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Little MP, Bazyka D, de Gonzalez AB, Brenner AV, Chumak VV, Cullings HM, Daniels RD, French B, Grant E, Hamada N, Hauptmann M, Kendall GM, Laurier D, Lee C, Lee WJ, Linet MS, Mabuchi K, Morton LM, Muirhead CR, Preston DL, Rajaraman P, Richardson DB, Sakata R, Samet JM, Simon SL, Sugiyama H, Wakeford R, Zablotska LB. A Historical Survey of Key Epidemiological Studies of Ionizing Radiation Exposure. Radiat Res 2024; 202:432-487. [PMID: 39021204 PMCID: PMC11316622 DOI: 10.1667/rade-24-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/23/2024] [Indexed: 07/20/2024]
Abstract
In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis.
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Affiliation(s)
- Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | | | - Alina V. Brenner
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Vadim V. Chumak
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | - Harry M. Cullings
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Grant
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Gerald M. Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay aux Roses France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Martha S. Linet
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | | | | | - Preetha Rajaraman
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - David B. Richardson
- Environmental and Occupational Health, 653 East Peltason, University California, Irvine, Irvine, CA 92697-3957 USA
| | - Ritsu Sakata
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Jonathan M. Samet
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Steven L. Simon
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Hiromi Sugiyama
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16 Street, 2 floor, San Francisco, CA 94143, USA
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Jang S, Lee J, Kim SH, Han S, Shin SG, Lee S, Kang I, Jo WS, Jeong S, Oh SJ, Lee CG. Radiation dose estimation with multiple artificial neural networks in dicentric chromosome assay. Int J Radiat Biol 2024; 100:865-874. [PMID: 38687685 DOI: 10.1080/09553002.2024.2338531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE The dicentric chromosome assay (DCA), often referred to as the 'gold standard' in radiation dose estimation, exhibits significant challenges as a consequence of its labor-intensive nature and dependency on expert knowledge. Existing automated technologies face limitations in accurately identifying dicentric chromosomes (DCs), resulting in decreased precision for radiation dose estimation. Furthermore, in the process of identifying DCs through automatic or semi-automatic methods, the resulting distribution could demonstrate under-dispersion or over-dispersion, which results in significant deviations from the Poisson distribution. In response to these issues, we developed an algorithm that employs deep learning to automatically identify chromosomes and perform fully automatic and accurate estimation of diverse radiation doses, adhering to a Poisson distribution. MATERIALS AND METHODS The dataset utilized for the dose estimation algorithm was generated from 30 healthy donors, with samples created across seven doses, ranging from 0 to 4 Gy. The procedure encompasses several steps: extracting images for dose estimation, counting chromosomes, and detecting DC and fragments. To accomplish these tasks, we utilize a diverse array of artificial neural networks (ANNs). The identification of DCs was accomplished using a detection mechanism that integrates both deep learning-based object detection and classification methods. Based on these detection results, dose-response curves were constructed. A dose estimation was carried out by combining a regression-based ANN with the Monte-Carlo method. RESULTS In the process of extracting images for dose analysis and identifying DCs, an under-dispersion tendency was observed. To rectify the discrepancy, classification ANN was employed to identify the results of DC detection. This approach led to satisfaction of Poisson distribution criteria by 32 out of the initial pool of 35 data points. In the subsequent stage, dose-response curves were constructed using data from 25 donors. Data provided by the remaining five donors served in performing dose estimations, which were subsequently calibrated by incorporating a regression-based ANN. Of the 23 points, 22 fell within their respective confidence intervals at p < .05 (95%), except for those associated with doses at levels below 0.5 Gy, where accurate calculation was obstructed by numerical issues. The accuracy of dose estimation has been improved for all radiation levels, with the exception of 1 Gy. CONCLUSIONS This study successfully demonstrates a high-precision dose estimation method across a general range up to 4 Gy through fully automated detection of DCs, adhering strictly to Poisson distribution. Incorporating multiple ANNs confirms the ability to perform fully automated radiation dose estimation. This approach is particularly advantageous in scenarios such as large-scale radiological incidents, improving operational efficiency and speeding up procedures while maintaining consistency in assessments. Moreover, it reduces potential human error and enhances the reliability of results.
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Affiliation(s)
- Seungsoo Jang
- Department of Advanced Nuclear Engineering, POSTECH, Pohang, Korea
| | - Janghee Lee
- Department of Advanced Nuclear Engineering, POSTECH, Pohang, Korea
| | | | | | | | | | | | - Wol Soon Jo
- Research Center, Dongnam Institute of Radiological and Medical Science, Busan, Korea
| | - Sookyung Jeong
- Research Center, Dongnam Institute of Radiological and Medical Science, Busan, Korea
| | - Su Jung Oh
- Research Center, Dongnam Institute of Radiological and Medical Science, Busan, Korea
| | - Chang Geun Lee
- Research Center, Dongnam Institute of Radiological and Medical Science, Busan, Korea
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Karadaş N, Özdemir HH, Yilmaz Y, Göktepe ŞÖ, Ece D, Karapinar DY. Primary Mold-Active Antifungal Prophylaxis Decreases the Need for Chest Computed Tomography Scans in Patients with Acute Lymphoblastic Leukemia. Indian J Hematol Blood Transfus 2024; 40:196-203. [PMID: 38708155 PMCID: PMC11065793 DOI: 10.1007/s12288-023-01697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/03/2023] [Indexed: 05/07/2024] Open
Abstract
Current guidelines recommend computed tomography (cCT) scans of the chest in children with leukemia following 96 h of the onset of idiopathic neutropenia to eliminate pulmonary invasive fungal infections (IFIs). However, cCT exposes some children who are at a very high risk of developing secondary cancers to radiation. We aimed to determine the effect of antifungal prophylaxis (AFP) with voriconazole (VCZ) on the need for cCT scans in children with acute lymphoblastic leukemia (ALL) to eliminate pulmonary IFIs during chemotherapy. We retrospectively screened all patients' data from their electronic charts. Children who were diagnosed as having ALL before February 2013 and did (AFP group) or did not (NoP group) receive AFP were divided into two groups and compared regarding cCT scans and relapse-mortality rates. Ninety-six children were diagnosed before February 2013 and did not receive primary AFP and 146 children were administered VCZ following a diagnosis of ALL. There were no significant demographic differences between the groups. A total of 128 cCTs had been required in 62 children in the NoP group, compared with 64 cCTs in 52 children in the AFP group. The percentage of the patients who had required at least one chest CT scan and the mean number of cCT scans in the NoP group were significantly higher compared with the AFP group. Proven-probable IFIs and relapse-mortality rates were higher in the NoP group compared with the AFP group. Mold-active AFP revealed a significant decrease in the need for cCT scans in children with ALL.
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Affiliation(s)
- Nihal Karadaş
- Ege University Faculty of Medicine, Children’s Hospital, Department of Pediatric Hematology, IZMIR, Bornova, Turkey
| | - Hamiyet Hekimci Özdemir
- Ege University Faculty of Medicine, Children’s Hospital, Department of Pediatric Hematology, IZMIR, Bornova, Turkey
| | - Yeşer Yilmaz
- Katip Çelebi University Medical School, IZMIR, Bornova, Turkey
| | - Şebnem Önen Göktepe
- Ege University Faculty of Medicine, Children’s Hospital, Department of Pediatric Hematology, IZMIR, Bornova, Turkey
| | - Dilek Ece
- Ege University Faculty of Medicine, Children’s Hospital, Department of Pediatric Hematology, IZMIR, Bornova, Turkey
| | - Deniz Yilmaz Karapinar
- Ege University Faculty of Medicine, Children’s Hospital, Department of Pediatric Hematology, IZMIR, Bornova, Turkey
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Martin CJ, Barnard M, de Vocht F. Evaluation of risks of cardiovascular disease from radiation exposure linked to computed tomography scans in the UK. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:011513. [PMID: 38422514 DOI: 10.1088/1361-6498/ad2ebd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/29/2024] [Indexed: 03/02/2024]
Abstract
Epidemiological studies of patient populations have shown that high doses of radiation increase risks of cardiovascular disease (CVD). Results from a recent meta-analysis of 93 epidemiological studies covering a wide range of doses provided evidence of a causal association between radiation exposure and CVD, and indicated excess relative risk per Gy for maximum dose below 500 mGy or delivered at low dose rates. These doses cover the range of organ doses expected from multiple diagnostic computed tomography (CT) scans. Dose-effect factors for the excess absolute risk of mortality from CVD following radiation exposure were derived from the meta-analysis. The present study uses these factors to estimate excess risks of mortality for various types of CVD, including cerebrovascular disease (CeVD), from CT scans of the body and head, assuming that the meta-analytic factors were accurate and represented a causal relationship. Estimates are based on cumulative doses to the heart and brain from CT scans performed on 105 574 patients on 12 CT scanners over a period of 5½ years. The results suggest that the excess number of deaths from CeVD could be 7 or 26 per 100 000 patients depending whether threshold brain doses of 200 mGy or 50 mGy, respectively are assumed. These results could have implications for head CT scans. However, the results rely on the validity of risk factors derived in the meta-analysis informing this assessment and which include significant uncertainties. Further incidence studies should provide better information on risk factors and dose thresholds, particularly for CeVD following head CT scans.
