Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease

Abstract

BackgroundThe seventh Committee on "Biological Effects of Ionizing Radiation" (BEIR VII, 2006) underlines "the need of studies of infants who are exposed to diagnostic radiation because catheters have been placed in their hearts". Objective To determine the lifetime attributable risk (LAR) of cancer associated with the estimated cumulative radiological dose in 59 children (42 male, age 2.863.2 years) with complex congenital heart disease, and to assess chromosomal DNA damage after cardiac catheterisation procedures. Methods In all patients, the cumulative exposure was estimated as effective dose in milliSievert (mSv), and LAR cancer was determined from the BEIR VII report. In a subset of 18 patients (13 male, age 5.265.7 years) micronucleus as a biomarker of DNA damage and longterm risk predictor of cancer was assayed before and 2 h after catheterisation procedures. Doseearea product (Gy cm 2 ) was assessed as a measure of patient dose. Results The median life time cumulative effective dose was 7.7 mSv per patient (range 4.6e41.2). Cardiac catheterisation procedures and CT were responsible for 95% of the total effective dose. For a 1-year-old child, the LAR cancer was 1 in 382 (25th to 75th centiles: 1 in 531 to 1 in 187) and 1 in 156 (25th to 75th centiles: 1 in 239 to 1 in 83) for male and female patients, respectively. Median micronucleus values increased significantly after the procedure in comparison with baseline (before 6& vs after 9&, p¼0.02). The median doseearea product value was 20 Gy cm 2 (range 1e277). Conclusion Children with congenital heart disease are exposed to a significant cumulative dose. Indirect cancer risk estimations and direct DNA data both emphasise the need for strict radiation dose optimisation in children.

Lung ultrasound characteristics of community‐acquired pneumonia in hospitalized children

“…22 Children are at least four times more sensitive than adults to the induction of cancer, as they have more rapidly dividing cells than adults and have longer life expectancy. [23][24][25] Unfortunately, pediatricians are often unaware of these risks. 26 The long-term risk associated with radiation exposure should be considered in the risk-benefit assessment behind appropriate prescription of diagnostic testing.…”

Suivi d’enfants exposés aux rayonnements ionisants dans le cadre de procédures radiologiques à visée diagnostique

“…Selon Ait-Ali (Ait-Ali et al, 2010) les procédures les plus irradiantes sont les procédures de cardiologie interventionnelle à visée diagnostique et/ou thérapeu-tique et les scanners. La dose de radiation délivrée lors d'un examen scanner est en moyenne 10 à 100 fois plus élevée que celle délivrée lors d'un examen radiologique conventionnel.…”

Almanac 2012: Congenital heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology

“…Data from Italy raised a concern that children with congenital heart disease are exposed to a significant cumulative dose of radiation. 56 Indirect cancer risk estimations and direct DNA studies showed that children with congenital heart disease are exposed to a significant radiation dose and emphasised the need for strict radiation dose optimisation in children. The accompanying editorial from Hoffmann and Bremerich expanded on the risks.…”