Original Investigation |

The Use of Computed Tomography in Pediatrics and the Associated Radiation Exposure and Estimated Cancer Risk

Diana L. Miglioretti, PhD1,2,12; Eric Johnson, MS1; Andrew Williams, PhD3; Robert T. Greenlee, PhD, MPH4; Sheila Weinmann, PhD, MPH5; Leif I. Solberg, MD6; Heather Spencer Feigelson, PhD, MPH7; Douglas Roblin, PhD8; Michael J. Flynn, PhD9; Nicholas Vanneman, MA10; Rebecca Smith-Bindman, MD11
[+] Author Affiliations
1Biostatistics Unit, Group Health Research Institute, University of Washington, Seattle
2Department of Biostatistics, University of Washington, Seattle
3Center for Health Research, Kaiser Permanente Hawaii, Honolulu
4Epidemiology Research Center, Marshfield Clinic Research Foundation, Wisconsin
5Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
6HealthPartners Institute for Education and Research, Minneapolis, Minnesota
7Institute for Health Research, Kaiser Permanente, Denver, Colorado
8Center for Health Research, Kaiser Permanente Southeast, Atlanta, Georgia
9Department of Radiology, Henry Ford Health System, Detroit, Michigan
10Institute of General Practice, Johann Wolfgang Goethe-University, Frankfurt, Germany (Mr Vanneman)
11Departments of Radiology and Biomedical Imaging, Epidemiology and Biostatistics, Obstetrics, and Gynecology and Reproductive Sciences, University of California, San Francisco
12Dr Miglioretti is now with the Department of Public Health Sciences, University California, Davis, and Group Research Institute, Seattle, Washington.
JAMA Pediatr. 2013;167(8):700-707. doi:10.1001/jamapediatrics.2013.311.
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Importance  Increased use of computed tomography (CT) in pediatrics raises concerns about cancer risk from exposure to ionizing radiation.

Objectives  To quantify trends in the use of CT in pediatrics and the associated radiation exposure and cancer risk.

Design  Retrospective observational study.

Setting  Seven US health care systems.

Participants  The use of CT was evaluated for children younger than 15 years of age from 1996 to 2010, including 4 857 736 child-years of observation. Radiation doses were calculated for 744 CT scans performed between 2001 and 2011.

Main Outcomes and Measures  Rates of CT use, organ and effective doses, and projected lifetime attributable risks of cancer.

Results  The use of CT doubled for children younger than 5 years of age and tripled for children 5 to 14 years of age between 1996 and 2005, remained stable between 2006 and 2007, and then began to decline. Effective doses varied from 0.03 to 69.2 mSv per scan. An effective dose of 20 mSv or higher was delivered by 14% to 25% of abdomen/pelvis scans, 6% to 14% of spine scans, and 3% to 8% of chest scans. Projected lifetime attributable risks of solid cancer were higher for younger patients and girls than for older patients and boys, and they were also higher for patients who underwent CT scans of the abdomen/pelvis or spine than for patients who underwent other types of CT scans. For girls, a radiation-induced solid cancer is projected to result from every 300 to 390 abdomen/pelvis scans, 330 to 480 chest scans, and 270 to 800 spine scans, depending on age. The risk of leukemia was highest from head scans for children younger than 5 years of age at a rate of 1.9 cases per 10 000 CT scans. Nationally, 4 million pediatric CT scans of the head, abdomen/pelvis, chest, or spine performed each year are projected to cause 4870 future cancers. Reducing the highest 25% of doses to the median might prevent 43% of these cancers.

Conclusions and Relevance  The increased use of CT in pediatrics, combined with the wide variability in radiation doses, has resulted in many children receiving a high-dose examination. Dose-reduction strategies targeted to the highest quartile of doses could dramatically reduce the number of radiation-induced cancers.

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Figure 1.
Trends in the Use of Computed Tomography (CT) Over Time, by Age Group and Health Care System

The solid lines show rates for children younger than 5 years of age; the dashed lines show rates for children 5 to 14 years of age. The gray lines show rates at each health system, and the red lines show the average rates across health systems.

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Figure 2.
Trends in the Use of Computed Tomography (CT) Over Time, by Age Group and Anatomic Area Imaged
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