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Comparative Study on Effective Dose and Cancer Risk in Dual-tracer Hybrid Imaging - International Commission on

Mehrnoosh Karimipourfard¹, Hojjat Mahani², Sedigheh Sina^1,3

¹Department of Ray-Medical Engineering, Shiraz University, Shiraz, Iran.

Journal of Medical Physics

|July 9, 2026

Summary

Dual-tracer hybrid imaging offers enhanced diagnostics but raises radiation concerns. This study quantifies doses and cancer risks, highlighting personalized dosimetry for improved patient safety and accurate risk assessment.

Keywords:

Cancer risk computed tomography dosimetry dual-tracer positron emission tomography single-photon emission computed tomography

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Area of Science:

Medical Imaging
Nuclear Medicine
Radiation Dosimetry

Background:

Dual-tracer hybrid imaging enables simultaneous assessment of two molecular biomarkers, improving diagnostic accuracy.
This technique raises concerns regarding increased patient radiation exposure.
Quantifying radiation doses and associated cancer risks is crucial for safe clinical implementation.

Purpose of the Study:

To investigate radiation doses and cancer risks associated with dual-tracer hybrid imaging.
To explore the utility of personalized dosimetry approaches for dual-tracer imaging.
To compare phantom-based dosimetry with patient-specific Monte Carlo simulations.

Main Methods:

Literature review to identify dual-tracer protocols and obtain dosimetric data.
Calculation of effective dose estimates using dose coefficients and reference phantom models.
Personalized dosimetry using GATE-based Monte Carlo simulations and quantification of cancer risks with the BEIR VII model.

Main Results:

Whole-body CT dose estimates showed good agreement with the MIRDct tool (max 9.2% discrepancy).
Thallium-201 (²⁰¹Tl) yielded the highest effective dose and cancer risk; Krypton-81m (^81mKr) and Nitrogen-13 (¹³N-ammonia) had the lowest.
Personalized dosimetry for dual-tracer positron emission tomography (PET) with Fluorodeoxyglucose (¹⁸F-FDG) and Gallium-68 Prostate-Specific Membrane Antigen (⁶⁸Ga-PSMA) showed minor deviations (max 5.6%) from phantom models.
Total effective dose reached up to 34 millisieverts (mSv).

Conclusions:

Harmonizing dual-tracer hybrid imaging protocols and addressing radiation dose escalation is essential.
Personalized dosimetry provides more accurate patient-specific radiation exposure estimates.
Implementing personalized dosimetry enhances safety by improving cancer risk assessment for individual patients.