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Affiliation(s)
- Colin J Martin
- Department of Clinical Physics and Bioengineering, University of Glasgow, Glasgow, United Kingdom
| | - Michael Barnard
- Department of Radiation Physics and Protection, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- NIHR Applied Research Collaboration West (ARC West), Bristol, United Kingdom
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Caramenti L, Gradowska PL, Moriña D, Byrnes G, Cardis E, Hauptmann M. Finite-Sample Bias of the Linear Excess Relative Risk in Cohort Studies of Computed Tomography-Related Radiation Exposure and Cancer. Radiat Res 2024; 201:206-214. [PMID: 38323646 DOI: 10.1667/rade-23-00187.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
The linear excess relative risk (ERR) is the most commonly reported measure of association in radiation epidemiological studies, when individual dose estimates are available. While the asymptotic properties of the ERR estimator are well understood, there is evidence of small sample bias in case-control studies of treatment-related radiation exposure and second cancer risk. Cohort studies of cancer risk after exposure to low doses of radiation from diagnostic procedures, e.g., computed tomography (CT) examinations, typically have small numbers of cases and risks are small. Therefore, understanding the properties of the estimated ERR is essential for interpretation and analysis of such studies. We present results of a simulation study that evaluates the finite-sample bias of the ERR estimated by time-to-event analyses and its confidence interval using simulated data, resembling a retrospective cohort study of radiation-related leukemia risk after CT examinations in childhood and adolescence. Furthermore, we evaluate how the Firth-corrected estimator reduces the finite-sample bias of the classical estimator. We show that the ERR is overestimated by about 30% for a cohort of about 150,000 individuals, with 42 leukemia cases observed on average. The bias is reduced for higher baseline incidence rates and for higher values of the true ERR. As the number of cases increases, the ERR is approximately unbiased. The Firth correction reduces the bias for all cohort sizes to generally around or under 5%. Epidemiological studies showing an association between radiation exposure from pediatric CT and cancer risk, unless very large, may overestimate the magnitude of the relationship, while there is no evidence of an increased chance for false-positive results. Conducting large studies, perhaps by pooling individual studies to increase the number of cases, should be a priority. If this is not possible, Firth correction should be applied to reduce small-sample bias.
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Affiliation(s)
- L Caramenti
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane; Neuruppin, Germany
| | - P L Gradowska
- Erasmus MC Cancer Institute; Rotterdam, The Netherlands
| | - D Moriña
- Department of Econometrics, Statistics and Applied Economics, Riskcenter-IREA, Universitat de Barcelona (UB); Barcelona, Spain
| | - G Byrnes
- International Agency for Research in Cancer (IARC); Lyon, France
| | - E Cardis
- Institute for Global Health, ISGlobal; Barcelona, Spain
- Universitat Pompeu Fabra (UPF); Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Madrid, Spain
| | - M Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane; Neuruppin, Germany
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Noto Y, Endo Y, Ohashi M, Hirano T, Kuramoto T, Chida K, Watanabe K. Usefulness of the spectral shaping dual-source computed tomography imaging technique in posterior corrective fusion for adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:706-712. [PMID: 38233628 DOI: 10.1007/s00586-023-08006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/31/2023] [Accepted: 10/14/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE Since childhood exposure to radiation has been demonstrated to increase cancer risk with increase in radiation dose, reduced radiation exposure during computed tomography (CT) evaluation is desired for adolescent idiopathic scoliosis (AIS). Therefore, this retrospective study aimed to investigate the radiation dose of dual-source CT using a spectral shaping technique and the accuracy of the thoracic pedicle screw (TPS) placement for posterior spinal fusion (PSF) in patients with AIS. METHODS Fifty-nine female patients with thoracic AIS who underwent PSF using CT-guided TPSs were included and divided into two groups comprised of 23 patients who underwent dual-source CT (DSCT) with a tin filter (DSCT group) and 36 who underwent conventional multislice CT (MSCT group). We assessed the CT radiation dose using the CT dose index (CTDIvol), effective dose (ED), and accuracy of TPS insertion according to the established Neo's classification. RESULTS The DSCT and MSCT groups differed significantly (p < 0.001) in the mean CTDIvol (0.76 vs. 3.31 mGy, respectively) and ED (0.77 vs. 3.47 mSv, respectively). Although the correction rate of the main thoracic curve in the DSCT group was lower (65.7% vs. 71.2%) (p = 0.0126), the TPS accuracy (Grades 0-1) was similar in both groups (381 screws [88.8%] vs. 600 screws [88.4%], respectively) (p = 0.8133). No patient required replacement of malpositioned screws. CONCLUSION Spectral shaping DSCT with a tube-based tin filter allowed a 75% radiation dose reduction while achieving TPS insertion accuracy similar to procedures based on conventional CT without spectral shaping.
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Affiliation(s)
- Yoshiyuki Noto
- Division of Radiological Technology, Department of Technical Support, Niigata University Medical and Dental Hospital, Niigata, Japan
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yuki Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Masayuki Ohashi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma City, Niigata, Japan
| | - Tatsuya Kuramoto
- Division of Radiological Technology, Department of Technical Support, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kei Watanabe
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan.
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Yoshitake T, Miyazaki O, Kitamura M, Ono K, Kai M. Quantitative Analysis of the Clinical Reasons Influencing the Frequency of Pediatric Head CT Examinations: A Single-Center Observation Study. Tomography 2023; 9:829-839. [PMID: 37104138 PMCID: PMC10144250 DOI: 10.3390/tomography9020067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
Epidemiological studies on radiation exposure from pediatric CT scans have attracted attention in terms of radiological protection. These studies have not taken into account the reasons why CT examinations were performed. It is presumed that there are clinical reasons that justify more frequent CT examinations in children. The purpose of this study was to characterize the clinical reasons why relatively high numbers of head CT examinations (NHCT) are frequently performed and to conduct a statistical analysis to determine the factors governing the NHCT. Patient information, the date of examination, and medical conditions for examination data stored on the radiology information system were used to investigate the reasons for undergoing CT examinations. The target facility was National Children's Hospital; data were obtained from March 2002 to April 2017, and the age of the study population was less than 16 years old. Quantitative analysis of the factors associated with frequent examinations was conducted by Poisson regression analysis. Among all patients who had a CT scan, 76.6% had head CT examinations, and 43.4% of children were under 1 year old at the time of the initial examination. There were marked differences in the number of examinations depending on the disease. The average NHCT was higher for children younger than 5 days of age. Among children less than 1 year of age with surgery, there was a marked difference between hydrocephalus, with a mean = 15.5 (95% CI 14.3,16.8), and trauma, with a mean = 8.3 (95% CI 7.2,9.4). In conclusion, this study revealed that NHCT was significantly higher in children who had undergone surgery than in those who had not been to the hospital. The clinical reasons behind patients with higher NHCT should be considered in investigating a causal relationship between CT exposure and brain tumors.
