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      Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study.

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          Abstract

          Although CT scans are very useful clinically, potential cancer risks exist from associated ionising radiation, in particular for children who are more radiosensitive than adults. We aimed to assess the excess risk of leukaemia and brain tumours after CT scans in a cohort of children and young adults.

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          Estimated risks of radiation-induced fatal cancer from pediatric CT.

          D. Brenner, C Elliston, E. Hall … (2001)
          In light of the rapidly increasing frequency of pediatric CT examinations, the purpose of our study was to assess the lifetime cancer mortality risks attributable to radiation from pediatric CT. Organ doses as a function of age-at-diagnosis were estimated for common CT examinations, and estimated attributable lifetime cancer mortality risks (per unit dose) for different organ sites were applied. Standard models that assume a linear extrapolation of risks from intermediate to low doses were applied. On the basis of current standard practice, the same exposures (milliampere-seconds) were assumed, independent of age. The larger doses and increased lifetime radiation risks in children produce a sharp increase, relative to adults, in estimated risk from CT. Estimated lifetime cancer mortality risks attributable to the radiation exposure from a CT in a 1-year-old are 0.18% (abdominal) and 0.07% (head)-an order of magnitude higher than for adults-although those figures still represent a small increase in cancer mortality over the natrual background rate. In the United States, of approximately 600,000 abdominal and head CT examinations annually performed in children under the age of 15 years, a rough estimate is that 500 of these individuals might ultimately die from cancer attributable to the CT radiation. The best available risk estimates suggest that pediatric CT will result in significantly increased lifetime radiation risk over adult CT, both because of the increased dose per milliampere-second, and the increased lifetime risk per unit dose. Lower milliampere-second settings can be used for children without significant loss of information. Although the risk-benefit balance is still strongly tilted toward benefit, because the frequency of pediatric CT examinations is rapidly increasing, estimates that quantitative lifetime radiation risks for children undergoing CT are not negligible may stimulate more active reduction of CT exposure settings in pediatric patients.
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            Risk of cancer after low doses of ionising radiation: retrospective cohort study in 15 countries.

            E Cardis, M Vrijheid, M Blettner … (2005)
            To provide direct estimates of risk of cancer after protracted low doses of ionising radiation and to strengthen the scientific basis of radiation protection standards for environmental, occupational, and medical diagnostic exposures. Multinational retrospective cohort study of cancer mortality. Cohorts of workers in the nuclear industry in 15 countries. 407 391 workers individually monitored for external radiation with a total follow-up of 5.2 million person years. Estimates of excess relative risks per sievert (Sv) of radiation dose for mortality from cancers other than leukaemia and from leukaemia excluding chronic lymphocytic leukaemia, the main causes of death considered by radiation protection authorities. The excess relative risk for cancers other than leukaemia was 0.97 per Sv, 95% confidence interval 0.14 to 1.97. Analyses of causes of death related or unrelated to smoking indicate that, although confounding by smoking may be present, it is unlikely to explain all of this increased risk. The excess relative risk for leukaemia excluding chronic lymphocytic leukaemia was 1.93 per Sv (< 0 to 8.47). On the basis of these estimates, 1-2% of deaths from cancer among workers in this cohort may be attributable to radiation. These estimates, from the largest study of nuclear workers ever conducted, are higher than, but statistically compatible with, the risk estimates used for current radiation protection standards. The results suggest that there is a small excess risk of cancer, even at the low doses and dose rates typically received by nuclear workers in this study.
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              The linear no-threshold relationship is inconsistent with radiation biologic and experimental data.

              M Tubiana-Hulin, Joseph M L Kaminski, Albert Yang … (2009)
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Lancet
                Title: Lancet (London, England)
                Publisher: Elsevier BV
                ISSN (Electronic): 1474-547X
                ISSN (Print): 0140-6736
                Publication date (Electronic): Aug 04 2012
                Volume: 380
                Issue: 9840
                Affiliations
                [1 ] Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK. mark.pearce@ncl.ac.uk
                Article
                Publisher Item ID: S0140-6736(12)60815-0
                DOI: 10.1016/S0140-6736(12)60815-0
                PMC ID: 3418594
                PubMed ID: 22681860
                SO-VID: f8b19d0d-19bb-4053-ac61-721ac941976b
                Copyright © Copyright © 2012 Elsevier Ltd. All rights reserved.
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