Imaging in Early-Stage Hodgkin's Lymphoma

To the Editor: Data on exposure to low-dose ionizing radiation from medical imaging procedures indicate that medical imaging can potentially harm patients if the cumulative radiation dose becomes excessive. 1This concern, in conjunction with the present environment of high medical costs, makes it important to identify practices in which it is prudent to eliminate medical imaging that is neither cost-effective nor beneficial.There is a good case for eliminating unnecessary imaging in patients with nonbulky early-stage Hodgkin's lymphoma.Not only is the recurrence rate 10% or less with the best standard of care, but also approximately 80% of these recurrences are first identified by the patient or the examining physician without the use of imaging. 2-4This means that the addition of serial post-therapy imaging provides "earlier" disease detection in only about 2% of treated patients, with no proven benefit. 5Yet these patients, who are usually young, generally undergo 5 to 10 episodes of surveillance computed tomography (CT) of the chest, abdomen, or pelvis, often in addition to several episodes of positron-emission tomography (PET)-CT, within the initial 3 to 5 years of their treatment, resulting in an effective cumulative dose of over 50 mSv.Physicians should therefore question the use of imaging studies in these patients beyond those performed for assessment of a response or for clear-cut cases in which management decisions must be guided by imaging.At the most, yearly chest radiography, which is associated with a considerably lower radiation dose than CT or PET-CT, should be performed in patients with previous mediastinal disease.Any imaging beyond that is not only unjustified but also potentially harmful.