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Affiliation(s)
- Takayasu Yoshitake
- Doctoral Course of Health Science, Graduate School of Nursing, Oita University of Nursing and Health Sciences, 2944-9 Megusuno, Oita 870-1201, Japan
| | - Osamu Miyazaki
- National Center for Child Health and Development, 2-10-1 Ohkura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Masayuki Kitamura
- National Center for Child Health and Development, 2-10-1 Ohkura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Koji Ono
- Division of Nursing, Higashigaoka Faculty of Nursing, Tokyo Health University, 2-5-1 Setagaya, Setagaya-ku, Tokyo 152-8558, Japan
| | - Michiaki Kai
- Department of Health Science, School of Health Science, Nippon Bunri University, 1727 Ichiki, Oita 870-0397, Japan
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Hamada N, Zablotska LB. New evidence for brain cancer risk after a single paediatric CT scan. Lancet Oncol 2023; 24:2-3. [PMID: 36493794 DOI: 10.1016/s1470-2045(22)00696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo 201-8511, Japan.
| | - Lydia B Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
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McBain-Miller J, Scurrah KJ, Brady Z, Mathews JD. Cohort profile: The Australian Paediatric Exposure to Radiation Cohort (Aust-PERC). PLoS One 2022; 17:e0271918. [PMID: 36083886 PMCID: PMC9462670 DOI: 10.1371/journal.pone.0271918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 07/08/2022] [Indexed: 11/25/2022] Open
Abstract
Although the carcinogenic effects of high-dose radiation are well-established, the risks at low doses, such as from diagnostic X-rays, are less well understood. Children are susceptible to radiation induced cancers, and in the last decade, several cohort studies have reported increased cancer risks following computed tomography (CT) scans in childhood. However, cohort studies can be limited by insufficient follow-up, indication bias, reverse causation, or by lack of organ doses from CT scans or other exposures. Aust-PERC is a retrospective cohort designed to study the effects of low-dose medical radiation exposure, primarily from CT scans, in young Australians. The cohort was ascertained using deidentified billing records from patients who were aged 0–19 years while enrolled in Medicare (Australia’s universal healthcare system) between 1985 and 2005. All procedures billed to Medicare in this age/time window that involved low-dose radiation were identified, and persons without such procedures were flagged as unexposed. The Aust-PERC cohort has been linked, using confidential personal identifiers, to the Australian Cancer Database and the National Death Index, on two occasions (to Dec. 2007 and Dec. 2012) by the responsible government agency (Australian Institute of Health and Welfare). Deidentified Medicare service records of all radiological procedures including CT scans, nuclear medicine (NM) scans and fluoroscopy and plain X-ray procedures have been available to derive estimated radiation doses in the cohort. Records of other medical and surgical procedures, together with demographic and socioeconomic variables are being used in analyses to assess biases arising from reverse causation and confounding. After excluding patients with errant records, 11 802 846 persons remained in the baseline cohort, with an average follow-up time of 22.3 years to December 2012. There were 275 489 patients exposed to diagnostic nuclear medicine scans and 688 363 patients exposed to CT scans before age 20 and before cancer diagnosis. Between 1 January 1985 and 31 December 2012, there were 105 124 deaths and 103 505 incident cancers. Dose-response analyses based on the relevant organ doses are underway for individual cancers, and we plan to extend the follow-up for another 8 years to Dec 2020. Analyses using this very large Aust-PERC cohort, with extended follow-up, will help to resolve international uncertainties about the causal role of diagnostic medical radiation as a cause of cancer.
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Affiliation(s)
- Jasmine McBain-Miller
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- * E-mail:
| | - Katrina J. Scurrah
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Zoe Brady
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- Department of Radiology and Nuclear Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - John D. Mathews
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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Zablotska LB, Richardson DB, Golden A, Pasqual E, Smith B, Rage E, Demers PA, Do M, Fenske N, Deffner V, Kreuzer M, Samet J, Bertke S, Kelly-Reif K, Schubauer-Berigan MK, Tomasek L, Wiggins C, Laurier D, Apostoaei I, Thomas BA, Simon SL, Hoffman FO, Boice JD, Dauer LT, Howard SC, Cohen SS, Mumma MT, Ellis ED, Eckerman KF, Leggett RW, Pawel DJ. The epidemiology of lung cancer following radiation exposure. Int J Radiat Biol 2022; 99:569-580. [PMID: 35947399 PMCID: PMC9943789 DOI: 10.1080/09553002.2022.2110321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Lydia B Zablotska
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - David B. Richardson
- Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences University of California, Irvine, Irvine, CA, USA
| | - Ashley Golden
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Elisa Pasqual
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20892, USA
| | | | - Estelle. Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | | | - Minh Do
- Occupational Cancer Research Centre, Toronto, Canada
| | - Nora Fenske
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Veronika Deffner
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | - Michaela Kreuzer
- Federal Office for Radiation Protection (BfS), Munich (Neuherberg), Germany
| | | | - Stephen Bertke
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Kaitlin Kelly-Reif
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | | | | | - Charles Wiggins
- University of New Mexico, Albuquerque, NM, USA
- New Mexico Tumor Registry, Albuquerque, NM, USA
| | - Dominque Laurier
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | | | - Brian A. Thomas
- Oak Ridge Center for Risk Analysis, Inc., Oak Ridge, TN, USA
| | - Steven L. Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20892, USA
| | - F. Owen Hoffman
- Oak Ridge Center for Risk Analysis, Inc., Oak Ridge, TN, USA
| | - John D. Boice
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- National Council on Radiation Protection and Measurements (NCRP), Bethesda, MD, USA
| | | | - Sara C. Howard
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
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11
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Little MP, Wakeford R, Bouffler SD, Abalo K, Hauptmann M, Hamada N, Kendall GM. Cancer risks among studies of medical diagnostic radiation exposure in early life without quantitative estimates of dose. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 832:154723. [PMID: 35351505 PMCID: PMC9167801 DOI: 10.1016/j.scitotenv.2022.154723] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/22/2022] [Accepted: 03/17/2022] [Indexed: 04/14/2023]
Abstract
BACKGROUND There is accumulating evidence of excess risk of cancer in various populations exposed at acute doses below several tens of mSv or doses received over a protracted period. There is also evidence that relative risks are generally higher after radiation exposures in utero or in childhood. METHODS AND FINDINGS We reviewed and summarised evidence from 89 studies of cancer following medical diagnostic exposure in utero or in childhood, in which no direct estimates of radiation dose are available. In all of the populations studied exposure was to sparsely ionizing radiation (X-rays). Several of the early studies of in utero exposure exhibit modest but statistically significant excess risks of several types of childhood cancer. There is a highly significant (p < 0.0005) negative trend of odds ratio with calendar period of study, so that more recent studies tend to exhibit reduced excess risk. There is no significant inter-study heterogeneity (p > 0.3). In relation to postnatal exposure there are significant excess risks of leukaemia, brain and solid cancers, with indications of variations in risk by cancer type (p = 0.07) and type of exposure (p = 0.02), with fluoroscopy and computed tomography scans associated with the highest excess risk. However, there is highly significant inter-study heterogeneity (p < 0.01) for all cancer endpoints and all but one type of exposure, although no significant risk trend with calendar period of study. CONCLUSIONS Overall, this large body of data relating to medical diagnostic radiation exposure in utero provides support for an associated excess risk of childhood cancer. However, the pronounced heterogeneity in studies of postnatal diagnostic exposure, the implied uncertainty as to the meaning of summary measures, and the distinct possibilities of bias, substantially reduce the strength of the evidence from the associations we observe between radiation imaging in childhood and the subsequent risk of cancer being causally related to radiation exposure.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA.
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester M13 9PL, UK
| | - Simon D Bouffler
- Radiation Effects Department, UK Health Security Agency (UKHSA), Chilton, Didcot OX11 0RQ, UK
| | - Kossi Abalo
- Laboratoire d'Épidémiologie, Institut de Radioprotection et de Sûreté Nucléaire, BP 17 92262 Fontenay-aux-Roses Cedex, France
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Strasse 38, 16816 Neuruppin, Germany
| | - Nobuyuki Hamada
- Radiation Safety Unit, Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 2-11-1 Iwado-kita, Komae, Tokyo 201-8511, Japan
| | - Gerald M Kendall
- Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford OX3 7LF, UK
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12
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Ghosh A. Biological and cellular responses of humans to high-level natural radiation: A clarion call for a fresh perspective on the linear no-threshold paradigm. MUTATION RESEARCH. GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2022; 878:503478. [PMID: 35649671 DOI: 10.1016/j.mrgentox.2022.503478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 06/15/2023]
Abstract
There remains considerable uncertainty in obtaining risk estimates of adverse health outcomes of chronic low-dose radiation. In the absence of reliable direct data, extrapolation through the linear no-threshold (LNT) hypothesis forms the cardinal tenet of all risk assessments for low doses (≤ 100 mGy) and for the radiation protection principle of As Low As Reasonably Achievable (ALARA). However, as recent evidences demonstrate, LNT assumptions do not appropriately reflect the biology of the cell at the low-dose end of the dose-response curve. In this regard, human populations living in high-level natural radiation areas (HLNRA) of the world can provide valuable insights into the biological and cellular effects of chronic radiation to facilitate improved precision of the dose-response relationship at low doses. Here, data obtained over decades of epidemiological and radiobiological studies on HLNRA populations is summarized. These studies do not show any evidence of unfavourable health effects or adverse cellular effects that can be correlated with high-level natural radiation. Contrary to the assumptions of LNT, no excess cancer risks or untoward pregnancy outcomes have been found to be associated with cumulative radiation dose or in-utero exposures. Molecular biology-driven studies demonstrate that chronic low-dose activates several cellular defence mechanisms that help cells to sense, recover, survive, and adapt to radiation stress. These mechanisms include stress-response signaling, DNA repair, immune alterations and most importantly, the radiation-induced adaptive response. The HLNRA data is consistent with the new evolving paradigms of low-dose radiobiology and can help develop the theoretical framework of an alternate dose-response model. A rational integration of radiobiology with epidemiology data is imperative to reduce uncertainties in predicting the potential health risks of chronic low doses of radiation.
