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Neurointerventions in children: radiation exposure and its import
D B Orbach1, C Stamoulis, K J Strauss
1From the Division of Neurointerventional and Interventional Radiology (D.B.O., J.M.).
Insights
Pediatric neurointerventions improve outcomes for cerebrovascular conditions but carry a risk of secondary tumors. Young children and those with multiple procedures face a higher lifetime risk, warranting careful consideration of radiation exposure.
Area of Science:
- Pediatric neurosurgery
- Interventional neuroradiology
- Radiation oncology
Background:
- Neurointerventions significantly improve outcomes for pediatric cerebrovascular conditions.
- Procedures use fluoroscopic guidance, exposing children to ionizing radiation.
- Prior studies suggest a link between CT scans and secondary tumors in children.
Purpose of the Study:
- To calculate the predicted risk of secondary tumors in pediatric neurointerventional patients.
- To assess the relationship between radiation dose and patient factors.
- To evaluate lifetime cancer risk in this vulnerable population.
Main Methods:
- Reviewed a cohort of pediatric neurointerventions.
- Tabulated skin radiation dose and calculated brain-absorbed doses using mathematical models.
- Utilized head CT registry findings to predict secondary tumor risk.
Main Results:
- Maximal skin and brain doses were lower than previously reported.
- Radiation dose correlated significantly with patient age and procedure complexity.
- A substantial increase in lifetime predicted tumor risk was observed in young children.
Conclusions:
- Neurointerventions offer improved prognoses for pediatric cerebrovascular diseases.
- The predicted risk of secondary tumors is a significant concern, especially for young children and those undergoing multiple procedures.
- Minimizing radiation exposure is crucial in pediatric neurointerventional radiology.
Background And Purpose:
Neurointerventions in children have dramatically improved the clinical outlook for patients with previously intractable cerebrovascular conditions, such as vein of Galen malformations and complex arteriovenous fistulas. However, these complex and sometimes lengthy procedures are performed under fluoroscopic guidance and thus unavoidably expose vulnerable pediatric patients to the effects of ionizing radiation. Recent epidemiologic evidence from a national registry of children who underwent CT scans suggests a higher-than-expected incidence of secondary tumors. We sought to calculate the predicted risk of secondary tumors in a large cohort of pediatric neurointerventional patients.
Materials And Methods:
We reviewed our cohort of pediatric neurointerventions, tabulated radiation dose delivered to the skin, and calculated the range of likely brain-absorbed doses by use of previously developed mathematical models. The predicted risk of secondary tumor development as a function of brain-absorbed dose in this cohort was then generated by use of the head CT registry findings.
Results:
Maximal skin dose and brain-absorbed doses in our cohort were substantially lower than have been previously described. However, we found 1) a statistically significant correlation between radiation dose and age at procedure, as well as number and type of procedures, and 2) a substantial increase in lifetime predicted risk of tumor above baseline in the cohort of young children who undergo neurointerventions.
Conclusions:
Although neurointerventional procedures have dramatically improved the prognosis of children facing serious cerebrovascular conditions, the predicted risk of secondary tumors, particularly in the youngest patients and those undergoing multiple procedures, is sobering.
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