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DNA double-strand breaks as potential indicators for the biological effects of ionising radiation exposure from cardiac CT and conventional coronary angiography: a randomised, controlled study

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Abstract

Objectives

To prospectively compare induced DNA double-strand breaks by cardiac computed tomography (CT) and conventional coronary angiography (CCA).

Methods

56 patients with suspected coronary artery disease were randomised to undergo either CCA or cardiac CT. DNA double-strand breaks were assessed in fluorescence microscopy of blood lymphocytes as indicators of the biological effects of radiation exposure. Radiation doses were estimated using dose–length product (DLP) and dose–area product (DAP) with conversion factors for CT and CCA, respectively.

Results

On average there were 0.12 ± 0.06 induced double-strand breaks per lymphocyte for CT and 0.29 ± 0.18 for diagnostic CCA (P < 0.001). This relative biological effect of ionising radiation from CCA was 1.9 times higher (P < 0.001) than the effective dose estimated by conversion factors would have suggested. The correlation between the biological effects and the estimated radiation doses was excellent for CT (r = 0.951, P < 0.001) and moderate to good for CCA (r = 0.862, P < 0.001). One day after radiation, a complete repair of double-strand breaks to background levels was found in both groups.

Conclusions

Conversion factors may underestimate the relative biological effects of ionising radiation from CCA. DNA double-strand break assessment may provide a strategy for individualised assessments of radiation.

Key Points

• Radiation dose causes concern for both conventional coronary angiography and cardiac CT.

• Estimations of the biological effects of ionising radiation may become feasible.

• Fewer DNA double-strand breaks are induced by cardiac CT than CCA.

• Conversion factors may underestimate the relative effects of ionising radiation from CCA.

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Abbreviations

CCA:

conventional coronary angiography

DAP:

dose–area product

DLP:

dose–length product

DNA:

deoxyribonucleic acid

DSB:

DNA double-strand break

FCS:

fetal calf serum

PBS:

phosphate buffered saline

RPMI:

Roswell Park Memorial Institute

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Acknowledgements

Conflict of interest

Dr. Dewey:

Significant: Research Grants: European Regional Development Fund, German Heart Foundation/German Foundation of Heart Research, Joint program from the German Science Foundation (DFG) and the German Federal Ministry and Education of Research (BMBF) for meta-analyses, GE Healthcare (Amersham), Bracco, Guerbet, and Toshiba Medical Systems.

Modest: Speakers Bureau: Toshiba Medical Systems, Guerbet, Cardiac MR Academy Berlin, and Bayer-Schering. Consultant: Guerbet.

Other: Cardiac CT Courses in Berlin: www.ct-kurs.de

Book Author: "Coronary CT Angiography", Springer, 2009, "Cardiac CT", Springer 2011.

Institutional master research agreements with Siemens Medical Solutions, Philips Medical Systems, and Toshiba Medical Systems. The terms of these agreements are managed by the legal department of Charité - Universitätsmedizin Berlin.

Dr. Hamm:

Research grants: GE Healthcare, Schering, Siemens Medical Solutions, and Toshiba Medical Systems.Speakers Bureau: Siemens Medical Solutions Schering.

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Authors and Affiliations

  1. Department of Cardiology, Charité Medical School, Berlin, Germany

    Michael Laule & Fabian Knebel

  2. Department of Radiology, Charité Medical School, Berlin, Germany

    Dominik Geisel, Elke Zimmermann, Matthias Rief, Johannes Greupner, Bernd Hamm & Marc Dewey

  3. Charité, Institut für Radiologie, Charitéplatz 1, 10117, Berlin, Germany

    Marc Dewey

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  1. Dominik Geisel
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Correspondence to Marc Dewey.

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Geisel, D., Zimmermann, E., Rief, M. et al. DNA double-strand breaks as potential indicators for the biological effects of ionising radiation exposure from cardiac CT and conventional coronary angiography: a randomised, controlled study. Eur Radiol 22, 1641–1650 (2012). https://doi.org/10.1007/s00330-012-2426-1

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