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Risk of hematologic malignant neoplasms from head CT radiation in children and adolescents presenting with minor head trauma: a nationwide population-based cohort study

  • Computed Tomography
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Abstract

Objectives

The carcinogenic risks of CT radiation in children and adolescents remain debated. We aimed to assess the carcinogenic risk of CTs performed in children and adolescents with minor head trauma.

Methods

In this nationwide population-based cohort study, we included 2,411,715 patients of age 0–19 with minor head trauma from 2009 to 2017. We excluded patients with elevated cancer risks or substantial past medical radiation exposure. Patients were categorized into CT-exposed or CT-unexposed group according to claim codes for head CT. The primary outcome was development of hematologic malignant neoplasms. Secondary outcomes included development of malignant solid neoplasms and benign neoplasms in the brain. We measured the incidence rate ratio (IRR) and incidence rate difference (IRD) using G-computation with Poisson regression adjusting for age, sex, hospital setting, and the type of head trauma.

Results

Hematologic malignant neoplasms developed in 100 of 216,826 patients during 1,303,680 person-years in the CT-exposed group and in 808 of 2,194,889 patients during 13,501,227 person-years in the CT-unexposed group. For hematologic malignant neoplasms, the IRR was 1.29 (95% CI, 1.03–1.60) and the IRD was 1.71 (95% CI, 0.04–3.37) per 100,000 person-years at risk. The majority of excess hematologic malignant neoplasms were leukemia (IRR, 1.40 [98.3% CI, 1.05–1.87]; IRD, 1.59 [98.3% CI, 0.02–3.16] per 100,000 person-years at risk). There were no between-group differences for secondary outcomes.

Conclusions

Radiation exposure from head CTs in children and adolescents with minor head trauma was associated with an increased incidence of hematologic malignant neoplasms.

Clinical relevance statement

Our study provides a quantitative grasp of the risk conferred by CT examinations in children and adolescents, thereby providing the basis for cost–benefit analyses and evidence-driven guidelines for patient triaging in head trauma.

Key Points

• This nationwide population-based cohort study showed that radiation exposure from head CTs in children and adolescents was associated with a higher incidence of hematologic malignant neoplasms.

• The incidence rate of hematologic malignant neoplasms in the CT-exposed group was 29% higher than that in the CT-unexposed group (IRR, 1.29 [95% CI, 1.03–1.60]), and there were approximately 1.7 excess neoplasms per 100,000 person-years at risk in the CT-exposed group (IRD, 1.71 [0.04–3.37]).

• Our study provides a quantified grasp of the risk conferred by CT examinations in children and adolescents, while controlling for biases observed in previous studies via specifying CT indication and excluding patients with predisposing conditions for cancer development.

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Abbreviations

ICD-10:

International Classification of Diseases, 10th Revision

IR:

Incidence rate

IRD:

Incidence rate difference

IRR:

Incidence rate ratio

References

  1. Brenner DJ, Doll R, Goodhead DT et al (2003) Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 100:13761–13766

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  2. Harvey HB, Brink JA, Frush DP (2015) Informed consent for radiation risk from CT is unjustified based on the current scientific evidence. Radiology 275:321–325

    Article  PubMed  Google Scholar 

  3. Hendee WR, O’Connor MK (2012) Radiation risks of medical imaging: separating fact from fantasy. Radiology 264:312–321

    Article  PubMed  Google Scholar 

  4. Brenner DJ, Hall EJ (2007) Computed tomography–an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  CAS  PubMed  Google Scholar 

  5. Ozasa K, Shimizu Y, Suyama A et al (2012) Studies of the mortality of atomic bomb survivors, report 14, 1950–2003: an overview of cancer and noncancer diseases. Radiat Res 177:229–243

    Article  ADS  CAS  PubMed  Google Scholar 

  6. Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mathews JD, Forsythe AV, Brady Z et al (2013) Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 346:f2360

    Article  PubMed  PubMed Central  Google Scholar 

  8. Huang WY, Muo CH, Lin CY et al (2014) Paediatric head CT scan and subsequent risk of malignancy and benign brain tumour: a nation-wide population-based cohort study. Br J Cancer 110:2354–2360

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hong JY, Han K, Jung JH, Kim JS (2019) Association of exposure to diagnostic low-dose ionizing radiation with risk of cancer among youths in South Korea. JAMA Netw Open 2:e1910584

    Article  PubMed  PubMed Central  Google Scholar 

  10. Meulepas JM, Ronckers CM, Smets A et al (2019) Radiation exposure from pediatric CT scans and subsequent cancer risk in the Netherlands. J Natl Cancer Inst 111:256–263

    Article  PubMed  Google Scholar 

  11. United Nations Scientific Committee on the Effects of Atomic Radiation (2014) Sources, effects and risks of ionizing radiation: UNSCEAR 2013 report to the general assembly with scientific annexes. Effects of radiation exposure of children. United Nations Scientific Committee on the Effects of Atomic Radiation, New York

  12. Walsh L, Shore R, Auvinen A, Jung T, Wakeford R (2014) Risks from CT scans–what do recent studies tell us? J Radiol Prot 34:E1-5

    Article  PubMed  Google Scholar 

  13. Lee KH, Lee S, Park JH et al (2021) Risk of hematologic malignant neoplasms from abdominopelvic computed tomographic radiation in patients who underwent appendectomy. JAMA Surg 156:343–351

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hu A, Lautz TB, Raval MV (2021) Comments on computed tomography for evaluating appendicitis. JAMA Surg 156:1071–1072

    Article  PubMed  Google Scholar 

  15. McCollough CH, Jordan DW, Dauer LT (2021) Comments on computed tomography for evaluating appendicitis. JAMA Surg 156:1072–1073

