Pediatric Nuclear Medicine Examinations and Subsequent Risk of Neoplasm: A Nationwide Population-Based Cohort Study

Abstract

Objective: To evaluate the association between radiation exposure from repeated nuclear medicine (NM) examinations and the subsequent risk of neoplasm in pediatric patients.Methods: From 2000 to 2017, participants under 18 years of age who underwent NM scanning were identified using the Health and Welfare Data Science Center (HWDC) dataset, which was extracted from the Taiwan National Health Insurance Research Database (NHIRD). Both the exposed cohort and unexposed subjects were followed up with until the presence of any malignancy arose, including malignant brain, lymphoid and hematopoietic tumors and benign brain or other central nervous tumors.Results: There were 35,292 patients in the exposed cohort and 141,152 matched subjects in the non-exposed group. The exposed cohort had an overall higher IR (IR: incidence rate, per 100,000 person-years) of any malignancy and benign central nervous tumor than the non-exposed group [IR, 16.9 vs. 1.54; adjusted hazard ratio (HR), 10.9; 95% CI, 6.53–18.2]. Further stratifying the number of NM examinations into 1-2, 3-4, and 5 or more times revealed that the IR of pediatric neoplasms increased gradually with the increased frequency of NM examinations (IR, 11.5; adjusted HR, 7.5; 95% CI, 4.29–13.1; IR, 25.8; adjusted HR, 15.9; 95% CI, 7.00–36.1; IR, 93.8; adjusted HR, 56.4; 95% CI, 28.8–110.3).Conclusion: NM examination is significantly associated with a higher risk of pediatric neoplasms, according to our population-based data. Thorough radiation protection and dose reduction in pediatric NM procedures should be an issue of concern.

Modulation of Secondary Cancer Risks from Radiation Exposure by Sex, Age and Gonadal Hormone Status: Progress, Opportunities and Challenges

“…In addition to young age, female sex was also mentioned as an important risk factor, but while the studies on cancer incidence following Chernobyl agree that there is a significant negative correlation between age of exposure and elevated radiation-attributable thyroid cancer incidence [ 12 , 13 , 14 , 15 ], sex differences and hormonal effects were not as clear-cut. While thyroid cancer rates were higher in girls than in boys exposed to the same dose of radiation in the Chernobyl studies [ 13 ], the sex difference appeared to be smaller than those reported from unexposed populations elsewhere [ 67 ]. This uncertainty echoes the CERRIE report [ 11 ] but may also be more specifically related to the specific incident.…”

Risks of leukemia, intracranial tumours and lymphomas in childhood and early adulthood after pediatric radiation exposure from computed tomography

“…We also extracted data on other high-radiation procedures using claims for cardiac catheterizations and common nuclear medicine procedures. 42 , 43 …”

“…We conducted sensitivity analyses using lag periods of 1–4 years and including the total number of other high-radiation procedures as a covariable in the model. 42 , 43 …”