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Affiliation(s)
- Anu Ghosh
- Animal House Facility & Radiation Signaling Section, Radiation Biology & Health Sciences Division, Bio-Science Group, Bhabha Atomic Research Centre, Mumbai 400 085, India; Homi Bhabha National Institute (HBNI), Anushaktinagar, Mumbai 400 094, India.
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13
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Patient dose in CT angiography examinations: An institutional survey. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Kwan ML, Miglioretti DL, Bowles EJA, Weinmann S, Greenlee RT, Stout NK, Rahm AK, Alber SA, Pequeno P, Moy LM, Stewart C, Fong C, Jenkins CL, Kohnhorst D, Luce C, Mor JM, Munneke JR, Prado Y, Buth G, Cheng SY, Deosaransingh KA, Francisco M, Lakoma M, Martinez YT, Theis MK, Marlow EC, Kushi LH, Duncan JR, Bolch WE, Pole JD, Smith-Bindman R. Quantifying cancer risk from exposures to medical imaging in the Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study: research methods and cohort profile. Cancer Causes Control 2022; 33:711-726. [PMID: 35107724 DOI: 10.1007/s10552-022-01556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study is quantifying the association between cumulative radiation exposure from fetal and/or childhood medical imaging and subsequent cancer risk. This manuscript describes the study cohorts and research methods. METHODS The RIC Study is a longitudinal study of children in two retrospective cohorts from 6 U.S. healthcare systems and from Ontario, Canada over the period 1995-2017. The fetal-exposure cohort includes children whose mothers were enrolled in the healthcare system during their entire pregnancy and followed to age 20. The childhood-exposure cohort includes children born into the system and followed while continuously enrolled. Imaging utilization was determined using administrative data. Computed tomography (CT) parameters were collected to estimate individualized patient organ dosimetry. Organ dose libraries for average exposures were constructed for radiography, fluoroscopy, and angiography, while diagnostic radiopharmaceutical biokinetic models were applied to estimate organ doses received in nuclear medicine procedures. Cancers were ascertained from local and state/provincial cancer registry linkages. RESULTS The fetal-exposure cohort includes 3,474,000 children among whom 6,606 cancers (2394 leukemias) were diagnosed over 37,659,582 person-years; 0.5% had in utero exposure to CT, 4.0% radiography, 0.5% fluoroscopy, 0.04% angiography, 0.2% nuclear medicine. The childhood-exposure cohort includes 3,724,632 children in whom 6,358 cancers (2,372 leukemias) were diagnosed over 36,190,027 person-years; 5.9% were exposed to CT, 61.1% radiography, 6.0% fluoroscopy, 0.4% angiography, 1.5% nuclear medicine. CONCLUSION The RIC Study is poised to be the largest study addressing risk of childhood and adolescent cancer associated with ionizing radiation from medical imaging, estimated with individualized patient organ dosimetry.
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Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, CA, USA.,Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.,Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Robert T Greenlee
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Alanna Kulchak Rahm
- Center for Health Research, Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Susan A Alber
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - Lisa M Moy
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Carly Stewart
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Charisma L Jenkins
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Diane Kohnhorst
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Casey Luce
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Joanne M Mor
- Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Julie R Munneke
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Yolanda Prado
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Glen Buth
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | | | - Kamala A Deosaransingh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Melanie Francisco
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Matthew Lakoma
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Emily C Marlow
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - James R Duncan
- Interventional Radiology Section, Washington University in St. Louis, St. Louis, MI, USA
| | - Wesley E Bolch
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Jason D Pole
- ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Rebecca Smith-Bindman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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15
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Little MP, Wakeford R, Bouffler SD, Abalo K, Hauptmann M, Hamada N, Kendall GM. Review of the risk of cancer following low and moderate doses of sparsely ionising radiation received in early life in groups with individually estimated doses. ENVIRONMENT INTERNATIONAL 2022; 159:106983. [PMID: 34959181 PMCID: PMC9118883 DOI: 10.1016/j.envint.2021.106983] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/16/2021] [Accepted: 11/13/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND The detrimental health effects associated with the receipt of moderate (0.1-1 Gy) and high (>1 Gy) acute doses of sparsely ionising radiation are well established from human epidemiological studies. There is accumulating direct evidence of excess risk of cancer in a number of populations exposed at lower acute doses or doses received over a protracted period. There is evidence that relative risks are generally higher after radiation exposures in utero or in childhood. METHODS AND FINDINGS We reviewed and summarised evidence from 60 studies of cancer or benign neoplasms following low- or moderate-level exposure in utero or in childhood from medical and environmental sources. In most of the populations studied the exposure was predominantly to sparsely ionising radiation, such as X-rays and gamma-rays. There were significant (p < 0.001) excess risks for all cancers, and particularly large excess relative risks were observed for brain/CNS tumours, thyroid cancer (including nodules) and leukaemia. CONCLUSIONS Overall, the totality of this large body of data relating to in utero and childhood exposure provides support for the existence of excess cancer and benign neoplasm risk associated with radiation doses < 0.1 Gy, and for certain groups exposed to natural background radiation, to fallout and medical X-rays in utero, at about 0.02 Gy.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA.
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester M13 9PL, UK
| | - Simon D Bouffler
- Radiation Effects Department, UK Health Security Agency (UKHSA), Chilton, Didcot OX11 0RQ, UK
| | - Kossi Abalo
- Laboratoire d'Épidémiologie, Institut de Radioprotection et de Sûreté Nucléaire, BP 17, 92262 Fontenay-aux-Roses Cedex, France
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Strasse 38, 16816 Neuruppin, Germany
| | - Nobuyuki Hamada
- Radiation Safety Unit, Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 2-11-1 Iwado-kita, Komae, Tokyo 201-8511, Japan
| | - Gerald M Kendall
- Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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16
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Little MP, Patel A, Lee C, Hauptmann M, Berrington de Gonzalez A, Albert P. Impact of Reverse Causation on Estimates of Cancer Risk Associated With Radiation Exposure From Computerized Tomography: A Simulation Study Modeled on Brain Cancer. Am J Epidemiol 2022; 191:173-181. [PMID: 34642734 DOI: 10.1093/aje/kwab247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 08/27/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Use of computed tomography (CT) scanning has increased substantially since its introduction in the 1990s. Several authors have reported increased risk of leukemia and brain tumors associated with radiation exposure from CT scans. However, reverse causation is a concern, particularly for brain cancer; in other words, the CT scan may have been taken because of preexisting cancer and therefore not have been a cause. We assessed the possibility of reverse causation via a simulation study focused on brain tumors, using a simplified version of the data structure for recent CT studies. Five-year-lagged and unlagged analyses implied an observed excess risk per scan up to 70% lower than the true excess risk per scan, particularly when more than 10% of persons with latent cancer had increased numbers of scans or the extra scanning rate after development of latent cancer was greater than 2 scans/year; less extreme values of these parameters imply little risk attenuation. Without a lag and when more than 20% of persons with latent cancer had increased scans-an arguably implausible scenario-the excess risk per scan was increased over the true excess risk per scan by up to 35%-40%. This study suggests that with a realistic lag, reverse causation results in downwardly biased risk, a result of induced classical measurement error, and is therefore unlikely to produce a spurious positive association between cancer and radiation dose from CT scans.
