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Ionizing Radiation Exposure From Imaging in Pediatric Solid Organ Transplant Recipients
Cal H Robinson1,2, Alisha Parikh1, Karlota Borges1
1Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada.
Insights
Pediatric solid organ transplant recipients had low-to-moderate cumulative radiation exposure from medical imaging. Computed tomography was the main contributor, highlighting the need to optimize ionizing modalities and use non-ionizing options.
Area of Science:
- Pediatric imaging
- Transplant medicine
- Radiation oncology
Background:
- Pediatric solid organ transplant recipients require extensive medical imaging.
- Data on cumulative radiation dose from these imaging procedures are limited.
- This study aimed to quantify cumulative ionizing radiation exposure and identify its sources in this population.
Purpose of the Study:
- To quantify the cumulative effective dose (CED) of ionizing radiation in pediatric solid organ transplant recipients.
- To identify the primary contributors to radiation exposure, including imaging modality and indication.
- To stratify radiation exposure based on transplant type and follow-up duration.
Main Methods:
- Retrospective cohort study of 543 children (0-18 years) undergoing their first solid organ transplant.
- Follow-up from first imaging pre-transplant until transfer of care, death, or 28 months post-enrollment.
- Cumulative effective dose (CED) estimated and stratified by era, modality, indication, and organ group.
Main Results:
- Median CED was 21 mSv across 29,821 imaging studies in 543 children over a median 3.4-year follow-up.
- Computed tomography accounted for 44% of CED; most studies were for clinical care, not planned protocols.
- Radiation exposure was highest in multi-organ recipients and lowest in kidney recipients.
Conclusions:
- Most pediatric solid organ transplant recipients experienced low-to-moderate radiation exposure from medical imaging.
- Optimizing ionizing imaging modalities to reduce radiation dose is crucial.
- Promoting the use of non-ionizing imaging modalities is recommended to minimize cumulative exposure.
Background:
Pediatric solid organ transplant recipients undergo extensive medical imaging. Limited data are available on the cumulative radiation dose from imaging. Our aim was to quantify cumulative ionizing radiation exposure and define its contributors.
Methods:
Retrospective cohort study of children (0-18 years) who received their first solid organ transplant (heart, lung, liver, kidney, or multi-organ) at a tertiary care children's hospital in Toronto, Canada over a 10-year period. Participants were followed from their first imaging procedure pre-transplantation until transfer of care, death, or 28-months after enrollment. The primary outcome was cumulative effective dose (CED; in millisieverts [mSv]) of ionizing radiation. CED estimates were stratified by era (pre- and post-transplant), imaging modality, imaging indication, and transplant organ group.
Results:
Among 543 pediatric solid organ transplant recipients, 29 821 imaging studies were conducted over median 3.4-year (IQR 1.0-6.1) follow-up. Median estimated CED was 21 mSv (IQR 9-41) and median 39 (IQR 20-71) imaging studies were performed per child. Throughout follow-up, 259 (48%) children were exposed to a CED ≤ 20 mSv, 168 (31%) to 20-50 mSv, 71 (13%) to 50-100 mSv, and 45 (8%) to > 100 mSv. Computed tomography was the highest contributor to CED (44%), with most studies performed for clinical care. Only 20% of CED was attributable to planned per-protocol imaging. Radiation exposure was highest in multi-organ transplant recipients and lowest in kidney recipients.
Conclusions:
Radiation exposure from medical imaging was low-to-moderate for most pediatric solid organ transplant recipients. Emphasis on optimizing ionizing modalities to reduce radiation dose and the promotion of non-ionizing imaging modalities remains important.
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