RtX-Induced Fatal Ca & Ped CT

Estimated Risks of Radiation-Induced Fatal Cancer from Pediatric CT

David J. Brenner1, Carl D. Elliston1, Eric J. Hall1 and Walter E. Berdon2 1 Center for Radiological Research, Columbia University, 630 W. 168th St., New York, NY 10032. 2 Department of Radiology, Division of Pediatric Radiology, Columbia-Presbyterian Medical Center, 630 W. 168th St., New York, NY 10032.

OBJECTIVE. 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.

MATERIALS AND METHODS. 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.

RESULTS. 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 natural 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.

CONCLUSION. 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.

AJR 2001; 176:289-296

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