Cumulative ionizing radiation exposure in pediatric patients with chronic diseases: a narrative review

Pediatric patients with chronic diseases commonly experience frequent imaging, which is likely to result in significant cumulative exposure to ionizing radiation. A review of the literature on cumulative and effective radiation doses reported in non-oncologic pediatric chronic disease populations was conducted; 129 records were identified through searches in the SCOPUS, PubMed, and Web of Science databases, and data on disease type, imaging modalities used, and reported dose metrics were extracted. Across the 41 included studies, radiation exposure was influenced by diagnosis, age at first imaging, disease severity, and imaging modality. Plain radiography was the modality used most frequently; however, computed tomography (CT) and fluoroscopy accounted for the majority of cumulative effective dose, in some patient groups exceeding 20-50 mSv. The findings highlight the importance of evidence-based radiation protection referral guidelines, standardized imaging protocols, and dose reporting to support safer imaging practices in this vulnerable population.