Radiation exposure from CT in early childhood: a French large-scale multicentre study

Bernier, Marie Odile; Rehel, J.L.; Brisse, H.; Wu-Zhou, X.; Caër-Lorho, Sylvaine; Jacob, Sophie; Chateil, Jean‐François; Aubert, Bernard; Laurier, Dominique

doi:10.1259/bjr/90758403

Cited by 83 publications

(37 citation statements)

References 33 publications

(37 reference statements)

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“…4,5 A CT scanning session delivers a higher effective radiation dose to a child than an adult. 2,17,28,35 The effective dose in a child younger than 1 year is double that of adults; this dose is 4-fold higher in a newborn. 26 In addition, children presumably have a longer life expectancy and thus more time to develop cancers compared with adults.…”

Section: Discussionmentioning

confidence: 99%

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

White

Shaikh

Moore

et al. 2014

PED

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Object A number of mathematical models predict the risk of future cancer from the ionizing radiation exposure of CT scanning. The predictions are alarming. Some models predict 29,000 future cancers and 14,500 deaths in the US will be directly caused by 1 year's worth of CT scanning. However, there are very few clinical data to justify or refute these claims. Young children are theoretically highly susceptible to the damaging effects of radiation. In this study, the authors examined children who underwent CSF shunt placement before 6 years of age. The authors chose to study shunt-treated patients with the assumption that these patients would undergo future imaging, facilitating surveillance. They chose a study period of 1991–2001 to allow more than 10 years of follow-up data. Methods The authors studied 104 consecutive children who underwent CSF shunt placement prior to 6 years of age and who had at least 10 years of follow-up data. Sixty-two of these patients underwent shunt placement prior to 1 year of age. The age at the initial scanning session, the number of future CT scanning sessions, diagnosis, and results of any future studies were recorded. The age-specific radiation dose was calculated for children younger than 1 year. Children younger than 1 year at the time of shunt placement were evaluated separately, based on the assumption that they represented the highest risk cohort. The authors examined all data for any evidence of future leukemia or head/neck tumor (benign or malignant). Results These children underwent a total of 1584 CT scanning sessions over a follow-up period of 1622 person-years. A total of 517 scanning sessions were performed prior to 6 years of age, including 260 in the 1st year of life. Children who underwent shunt placement before 1 year of age underwent an average of 16.3 ± 13.5 CT sessions (range 1–41). Children undergoing placement between 1 and 6 years of age received an average of 14.1 ± 12.5 CT studies (range 5–52). There were no subsequent tumors (benign or malignant) or leukemia detected. Conclusions Previously published models predict a significant number of future cancers directly caused by CT scanning. However, there are very few published clinical data. In the authors' study, zero future radiation-induced malignancies were detected after routine CT scanning in a high-risk group. While the authors do not consider their single-institution study adequate to define the actual risk, their data suggest that the overall risk is low. The authors hope this study encourages future collaborative efforts to define the actual risk to patients.

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Section: Discussionmentioning

confidence: 99%

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

White

Shaikh

Moore

et al. 2014

PED

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“…1 The damaging effect of high doses of ionising radiation on hippocampal neurogenesis and functioning such as cognition is wellknown. 2 Radiation-associated impairment in learning and memory is observed in the clinical setting after high-dose brain radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

Neonatal Irradiation Leads to Persistent Proteome Alterations Involved in Synaptic Plasticity in the Mouse Hippocampus and Cortex

Kempf¹,

Sepe

Toerne³

et al. 2015

J. Proteome Res.

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Recent epidemiological data indicate that radiation doses as low as those used in computer tomography may result in long-term neurocognitive side effects. The aim of this study was to elucidate long-term molecular alterations related to memory formation in the brain after low and moderate doses of γ radiation. Female C57BL/6J mice were irradiated on postnatal day 10 with total body doses of 0.1, 0.5, or 2.0 Gy; the control group was sham-irradiated. The proteome analysis of hippocampus, cortex, and synaptosomes isolated from these brain regions indicated changes in ephrin-related, RhoGDI, and axonal guidance signaling. Immunoblotting and miRNA-quantification demonstrated an imbalance in the synapse morphology-related Rac1-Cofilin pathway and long-term potentiation-related cAMP response element-binding protein (CREB) signaling. Proteome profiling also showed impaired oxidative phosphorylation, especially in the synaptic mitochondria. This was accompanied by an early (4 weeks) reduction of mitochondrial respiration capacity in the hippocampus. Although the respiratory capacity was restored by 24 weeks, the number of deregulated mitochondrial complex proteins was increased at this time. All observed changes were significant at doses of 0.5 and 2.0 Gy but not at 0.1 Gy. This study strongly suggests that ionizing radiation at the neonatal state triggers persistent proteomic alterations associated with synaptic impairment.

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“…Similar analyses have previously been conducted in the UK [16] and Germany [17], but were concerned mainly with single-or four-slice CT. Other studies in patients of paediatric age have been performed in Switzerland [18], Germany [19] and France [20]. More recent experience with MDCT has been examined in Ireland [21] and Malta [22], both in a small group of hospitals.…”

Section: Introductionmentioning

confidence: 99%

Adult exposures from MDCT including multiphase studies: first Italian nationwide survey

et al. 2013

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Society of Radiology. This e-offprint isAbstract Objectives To evaluate the radiation dose in routine multidetector computed tomography (MDCT) examinations in Italian population. Methods This was a retrospective multicentre study included 5,668 patients from 65 radiology departments who had undergone common CT protocols: head, chest, abdomen, chest-abdomen-pelvis (CAP), spine and cardiac. Data included patient characteristics, CT parameters, volumetric CT dose index (CTDI vol ) and dose length product (DLP) for each CT acquisition phase. Descriptive statistics were calculated, and a multi-regression analysis was used to outline the main factors affecting exposure. Results The 75th percentiles of CTDI vol (mGy) and DLP (mGy cm) for whole head were 69 mGy and 1,312 mGy cm, respectively; for chest, 15 mGy and 569 mGy cm; spine, 42 mGy and 888 mGy cm; cardiac, 7 mGy and 131 mGy cm for calcium score, and 61 mGy and 1,208 mGy cm for angiographic CT studies. High variability was present in the DLP of abdomen and CAP protocols, where multiphase examinations dominated (71 % and 73 % respectively): for abdomen, 18 mGy, with 555 and 920 mGy cm in abdomen and abdomen-pelvis acquisitions respectively; for CAP, 17 mGy, with 508, 850 and 1,200 mGy cm in abdomen, abdomen-pelvis and CAP acquisitions respectively. Conclusion The results of this survey could help in the definition of updated diagnostic reference levels (DRL). Key Points • Radiation dose associated with multidetector CT (MDCT) is an important health issue.• This national survey assessed dose exposures of 5,668 patients undergoing MDCT.• Dose indices correlate with BMI, voltage, rotation time, pitch and tube current.• These results may contribute to an update of national diagnostic reference levels.

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Radiation exposure from CT in early childhood: a French large-scale multicentre study

Cited by 83 publications

References 33 publications

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

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

Neonatal Irradiation Leads to Persistent Proteome Alterations Involved in Synaptic Plasticity in the Mouse Hippocampus and Cortex

Adult exposures from MDCT including multiphase studies: first Italian nationwide survey

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