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17
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Garg M, Prabhakar N, Bhalla AS. Cancer risk of CT scan in COVID-19: Resolving the dilemma. Indian J Med Res 2021; 153:568-571. [PMID: 34596597 PMCID: PMC8555607 DOI: 10.4103/ijmr.ijmr_1476_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mandeep Garg
- Department of Radiodiagnosis & Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis & Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110 029, India
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18
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Zamani H, Kavousi N, Masjedi H, Omidi R, Rahbar S, Perota G, Razavi E, Zare MH, Abedi-Firouzjah R. ESTIMATION OF DIAGNOSTIC REFERENCE LEVELS AND ACHIEVABLE DOSES FOR PEDIATRIC PATIENTS IN COMMON COMPUTED TOMOGRAPHY EXAMINATIONS: A MULTI-CENTER STUDY. RADIATION PROTECTION DOSIMETRY 2021; 194:214-222. [PMID: 34244802 DOI: 10.1093/rpd/ncab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/06/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
This study was conducted to determine first local diagnostic reference levels (DRLs) and achievable doses (ADs) for pediatric patients during the most common computed tomography (CT) procedures in Yazd province. The DRL was obtained based on volume CT dose index (CTDIvol) and dose length product (DLP) for four various age groups of children. Data were collected from the most commonly performed pediatric CT scans, including abdomen-pelvis, chest, brain and sinus examinations, at six high-loaded institutes. The patients' data (766 no.) in terms of CTDIvol and DLP were obtained from four age groups: ≤1-, 1-5-, 5-10- and 10-15-y-old. The 75th percentiles of CTDIvol and DLP were considered as DRL values and the 50th percentiles were described as ADs for those parameters. Consequently, the acquired DRLs were compared with other national and international published values. The DRLs in terms of CTDIvol for abdomen-pelvis, chest, brain and sinus examinations were 3, 8, 9 and 10 mGy; 4, 5, 5 and 5 mGy; 25, 28, 29 and 38 mGy; and 23, 24, 26 and 27 mGy for four different age groups of ≤1-, 1-5-, 5-10- and 10-15-y-old, respectively. The DRL values in terms of DLP were 75, 302, 321 and 342 mGy.cm; 109, 112, 135 and 170 mGy.cm, 352, 355, 360 and 481 mGy.cm; and 206, 211, 228 and 245 mGy.cm, respectively, for the mentioned age groups. In this study, the DRL and AD values in the brain examination were greater among the other studied regions. The DRL plays a critical role in the optimization of radiation doses delivered to patients and in improving their protection. This study provides the local DRLs and ADs for the most common pediatric CT scanning in Yazd province to create optimum situation for the clinical practice.
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Affiliation(s)
- Hamed Zamani
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd 8915173160, Iran
| | - Nasim Kavousi
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Masjedi
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd 8915173160, Iran
| | - Reza Omidi
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd 8915173160, Iran
| | - Shiva Rahbar
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd 8915173160, Iran
| | - Ghazale Perota
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd 8915173160, Iran
| | | | - Mohammad Hosein Zare
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd 8915173160, Iran
- Clinical Research Development Center of Shahid Sadoughi hospital, Shahid Sadoughi University of Medical Sciences, Yazd 8915173160, Iran
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19
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Ploussi A, Brountzos E, Rammos S, Apostolopoulou S, Efstathopoulos EP. Radiation Exposure in Pediatric Interventional Procedures. Cardiovasc Intervent Radiol 2021; 44:857-865. [PMID: 34009422 DOI: 10.1007/s00270-020-02752-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/18/2020] [Indexed: 01/14/2023]
Abstract
The article is part of the series of articles on radiation protection. You can find further articles in the special section of the CVIR issue. The expanding applications of interventional procedures coupled with the potential harmful effects of ionizing radiation highlight the need to assess the delivered radiation dose and establish an effective radiation protection program, particularly in the radiosensitive pediatric population. Given the complexity and heterogeneity of interventional procedures as well as the unique characteristics of children, the management of radiation dose is proving to be quite challenging. The aim of the current article is to provide an overview of the radiation exposure in pediatric patients during interventional procedures focusing on the importance of radiation protection in the pediatric population, the reported radiation doses and the techniques of minimizing radiation dose.
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Affiliation(s)
- Agapi Ploussi
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Spyridon Rammos
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, "Onassis" Cardiac Surgery Center, Andrea Siggrou 356 Av., 17674, Kallithea, Greece
| | - Sotiria Apostolopoulou
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, "Onassis" Cardiac Surgery Center, Andrea Siggrou 356 Av., 17674, Kallithea, Greece
| | - Efstathios P Efstathopoulos
- 2nd Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece.
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20
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Kadowaki Y, Hamada N, Kai M, Furukawa K. Evaluation of the lifetime brain/central nervous system cancer risk associated with childhood head CT scanning in Japan. Int J Cancer 2021; 148:2429-2439. [PMID: 33320957 DOI: 10.1002/ijc.33436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022]
Abstract
The use of computed tomography (CT) scanning has increased worldwide over the decades, and Japan is one of the leading countries in annual frequency of diagnostic CT. Although benefits of CT scan are undisputable, concerns have been raised about potential health effects of ionizing radiation exposure from CT, particularly among children who are likely more susceptible to radiation than adults. Our study aims to evaluate the cumulated lifetime risk of the brain/central nervous system (CNS) cancer due to head CT examinations performed on Japanese children at age 0 to 10 years in 2012, 2015 and 2018. The frequency and dose distribution of head CT examinations were estimated based on information from recent national statistics and nationwide surveys. The lifetime risk attributable to exposure was calculated by applying risk models based on the study of Japanese atomic-bomb survivors. In contrast to the overall increasing trend, the frequency of childhood CT, especially at age < 5, was decreasing, reflecting a growing awareness for efforts to reduce childhood CT exposure over the past decade. In 2018, 138 532 head CT examinations were performed at age 0 to 10, which would consequently induce a lifetime excess of 22 cases (1 per 6300 scans) of brain/CNS cancers, accounting for 5% of the total cases. More excess cases were estimated among men than among women, and excess cases could emerge at relatively young ages. These results would have useful implications as scientific basis for future large-scale epidemiological studies and also as quantitative evidence to justify the benefits of CT vs risks in Japan.
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Affiliation(s)
- Yuko Kadowaki
- Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | - Michiaki Kai
- Department of Environmental Health Science, Oita University of Nursing and Health Sciences, Oita, Japan
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21
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Wakeford R, Bithell JF. A review of the types of childhood cancer associated with a medical X-ray examination of the pregnant mother. Int J Radiat Biol 2021; 97:571-592. [PMID: 33787450 DOI: 10.1080/09553002.2021.1906463] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/11/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE For 65 years the interpretation of the statistical association between the risk of cancer in a child and a prior diagnostic X-ray examination of the abdomen of the pregnant mother has been debated. The objections to a direct cause-and-effect explanation of the association vary in their strength, but one of the most notable grounds for controversy is the finding from the first and largest case-control study reporting the association, the Oxford Survey of Childhood Cancers (OSCC), of an almost uniformly raised relative risk (RR) for nearly all of the types of cancer that are most frequent in children. Here we compare the antenatal X-ray associations found in the OSCC for different types of childhood cancer with the results of all other case-control and case-cohort studies appropriately combined in meta-analyses, and we also review the findings of the few cohort studies that have been conducted. CONCLUSIONS From the case-control/case-cohort studies other than the OSCC there are consistent and clear elevations of risk for all types of childhood cancer combined, all leukemia, and all cancers except leukemia combined. This compatibility of the findings of the OSCC with those of the combined other studies is less clear, or effectively absent, when some categories containing smaller numbers of incident cases/deaths are considered, but lack of precision of risk estimates due to sparse data presents inferential challenges, although there is a consistent absence of an association for bone tumors. Further, more recent studies almost certainly address lower intrauterine doses, with an anticipated decrease in estimated risks, which could be misleading when comparisons involve a limited number of studies that are mainly from later years, and a similar problem arises when having to employ all types of antenatal X-ray exposures for a study because data for abdominal exposures are absent. The problem of low statistical power is greater for cohort studies, and this, together with other shortcomings identified in the studies, limits the interpretational value of results. The findings of non-medical intrauterine exposure studies are constrained by sparse data and make a limited contribution to an understanding of the association. Certain aspects of the various studies require a need for caution in interpretation, but overall, the appropriate combination of all case-control/case-cohort studies other than the OSCC lends support to the inference that low-level exposure to radiation in utero proportionally increases the risk of the typical cancers of childhood to around the same level.
