Medical conditions associated with the use of CT in children and young adults, Great Britain, 1995–2008

Abstract

Objective: To describe the medical conditions associated with the use of CT in children or young adults with no previous cancer diagnosis. Methods: Radiologist reports for scans performed in 1995-2008 in non-cancer patients less than 22 years of age were collected from the radiology information system in 44 hospitals of Great Britain. By semantic search, an automated procedure identified 185 medical conditions within the radiologist reports. Manual validation of a subsample by a paediatric radiologist showed a satisfactory performance of the automatic coding procedure. Results: Medical information was extracted for 37,807 scans; 19.5% scans were performed in children less than 5 years old; 52.0% scans were performed in 2000 or after. Trauma, diseases of the nervous (mainly hydrocephalus) or the circulatory system were each mentioned in 25-30% of scans. Hydrocephalus was mentioned in 19% of all scans, 59% of scans repeated $5 times in a year, and was the most frequent condition in children less than 5 years of age. Congenital diseases/malformations, disorders of the musculoskeletal system/connective tissues and infectious or respiratory diseases were each mentioned in 5-10% of scans. Suspicionor diagnosis of benign or malignant tumour was identified in 5% of scans. Conclusion: This study describes the medical conditions that likely underlie the use of CT in children in Great Britain. It shows that patients with hydrocephalus may receive high cumulative radiation exposures from CT in early life, i.e. at ages when they are most sensitive to radiation. Advances in knowledge: The majority of scans were unrelated to cancer suspicion. Repeated scans over time were mainly associated with the management of hydrocephalus. INTRODUCTIONThe benefits of CT, in the diagnosis and follow-up of numerous conditions, are undeniable. The justification for CT scanning must be balanced against the potential harmful effects of radiation exposures, particularly in children, who appear to be at a greater risk of radiation-related cancer than adults.1,2 Increased cancer risks in relation to CT exposures at young ages have been reported in several populations. The UK CT cohort study showed a significant dose-response relationship between radiation doses from scans received before the age of 22 years and the risk of cerebral tumours and leukaemia/myelodysplastic syndromes.3 After a first scan before the age of 10 years, 1 excess case of leukaemia and 1 excess case of cerebral tumour per 10,000 head scans were estimated to occur in the subsequent 10 years. Other cohort studies have found comparable results. 4-7The interpretation of these results nevertheless requires an understanding of whether the excess risks of later malignancies observed after CT scans were due to the radiation exposure or to the underlying medical condition. 8,9 It is indeed possible that the increased incidence rates observed after receipt of CT scans were, at least in part, attributable to the indication for CT use, whether it was the first symptoms of a tumour, a fol...

The Importance of Neurological Examination For Computerized Brain Tomography Indication In Pediatric Emergency Room

“…[12] Gereksiz BT çekimi maliyet artışı, iş gücü kaybı yanı sıra özellikle çocuklarda daha ciddi olan iyonizan radyasyona bağlı kanser gelişme riskini arttırmaktadır. [6,13] Çocuklarda hızlı ve artmış hücre bölünmesi yanında doku ve organ gelişimleri devam etmekte olup, radyasyonun indüklediği kanser gelişimi için önlerinde daha uzun bir hayat vardır. [14,15] Bugüne kadar yapılan çalışmalarda BT kaynaklı radyasyona maruz kalma ile lösemi, beyin tümörleri, tiroid kanserleri, katarakt cilt kanserlerinin görülme riskinin arttığı bildirilmiştir.…”

Exposure to Medical Radiation during Fetal Life, Childhood and Adolescence and Risk of Brain Tumor in Young Age: Results from The MOBI-Kids Case-Control Study

“…2). We also adjusted for the presence of any genetic/congenital disease because these may be associated with brain cancer or with exposure to CT-scans [22,24]. After adjustment, there was a slight decrease in point estimates in all categories, suggesting possible confounding; however, the change in risk estimates was modest.…”

“…Analyses of data from the United Kingdom and French pediatric CT cohorts and simulation studies indicate that genetic predisposing conditions have little effects on radiation-risk estimates [11,16,18], but may act as effect modifiers [16,19]. Apart from genetic predisposing conditions, several neurological and congenital conditions are associated with childhood brain cancer or higher CT-scan exposure [20][21][22][23][24], and could potentially confound estimates of brain cancer risk from medical radiation.…”

The 2019 Bo Lindell Laureate Lecture: On the use of interdisciplinary, stakeholder-driven, radiation protection research in support of medical uses of ionising radiation

“…For example, epidemiologists at the University of Newcastle have increased the size of the UK CT scan study cohort to over 450,000 individuals (Bernier et al, 2019), which has provided a sufficiently large population for the Radiation Theme partners to investigate how computed tomography (CT) risks might be modified by underlying health conditions (Harbron, 2016) or other confounders (e.g. transplantation status) (Harbron et al, 2018a), together with improved dose assessment (Harbron et al, 2016) and overall risk of cancers (Journy et al, 2016(Journy et al, , 2017Harbron et al, 2017aHarbron et al, , 2018a for low-dose medically exposed populations. In the area of radiobiology, key recent outputs include development and validation of cytogenetic and genetic biomarkers of radiation exposure in medically exposed populations to underpin dose assessment (Cruz-Garcia et al, 2018;Einbeck et al, 2018;Moquet et al, 2018;O'Brien et al, 2018;Tichy et al, 2018), development of a new method of premature chromosome condensation to increase the speed of biological assessment of higher doses (Sun et al, 2019(Sun et al, , 2020, development of a new protocol for rapid gene-expression-based dose estimation (Polozov et al, 2019), and identification of further new genes suitable for biodosimetric purposes using rapid long-read DNA sequencing methods (Cruz-Garcia et al, 2020).…”

“…Medical radiation protection is a topic of current interest worldwide. As new technologies are developed, it is hugely important that radiation protection legislation and guidance keeps pace, in order to derive the benefits of the new techniques while providing adequate protection and reassurance to the individuals occupationally exposed in medical settings and their patients (Journy et al., 2016).…”