    Article  PubMed  Google Scholar 

  16. Schaps D, Frush DP, Rice HE (2021) Comments on computed tomography for evaluating appendicitis. JAMA Surg 156:1073

    Article  PubMed  Google Scholar 

  17. Lodwick DL, Cooper JN, Kelleher KJ, Brilli R, Minneci PC, Deans KJ (2015) Variation in utilization of computed tomography imaging at tertiary pediatric hospitals. Pediatrics 136:e1212-1219

    Article  PubMed  Google Scholar 

  18. Larson DB, Johnson LW, Schnell BM, Goske MJ, Salisbury SR, Forman HP (2011) Rising use of CT in child visits to the emergency department in the United States, 1995–2008. Radiology 259:793–801

    Article  PubMed  Google Scholar 

  19. Carcinogenic risk of brain CT radiation exposure in patients who diagnosed head trauma: a population-based study using big data from national health insurance service. KCT0007485. Available from: https://cris.nih.go.kr/cris/search/detailSearch.do/20460. Accessed 30 June 2022

  20. Vandenbroucke JP, von Elm E, Altman DG et al (2007) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med 4:e297

    Article  PubMed  PubMed Central  Google Scholar 

  21. Benchimol EI, Smeeth L, Guttmann A et al (2015) The reporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med 12:e1001885

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lee YH, Han K, Ko SH, Ko KS, Lee KU (2016) Data analytic process of a nationwide population-based study using national health information database established by national health insurance service. Diabetes Metab J 40:79–82

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ozasa K, Grant EJ, Kodama K (2018) Japanese legacy cohorts: the life span study atomic bomb survivor cohort and survivors’ offspring. J Epidemiol 28:162–169

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gharibzadeh S, Mohammad K, Rahimiforoushani A, Amouzegar A, Mansournia MA (2016) Standardization as a tool for causal inference in medical research. Arch Iran Med 19:666–670

    PubMed  Google Scholar 

  25. Sjölander A (2016) Regression standardization with the R package stdReg. Eur J Epidemiol 31:563–574

    Article  PubMed  Google Scholar 

  26. Journy N, Rehel JL, Ducou Le Pointe H et al (2015) Are the studies on cancer risk from CT scans biased by indication? Elements of answer from a large-scale cohort study in France. Br J Cancer 112:185–193

    Article  CAS  PubMed  Google Scholar 

  27. Krille L, Dreger S, Schindel R et al (2015) Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study. Radiat Environ Biophys 54:1–12

    Article  CAS  PubMed  Google Scholar 

  28. Foucault A, Ancelet S, Dreuil S et al (2022) Childhood cancer risks estimates following CT scans: an update of the French CT cohort study. Eur Radiol 32:5491–5498

    Article  PubMed  Google Scholar 

  29. Berrington de Gonzalez A, Salotti JA, McHugh K et al (2016) Relationship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions. Br J Cancer 114:388–394

    Article  PubMed  Google Scholar 

  30. Richardson D, Sugiyama H, Nishi N et al (2009) Ionizing radiation and leukemia mortality among Japanese atomic bomb survivors, 1950–2000. Radiat Res 172:368–382

    Article  ADS  CAS  PubMed  Google Scholar 

  31. Fernandes K, Levin TL, Miller T, Schoenfeld AH, Amis ES Jr (2016) Evaluating an image gently and image wisely campaign in a multihospital health care system. J Am Coll Radiol 13:1010–1017

    Article  PubMed  Google Scholar 

  32. Gambacorta A, Moro M, Curatola A et al (2022) PECARN Rule in diagnostic process of pediatric patients with minor head trauma in emergency department. Eur J Pediatr 181:2147–2154

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mooney JS, Yates A, Sellar L et al (2011) Emergency head injury imaging: implementing NICE 2007 in a tertiary neurosciences centre and a busy district general hospital. Emerg Med J 28:778–782

    Article  CAS  PubMed  Google Scholar 

  34. Seo HJ, Oh IH, Yoon SJ (2012) A comparison of the cancer incidence rates between the national cancer registry and insurance claims data in Korea. Asian Pac J Cancer Prev 13:6163–6168

    Article  PubMed  Google Scholar 

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Funding

This study has received funding by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2021R1F1A1063403) and Seoul National University Bundang Hospital Research Fund (02–2021-0049).

Author information

Author notes

  1. Seungjae Lee and Hae Young Kim contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea

    Seungjae Lee, Kyung Hee Lee, Jungheum Cho, Jinhee Hwang & Ji Hoon Park

  2. Institute of Health and Environment, Seoul National University, Seoul, South Korea

    Seungjae Lee

  3. Department of Radiology, Asan Medical Center, Seoul, South Korea

    Hae Young Kim

  4. Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-Do, South Korea

    Kyung Hee Lee & Ji Hoon Park

  5. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Choonsik Lee

  6. Department of Nuclear Engineering, Kyung Hee University, Seoul, Gyeonggi-Do, South Korea

    Kwang Pyo Kim

  7. Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea

    Jinhee Hwang & Ji Hoon Park

  8. Department of Medical Device Development, Seoul National University College of Medicine, Seoul, South Korea

    Ji Hoon Park

Authors
  1. Seungjae Lee
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Corresponding author

Correspondence to Ji Hoon Park.

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Guarantor

The scientific guarantor of this publication is Ji Hoon Park.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (SL).

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Study subjects or cohorts overlap

Study subjects or cohorts have not been previously reported elsewhere.

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• performed at one institution

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Lee, S., Kim, H.Y., Lee, K.H. et al. Risk of hematologic malignant neoplasms from head CT radiation in children and adolescents presenting with minor head trauma: a nationwide population-based cohort study. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10646-2

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  • DOI: https://doi.org/10.1007/s00330-024-10646-2

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