Computed tomographies and cancer risk in children: a literature overview of CT practices, risk estimations and an epidemiologic cohort study proposal

Abstract

Radiation protection is a topic of great public concern and of many scientific investigations, because ionizing radiation is an established risk factor for leukaemia and many solid tumours. Exposure of the public to ionizing radiation includes exposure to background radiation, as well as medical and occupational exposures. A large fraction of the exposure from diagnostic procedures comes from medical imaging. Computed tomography (CT) is the major single contributor of diagnostic radiation exposure. An increase in the use of CTs has been reported over the last decades in many countries. Children have smaller bodies and lower shielding capacities, factors that affect the individual organ doses due to medical imaging. Several risk models have been applied to estimate the cancer burden caused by ionizing radiation from CT. All models predict higher risks for cancer among children exposed to CT as compared to adults. However, the cancer risk associated with CT has not been assessed directly in epidemiological studies. Here, plans are described to conduct an historical cohort study to investigate the cancer incidence in paediatric patients exposed to CT before the age of 15 in Germany. Patients will be recruited from radiology departments of several hospitals. Their individual exposure will be recorded, and time-dependent cumulative organ doses will be calculated. Follow-up for cancer incidence via the German Childhood Cancer Registry will allow computation of standardized incidence ratios using population-based incidence rates for childhood cancer. Dose-response modelling and analyses for subgroups of children based on the indication for and the result of the CT will be performed.

Risk of radiation-induced malignancies from CT scanning in children who underwent shunt treatment before 6 years of age: a retrospective cohort study with a minimum 10-year follow-up

“…6,8,30 Multiple authors have then extrapolated the expected risk of future cancer from CT scanning by equating the phantom model doses to the known risk reported in the BEIR VII report. 1,3,7,9,11,12,14,18,21,22,28,34 These models predict an alarming number of future cancers. Berrington de González et al predicted 29,000 future cancers and 14,500 future deaths in the US caused by 1 year of CT scanning.…”

CT exposure in adult and paediatric patients: a review of the mechanisms of damage, relative dose and consequent possible risks

“…0.04 9 0.25 plus an additional 1 %). Due to the greater sensitivity of young subjects to radiation damage, the risk factor is 3-4 times more than in adults [27,28].…”

Experiences of Parents Caring for Infants with Rare Scalp Mass as Identified through a Disease-Specific Blog

“…These tests frequently included radiographs and CT scans, both of which have been associated with an increased risk of cancer when administered during infancy. [25][26][27][28][29][30][31][32] Parents accessing the blog shared their concern about these diagnostic procedures. Because DSFC is a benign condition, observation is the best plan, and multiple diagnostic tests are unnecessary.…”