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Lessons we have learned from our children: cancer risks from diagnostic radiology
1Center for Radiological Research, Columbia University, 630 West 168th Street, New York, NY 10032, USA. ejh1@columbia.edu
Insights
Pediatric CT scans increase cancer risk in children, who are more sensitive to radiation. While individual risk is low, the high volume of procedures poses a public health concern, necessitating dose reduction and selective use.
Area of Science:
- Radiation oncology
- Pediatric radiology
- Cancer epidemiology
Background:
- Children are significantly more susceptible to radiation-induced cancer than adults.
- Helical CT has advanced pediatric diagnostics but involves higher radiation doses for children.
Discussion:
- A-bomb survivor data now provide mature risk estimates within the dose range of pediatric CT.
- Observed excess cancer incidence in individuals exposed decades ago to doses similar to current pediatric CT scans is statistically significant.
Key Insights:
- A single abdominal helical CT scan in a young girl carries approximately a 1 in 1000 risk of fatal cancer.
- The individual cancer risk is small and outweighed by the medical benefits of CT scans.
Outlook:
- The cumulative public health impact of 2.7 million annual pediatric CT procedures is substantial.
- Minimizing radiation doses through optimized technique (kVp, mAs) and judicious patient selection is crucial.
Abstract:
The A-bomb survivors represent the best source of data for risk estimates of radiation-induced cancer. It is clear that children are ten times more sensitive than adults to the induction of cancer. The introduction of helical CT has transformed diagnostic radiology, especially in pediatric patients. The undoubted benefits carry the price tag of much higher doses, and in children, even higher effective doses. The A-bomb data have "matured" and we now have cancer risk estimates for a dose range which coincides with the organ doses from pediatric CT. Individuals exposed 50 years ago to doses comparable to those associated with helical CT today, show a small but statistically significant excess incidence of cancer. There are no assumptions, and no extrapolations involved. An abdominal helical CT scan in a young girl results in a risk of fatal cancer later in life that amounts to about one in a thousand. The risk to the individual is small, and readily balanced by the medical benefits. The public health problem is, however, significant when the small individual risk is multiplied by the 2.7 million of such procedures performed annually. Every effort is needed to minimize doses by an appropriate choice of peak kilovoltage (kVp) and milliampere-seconds (mAs), and at the same time to urge a more selective use of pediatric CT.