Ionizing Radiation Exposure From Imaging in Pediatric Solid Organ Transplant Recipients

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.

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.

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.

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.