265609.ref018","first-page":"81","article-title":"Effective Dose and Size Specific Dose Estimation with and without Tube Current Modulation for Thoracic Computed Tomography Examinations: A Phantom Study","volume":"11","author":"S. Gharbi","year":"2017","journal-title":"World Academy of Science, Engineering and Technology, International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering"},{"issue":"23","key":"pone.0265609.ref019","doi-asserted-by":"crossref","first-page":"2394","DOI":"10.1161\/CIRCULATIONAHA.109.935346","article-title":"Individualized Assessment of Radiation Dose in Patients Undergoing Coronary Computed Tomographic Angiography With 256-","volume":"122","author":"K Perisinakis","year":"2010","journal-title":"Slice Scanning. Circulation"},{"year":"2021","key":"pone.0265609.ref020","article-title":"AAPM Reports\u2014Size-Specific Dose Estimates (SSDE) in Pediatric and Adult Body CT Examinations [Internet]"},{"key":"pone.0265609.ref021","doi-asserted-by":"crossref","DOI":"10.1109\/ICASET.2019.8714246","article-title":"University Hospital in Sharjah Diagnostic Reference Levels for Multi-detector CT Examinations","author":"E Dalah","year":"2019","journal-title":"2019 Advances in Science and Engineering Technology International Conferences (ASET)"},{"issue":"12","key":"pone.0265609.ref022","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1055\/s-2002-35937","article-title":"CT-Expo\u2014a novel program for dose evaluation in CT","volume":"174","author":"G Stamm","year":"2002","journal-title":"R\u00f6Fo\u2014Fortschritte auf dem Gebiet der R\u00f6ntgenstrahlen und der bildgebenden Verfahren"},{"issue":"S 01","key":"pone.0265609.ref023","article-title":"a tool for dose evaluation in computed tomography","volume":"186","author":"A Schegerer","year":"2014","journal-title":"R\u00f6Fo\u2014Fortschritte auf dem Gebiet der R\u00f6ntgenstrahlen und der bildgebenden Verfahren"},{"issue":"2\u20134","key":"pone.0265609.ref024","article-title":"The 2007 recommendations of the international commission on radiological protection","volume":"37","author":"ICRP","year":"2007","journal-title":"ICRP Publication 103. Ann. ICRP"},{"issue":"1\u20133","key":"pone.0265609.ref025","first-page":"1","article-title":"Recommendations of the International Commission on Radiological Protection ICRP Publication 60","volume":"21","author":"ICRP, 1990","year":"1991","journal-title":"Ann ICRP"},{"issue":"S2","key":"pone.0265609.ref026","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s10554-009-9439-0","article-title":"Low-dose prospectively gated 256-slice coronary computed tomographic angiography","volume":"25","author":"W Weigold","year":"2009","journal-title":"The International Journal of Cardiovascular Imaging"},{"issue":"17","key":"pone.0265609.ref027","doi-asserted-by":"crossref","first-page":"5209","DOI":"10.1088\/0031-9155\/54\/17\/009","article-title":"Reduction of the estimated radiation dose and associated patient risk with prospective ECG-gated 256-slice CT coronary angiography","volume":"54","author":"E Efstathopoulos","year":"2009","journal-title":"Physics in Medicine and Biology"},{"issue":"2","key":"pone.0265609.ref028","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1148\/radiol.2482072192","article-title":"Prospective versus Retrospective ECG Gating for 64-Detector CT of the Coronary Arteries: Comparison of Image Quality and Patient Radiation Dose","volume":"248","author":"W Shuman","year":"2008","journal-title":"Radiology"},{"issue":"2\u20134","key":"pone.0265609.ref029","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1093\/rpd\/ncq279","article-title":"Patient doses in CT examinations in Switzerland: implementation of national diagnostic reference levels","volume":"142","author":"R Treier","year":"2010","journal-title":"Radiation Protection Dosimetry"},{"issue":"3","key":"pone.0265609.ref030","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.ejmp.2011.06.002","article-title":"Impact of miscentering on patient dose and image noise in x-ray CT imaging: Phantom and clinical studies","volume":"28","author":"M Habibzadeh","year":"2012","journal-title":"Physica Medica"},{"issue":"3","key":"pone.0265609.ref031","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1148\/radiol.14132328","article-title":"How I Do It: Managing Radiation Dose in CT","volume":"273","author":"W Mayo-Smith","year":"2014","journal-title":"Radiology"},{"issue":"5","key":"pone.0265609.ref032","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1007\/s00330-001-1278-x","article-title":"Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation","volume":"12","author":"T Jakobs","year":"2002","journal-title":"European Radiology"},{"issue":"9","key":"pone.0265609.ref033","doi-asserted-by":"crossref","first-page":"759","DOI":"10.5152\/akd.2014.5720","article-title":"Comparison of image quality and radiation dose between prospectively ECG-triggered and retrospectively ECG-gated CT angiography: Establishing heart rate cut-off values in first-generation dual-source CT","volume":"15","author":"E Unal","year":"2015","journal-title":"The Anatolian Journal of Cardiology"},{"issue":"8","key":"pone.0265609.ref034","doi-asserted-by":"crossref","first-page":"4249","DOI":"10.1118\/1.3460797","article-title":"A method to evaluate the dose increase in CT with iodinated contrast medium","volume":"37","author":"E Amato","year":"2010","journal-title":"Medical Physics"},{"issue":"2","key":"pone.0265609.ref035","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1051\/radiopro\/2016087","article-title":"Estimating risk of exposure induced cancer death in patients undergoing computed tomography pulmonary angiography","volume":"52","author":"H Karimizarchi","year":"2017","journal-title":"Radioprotection"},{"issue":"5","key":"pone.0265609.ref036","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.2214\/AJR.19.21749","article-title":"Organ Doses, Effective Dose, and Cancer Risk From Coronary CT Angiography Examinations","volume":"214","author":"M Mahmoodi","year":"2020","journal-title":"American Journal of Roentgenology"},{"issue":"1","key":"pone.0265609.ref037","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1667\/RR2083.1","article-title":"Radiation and Smoking Effects on Lung Cancer Incidence among Atomic Bomb Survivors","volume":"174","author":"K Furukawa","year":"2010","journal-title":"Radiation Research"},{"issue":"3","key":"pone.0265609.ref038","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1667\/RR2819.1","article-title":"Radiation and Smoking Effects on Lung Cancer Incidence by Histological Types Among Atomic Bomb Survivors","volume":"178","author":"H Egawa","year":"2012","journal-title":"Radiation Research"},{"issue":"5","key":"pone.0265609.ref039","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1667\/RR14583.1","article-title":"Lung, Laryngeal and Other Respiratory Cancer Incidence among Japanese Atomic Bomb Survivors: An Updated Analysis from 1958 through 2009","volume":"187","author":"E Cahoon","year":"2017","journal-title":"Radiation Research"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0265609","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T17:31:12Z","timestamp":1649698272000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0265609"}},"subtitle":[],"editor":[{"given":"Chim C.","family":"Lang","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,4,11]]},"references-count":39,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0265609","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2022,4,11]]}}}