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Affiliation(s)
- Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| | - John F Bithell
- Department of Statistics, University of Oxford, Oxford, UK
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22
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Apostoaei AI, Thomas BA, Hoffman FO, Kocher DC, Thiessen KM, Borrego D, Lee C, Simon SL, Zablotska LB. Fluoroscopy X-Ray Organ-Specific Dosimetry System (FLUXOR) for Estimation of Organ Doses and Their Uncertainties in the Canadian Fluoroscopy Cohort Study. Radiat Res 2021; 195:385-396. [PMID: 33544842 PMCID: PMC8133309 DOI: 10.1667/rade-20-00212.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/13/2021] [Indexed: 11/03/2022]
Abstract
As part of ongoing efforts to assess lifespan disease mortality and incidence in 63,715 patients from the Canadian Fluoroscopy Cohort Study (CFCS) who were treated for tuberculosis between 1930 and 1969, we developed a new FLUoroscopy X-ray ORgan-specific dosimetry system (FLUXOR) to estimate radiation doses to various organs and tissues. Approximately 45% of patients received medical procedures accompanied by fluoroscopy, including artificial pneumothorax (air in pleural cavity to collapse of lungs), pneumoperitoneum (air in peritoneal cavity), aspiration of fluid from pleural cavity and gastrointestinal series. In addition, patients received chest radiographs for purposes of diagnosis and monitoring of disease status. FLUXOR utilizes age-, sex- and body size-dependent dose coefficients for fluoroscopy and radiography exams, estimated using radiation transport simulations in up-to-date computational hybrid anthropomorphic phantoms. The phantoms include an updated heart model, and were adjusted to match the estimated mean height and body mass of tuberculosis patients in Canada during the relevant time period. Patient-specific data (machine settings, exposure duration, patient orientation) used during individual fluoroscopy or radiography exams were not recorded. Doses to patients were based on parameter values inferred from interviews with 91 physicians practicing at the time, historical literature, and estimated number of procedures from patient records. FLUXOR uses probability distributions to represent the uncertainty in the unknown true, average value of each dosimetry parameter. Uncertainties were shared across all patients within specific subgroups of the cohort, defined by age at treatment, sex, type of procedure, time period of exams and region (Nova Scotia or other provinces). Monte Carlo techniques were used to propagate uncertainties, by sampling alternative average values for each parameter. Alternative average doses per exam were estimated for patients in each subgroup, with the total average dose per individual determined by the number of exams received. This process was repeated to produce alternative cohort vectors of average organ doses per patient. This article presents estimates of doses to lungs, female breast, active bone marrow and heart wall. Means and 95% confidence intervals (CI) of average organ doses across all 63,715 patients were 320 (160, 560) mGy to lungs, 250 (120, 450) mGy to female breast, 190 (100, 340) mGy to heart wall and 92 (47, 160) mGy to active bone marrow. Approximately 60% of all patients had average doses to the four studied organs of less than 10 mGy, 10% received between 10 and 100 mGy, 25% between 100 and 1,000 mGy, and 5% above 1,000 mGy. Pneumothorax was the medical procedure that accounted for the largest contribution to cohort average doses. The major contributors to uncertainty in estimated doses per procedure for the four organs of interest are the uncertainties in exposure duration, tube voltage, tube output, and patient orientation relative to the X-ray tube, with the uncertainty in exposure duration being most often the dominant source. Uncertainty in patient orientation was important for doses to female breast, and, to a lesser degree, for doses to heart wall. The uncertainty in number of exams was an important contributor to uncertainty for ∼30% of patients. The estimated organ doses and their uncertainties will be used for analyses of incidence and mortality of cancer and non-cancer diseases. The CFCS cohort is an important addition to existing radio-epidemiological cohorts, given the moderate-to-high doses received fractionated over several years, the type of irradiation (external irradiation only), radiation type (X rays only), a balanced combination of both genders and inclusion of people of all ages.
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Affiliation(s)
| | - Brian A. Thomas
- Oak Ridge Center for Risk Analysis, Inc., Oak Ridge, Tennessee 37830
| | - F. Owen Hoffman
- Oak Ridge Center for Risk Analysis, Inc., Oak Ridge, Tennessee 37830
| | - David C. Kocher
- Oak Ridge Center for Risk Analysis, Inc., Oak Ridge, Tennessee 37830
| | | | - David Borrego
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-9778
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-9778
| | - Steven L. Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-9778
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California 94143-1228
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23
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Lee KH, Lee S, Park JH, Lee SS, Kim HY, Lee WJ, Cha ES, Kim KP, Lee W, Lee JY, Lee KH. Risk of Hematologic Malignant Neoplasms From Abdominopelvic Computed Tomographic Radiation in Patients Who Underwent Appendectomy. JAMA Surg 2021; 156:343-351. [PMID: 33471110 DOI: 10.1001/jamasurg.2020.6357] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Whether computed tomography (CT) radiation is truly carcinogenic remains controversial. Large epidemiological studies that purportedly showed an association between CT radiation and carcinogenesis were limited by confounding by indication and reverse causation, because the reasons for CT examination were unknown. Objective To measure the risk of hematologic malignant neoplasms associated with perioperative abdominopelvic CT radiation among patients who underwent appendectomy for acute appendicitis. Design, Setting, and Participants This nationwide population-based cohort study used the National Health Insurance Service claims database in South Korea to assess 825 820 patients who underwent appendectomy for appendicitis from January 1, 2005, to December 31, 2015, and had no underlying risk factors for cancer. Patients were divided into CT-exposed (n = 306 727) or CT-unexposed (n = 519 093) groups. The study was terminated on December 31, 2017, and data were analyzed from October 30, 2018, to September 27, 2020. Exposures Perioperative abdominopelvic CT examination from 7 days before to 7 days after appendectomy. Main Outcomes and Measures The primary outcome was the incidence rate ratio (IRR) of hematologic malignant neoplasms for both groups. The secondary outcomes were IRR of abdominopelvic organ cancers and IRR of all cancers. The lag period was 2 years for the primary outcome and 5 years for secondary outcomes. The IRRs were calculated using Poisson regression models with adjustment for age and sex. Results Among the study population of 825 820 patients (52.9% male; median age, 28 [interquartile range, 15-41] years), hematologic malignant neoplasms developed in 323 patients in the CT-exposed group during 1 486 518 person-years and 500 patients in the CT-unexposed group during 3 422 059 person-years. For all hematologic malignant neoplasms, the IRR for the CT-exposed vs CT-unexposed group was 1.26 (95% CI, 1.09-1.45; P = .002). In terms of individual categories of hematologic malignant neoplasms, the CT-exposed group had an elevated risk only for leukemia (IRR, 1.40 [98.75% CI, 1.04-1.87, adjusted by Bonferroni correction]; P = .005). There was no between-group difference in incidence rate of abdominopelvic organ cancers (IRR, 1.07 [95% CI, 1.00-1.15]; P = .06) and that of all cancers (IRR, 1.04 [95% CI, 0.99-1.09]; P = .14). Conclusions and Relevance This study controlled for reverse causation bias by defining the reasons for CT scan, and findings suggest that abdominopelvic CT radiation is associated with a higher incidence of hematologic malignant neoplasms. Efforts should be continued for judicious use of CT examinations.
