Estimate of the secondary cancer risk from megavoltage CT in tomotherapy

We have assessed the radiation-induced excess cancer risk to organs from megavoltage computed tomography (MVCT). MVCT was performed in coarse, normal and fine scanning modes. Using a glass dosimeter, we measured the primary and the secondary doses inside a homemade phantom and at various distances from the imaging center. The organ-specific excess absolute risk (EAR) for cancer induction was estimated using an organ-equivalent dose (OED) based on the measured imaging doses. The average primary doses inside the phantom for the coarse, normal and fine scanning modes were 0.78, 1.15 and 2.15 cGy, respectively. The average secondary dose per scan, measured 20 to 60 cm from the imaging center, ranged from 0.044 to 0.008 cGy. The EAR for major organs indicated that when 30 MVCT scans are performed to position each patient during the course of radiation treatment, organ-specific cancers may develop in as many as 6 per 10,000 persons per year.