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Affiliation(s)
- Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea
| | - Seungjae Lee
- Department of Applied Bioengineering, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea.,Department of Applied Bioengineering, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Korea
| | - Sung Soo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Hae Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Gyeonggi-do, Korea
| | - Woojoo Lee
- Department of Public Health Science, Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Ji Yun Lee
- Division of Hematology-Oncology, Department of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea.,Department of Applied Bioengineering, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Korea.,Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea
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24
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Lacy T, Ding A, Minkemeyer V, Frush D, Samei E. Patient-based Performance Assessment for Pediatric Abdominal CT: An Automated Monitoring System Based on Lesion Detectability and Radiation Dose. Acad Radiol 2021; 28:217-224. [PMID: 32063494 DOI: 10.1016/j.acra.2020.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/18/2020] [Accepted: 01/18/2020] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVE To deploy an automated tool for evaluating pediatric body computed tomography (CT) performance utilizing metrics of radiation dose and image quality for the task of liver lesion detection. MATERIALS AND METHODS This IRB approved retrospective investigation used 507 IV-contrast-enhanced abdominopelvic CT scans of pediatric patients (<18 years) between June 2014 and November 2017 acquired on three scanner models from two manufacturers. The scans were evaluated in terms of radiation metrics (CTDIvol, DLP, and SSDE) as well as task-based performance based on the clinical task of detecting a 5 mm liver lesion with a 10 HU attenuation difference from background liver. An informatics algorithm extracted a previously-validated quantitative detectability index (d') from each case reflective of the likelihood of detecting a liver lesion. The results were analyzed in terms of the relationship between d' and radiation dose metrics. RESULTS There was minimal SSDE variability by age. Median SSDE at 100 kV on one scanner model was 5.2 mGy (5.0-5.4 mGy interquartile range). However, when assessing image quality by applying d', the age groups separated such that the younger patients had higher d' values than older patients. Similar trends were seen in all scanners. CONCLUSIONS An automated method to assess clinical image quality for pediatric CT provided a metric of image quality that varied as expected across ages (i.e., higher quality for younger patients). This tool affords the establishment of a quality reference level that, in addition to dose estimations currently available, would allow for enhanced assessment (e.g., facilitated audit) of CT imaging performance.
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25
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Koterov AN, Ushenkova LN, Biryukov AP. Hill’s Temporality Criterion: Reverse Causation and Its Radiation Aspect. BIOL BULL+ 2021. [DOI: 10.1134/s1062359020120031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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26
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Leventer-Roberts M, Lev Bar-Or R, Gofer I, Rosenbaum Z, Hoshen M, Feldman B, Balicer R. Choosing Wisely: Determining performance of unjustified imaging in a large healthcare system. Int J Clin Pract 2021; 75:e13644. [PMID: 32748452 DOI: 10.1111/ijcp.13644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 07/24/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS The Choosing Wisely Campaign identifies procedures and treatments that lack clinical justification for routine use according to expert opinion and evidence-based medicine. This study describes the rates and features of two such examples over a 10-year period. METHODS This is a cross-sectional rolling cohort study between 2008 and 2017 in Clalit Health Services, the largest healthcare delivery system in Israel, with seven main hospitals and over 4.5 million members nationwide. All adult members who visited a Clalit Emergency Department (ED), and all children members who visited a Clalit ED for abdominal pain or appendicitis were eligible to be included in this study. Our measures were routine chest radiograph (CXR) in the context of pre-admission assessment for adults and abdominal computed tomography (CT) to rule out appendicitis for children. RESULTS Of the 3 689 869 adult visits without a clinical indication for a CXR, 9.1% or 337 058 of them received a chest radiograph. Of the 35 973 children visits for presumed appendicitis, 7.2% of them had no imaging performed, 82.3% had an ultrasound (US), 6.9% had an US followed by a CT, and 3.6% or 1293 of them received a CT. There were several independent risk factors such as BMI, hospital, sex, year and diagnosis that are associated with having imaging that is not clinically indicated. CONCLUSIONS Overall, this study found that diagnostic imaging practices are applied inconsistently by hospital and by population. Intervention efforts should be focused on subpopulations at greatest risk to further reduce exposure to such imaging.
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Affiliation(s)
- Maya Leventer-Roberts
- Clalit Research Institute, Tel Aviv, Israel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ilan Gofer
- Clalit Research Institute, Tel Aviv, Israel
| | | | | | | | - Ran Balicer
- Clalit Research Institute, Tel Aviv, Israel
- Clalit Health Services, Tel Aviv, Israel
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
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27
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Early life ionizing radiation exposure and cancer risks: systematic review and meta-analysis. Pediatr Radiol 2021; 51:45-56. [PMID: 32910229 DOI: 10.1007/s00247-020-04803-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/12/2020] [Accepted: 08/05/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Ionizing radiation use for medical diagnostic purposes has substantially increased over the last three decades. Moderate to high doses of radiation are well established causes of cancer, especially for exposure at young ages. However, cancer risk from low-dose medical imaging is debated. OBJECTIVE To review the literature on cancer risks associated with prenatal and postnatal medical diagnostic ionizing radiation exposure among children and to assess this risk through a meta-analysis. MATERIALS AND METHODS A literature search of five electronic databases supplemented by a hand search was performed to retrieve relevant epidemiological studies published from 2000 to 2019, including patients younger than 22 years of age exposed to medical imaging ionizing radiation. Pooled odds ratio (ORpooled) and pooled excess relative risk (ERRpooled) representing the excess of risk per unit of organ dose were estimated with a random effect model. RESULTS Twenty-four studies were included. For prenatal exposure (radiographs or CT), no significant increased risk was reported for all cancers, leukemia and brain tumors. For postnatal exposure, increased risk was observed only for CT, mostly for leukemia (ERRpooled=26.9 Gy-1; 95% confidence interval [CI]: 2.7-57.1) and brain tumors (ERRpooled=9.1 Gy-1; 95% CI: 5.2-13.1). CONCLUSION CT exposure in childhood appears to be associated with increased risk of cancer while no significant association was observed with diagnostic radiographs.
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28
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Stowe J, O Halloran C, Photopoulos G, Lia AD, Quinn M, Tschan F, Verwoolde R, Buissink C. CTSim: Changing teaching practice in radiography with simulation. Radiography (Lond) 2020; 27:490-498. [PMID: 33250357 DOI: 10.1016/j.radi.2020.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Simulation offers radiography students the possibility to experiment with Computed Tomography (CT) in a way not possible in clinical practice. The aim of this work was to test a newly developed simulator 'CTSim' for effectiveness in teaching and learning. METHODS The simulator was tested in two phases. The first phase used a test-retest methodology with two groups, a group that experienced a Simulation based learning intervention and one which did not. The second phase subsequently tested for changes when the same intervention was introduced as part of an existing CT training module. RESULTS Phase 1 demonstrated statistically significant improvement of mean scores from 58% to 68% (P < .05) for students who experienced the intervention against no change in scores for the control group. Phase 2 saw mean scores improve statistically significantly in a teaching module from 66% to 73% (P < .05) following the application of the intervention as an active learning component. CONCLUSION The use of the CTSim simulator had a demonstrable effect on student learning when used as an active learning component in CT teaching. IMPLICATIONS FOR PRACTICE Simulation tools have a place in enhancing teaching and learning in terms of effectiveness and also introduce variety in the medium by which this is done.
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Affiliation(s)
- J Stowe
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland.
| | - C O Halloran
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - G Photopoulos
- Radiological Technology Program, School of Health Sciences, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A D Lia
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - M Quinn
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - F Tschan
- Haute École de Santé Vaud, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - R Verwoolde
- Department of Medical Imaging and Radiation Therapy, Hanze University of Applied, Sciences, Groningen, Netherlands
| | - C Buissink
- Department of Medical Imaging and Radiation Therapy, Hanze University of Applied, Sciences, Groningen, Netherlands
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29
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Ploussi A, Syrgiamiotis V, Makri T, Hatzigiorgi C, Efstathopoulos EP. Local diagnostic reference levels in pediatric CT examinations: a survey at the largest children's hospital in Greece. Br J Radiol 2020; 93:20190358. [PMID: 32976036 PMCID: PMC7716000 DOI: 10.1259/bjr.20190358] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The increased frequency of pediatric CT examinations and the high radiosensitivity of children entail the need to determine DRLs and optimize CT protocols. The aim of the study was twofold. Firstly, to establish pediatric LDRLs according to age and weight for the most common types of CT examinations at the largest children's hospital in Greece. Secondly, to compare LDRLs with European DRLs. METHODS A total of 756 pediatric patients who underwent head, chest, and abdomen-pelvis CT examinations were included. Patients were categorized into age groups according to the hospital's protocols. All CT examinations were performed using iterative reconstruction algorithm and AEC. LDRLs were determined in terms of 75th percentile of CTDIvol and DLP. Values of LDRLs were subsequently regrouped into weight categories and compared with European DRLs. RESULTS Gathering all age groups for head CT examinations and all weight groups for body CT examinations, LDRLs were ranged from (22-68, 2-5, 2-10) mGy in terms of CTDIvol; (317-786, 22-168, 58-425) mGy.cm in terms of DLP per acquisition and (324-838, 42-265, 85-498) mGy.cm in terms of total DLP for head, chest and abdomen-pelvis CT examinations, respectively. CONCLUSION CTDI LDRLs were comparable to European DRLs for head and either comparable or lower than European DRLs for body CT examinations. DLP LDRLs were higher than European DRLs for head and lower for body CT examinations. ADVANCES IN KNOWLEDGE Age- and weight-based LDRLs for pediatric CT examinations were established for the largest children's hospital in Greece. Further investigations across the country are required for the establishment of national pediatric DRLs in Greece.
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Affiliation(s)
- Agapi Ploussi
- 2nd Department of Radiology, University General Hospital ‘Attikon’, School of Medicine, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | | | | | | | - Efstathios P. Efstathopoulos
- 2nd Department of Radiology, University General Hospital ‘Attikon’, School of Medicine, National and Kapodistrian University of Athens, 12462, Athens, Greece
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Harbron RW, Pasqual E. Ionising radiation as a risk factor for lymphoma: a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:R151-R185. [PMID: 33017815 DOI: 10.1088/1361-6498/abbe37] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
The ability of ionising radiation to induce lymphoma is unclear. Here, we present a narrative review of epidemiological evidence of the risk of lymphoma, including chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM), among various exposed populations including atomic bombing survivors, industrial and medical radiation workers, and individuals exposed for medical purposes. Overall, there is a suggestion of a positive dose-dependent association between radiation exposure and lymphoma. The magnitude of this association is highly imprecise, however, with wide confidence intervals frequently including zero risk. External comparisons tend to show similar incidence and mortality rates to the general population. Currently, there is insufficient information on the impact of age at exposure, high versus low linear energy transfer radiation, external versus internal or acute versus chronic exposures. Associations are stronger for males than females, and stronger for non-Hodgkin lymphoma and MM than for Hodgkin lymphoma, while the risk of radiation-induced CLL may be non-existent. This broad grouping of diverse diseases could potentially obscure stronger associations for certain subtypes, each with a different cell of origin. Additionally, the classification of malignancies as leukaemia or lymphoma may result in similar diseases being analysed separately, while distinct diseases are analysed in the same category. Uncertainty in cell of origin means the appropriate organ for dose response analysis is unclear. Further uncertainties arise from potential confounding or bias due to infectious causes and immunosuppression. The potential interaction between radiation and other risk factors is unknown. Combined, these uncertainties make lymphoma perhaps the most challenging malignancy to study in radiation epidemiology.
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Affiliation(s)
- Richard W Harbron
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, United Kingdom
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elisa Pasqual
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Acharya PT, Parentes V, Frush DP, Reid JR. Radiation in Pediatric Imaging: A Primer for Pediatricians. Pediatr Ann 2020; 49:e370-e373. [PMID: 32929511 DOI: 10.3928/19382359-20200825-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Medical imaging in children makes up a considerable percentage of all imaging procedures performed in the United States. Although in recent years there has been a 15% to 20% reduction in the exposure to ionizing radiation from medical imaging in the US population, the total number of computed tomography (CT) scans has increased from 2006 to 2016, and about 85% of all medical ionizing radiation in children is due to CT. [Pediatr Ann. 2020;49(9):e370-e373.].
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Yoshitake T, Ono K, Ishiguchi T, Maeda T, Kai M. Clinical indications for the use of computed tomography in children who underwent frequent computed tomography: a near-13-year follow-up retrospective study at a single institution in Japan. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2020; 59:407-414. [PMID: 32556632 DOI: 10.1007/s00411-020-00857-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
Recent studies suggest a causal link of childhood leukemia and brain tumor with repeated computed tomography (CT) scans. The reasons why frequent CT scans are taken in a specific child remain unclear. The present study aimed to clarify the medical reasons why frequent CT examinations in children, and the characteristics of the diseases of those children that required multiple CT scans. A long-term follow-up retrospective study was conducted over a 12.75-year period at a single institution. Radiological reports were investigated that contained the indications for the CT scans. The clinical indications were classified for the examination of children under 16 years of age who underwent more than three CT scans into trauma, tumor, inflammation, and others. This study showed that 8.5% of CT examinations were done three times or more. The numbers of patients by indication were 23.3% for trauma, 5.3% for hydrocephalus, and 2.3% for appendicitis. The frequencies of trauma and inflammation decreased rapidly with an increasing number of CT scans. In particular, hydrocephalus brought high frequency more than ten scans. Regarding the frequencies of clinical indications by age groups, there was a significant difference (p<0.05). The near-13-year follow-up study indicated the main clinical indications for frequent CT scans in children were trauma and hydrocephalus. Multiple follow-up CT scans in children with hydrocephalus would be traded off against the resultant increase in brain tumor risk associated with CT exposure.
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Affiliation(s)
- Takayasu Yoshitake
- Shinbeppu Hospital, 3898 Tsurumi, Beppu City, Oita Prefecture, 874-0833, Japan.
- Oita University of Nursing and Hearth Sciences, 2944-9 Megusuno, Oita, Oita, Japan.
| | - Koji Ono
- Tokyo Healthcare University, 3-11-3 Setagaya, Setagaya-ku, Tokyo, Japan
| | - Tsuneo Ishiguchi
- Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, Japan
| | - Toru Maeda
- Oita Prefectural Hospital, 476 Bunyo, Oita, Oita, Japan
| | - Michiaki Kai
- Oita University of Nursing and Hearth Sciences, 2944-9 Megusuno, Oita, Oita, Japan
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Brenner AV, Sugiyama H, Preston DL, Sakata R, French B, Sadakane A, Cahoon EK, Utada M, Mabuchi K, Ozasa K. Radiation risk of central nervous system tumors in the Life Span Study of atomic bomb survivors, 1958-2009. Eur J Epidemiol 2020; 35:591-600. [PMID: 31982981 PMCID: PMC7329623 DOI: 10.1007/s10654-019-00599-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
Abstract
Radiation exposure is among the few factors known to be associated with risk of central nervous system (CNS) tumors. However, the patterns of radiation risk by histological type, sex or age are unclear. We evaluated radiation risks of first primary glioma, meningioma, schwannoma, and other or not otherwise specified (other/NOS) tumors in the Life Span Study cohort of atomic bomb survivors. Cases diagnosed between 1958 and 2009 were ascertained through population-based cancer registries in Hiroshima and Nagasaki. To estimate excess relative risk per Gy (ERR/Gy), we fit rate models using Poisson regression methods. There were 285 CNS tumors (67 gliomas, 107 meningiomas, 49 schwannomas, and 64 other/NOS tumors) among 105,444 individuals with radiation dose estimates to the brain contributing 3.1 million person-years of observation. Based on a simple linear model without effect modification, ERR/Gy was 1.67 (95% confidence interval, CI: 0.12 to 5.26) for glioma, 1.82 (95% CI: 0.51 to 4.30) for meningioma, 1.45 (95% CI: - 0.01 to 4.97) for schwannoma, and 1.40 (95% CI: 0.61 to 2.57) for all CNS tumors as a group. For each tumor type, the dose-response was consistent with linearity and appeared to be stronger among males than among females, particularly for meningioma (P = 0.045). There was also evidence that the ERR/Gy for schwannoma decreased with attained age (P = 0.002). More than 60 years after the bombings, radiation risks for CNS tumors continue to be elevated. Further follow-up is necessary to characterize the lifetime risks of specific CNS tumors following radiation exposure.
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Affiliation(s)
- Alina V Brenner
- Radiation Effects Research Foundation, Epidemiology, 5-2 Hijiyama Park, Minami-ku, Hiroshima, 732-0815, Japan.
| | - Hiromi Sugiyama
- Radiation Effects Research Foundation, Epidemiology, 5-2 Hijiyama Park, Minami-ku, Hiroshima, 732-0815, Japan
| | | | - Ritsu Sakata
- Radiation Effects Research Foundation, Epidemiology, 5-2 Hijiyama Park, Minami-ku, Hiroshima, 732-0815, Japan
| | - Benjamin French
- Radiation Effects Research Foundation, Epidemiology, 5-2 Hijiyama Park, Minami-ku, Hiroshima, 732-0815, Japan
| | - Atsuko Sadakane
- Radiation Effects Research Foundation, Epidemiology, 5-2 Hijiyama Park, Minami-ku, Hiroshima, 732-0815, Japan
| | - Elizabeth K Cahoon
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mai Utada
- Radiation Effects Research Foundation, Epidemiology, 5-2 Hijiyama Park, Minami-ku, Hiroshima, 732-0815, Japan
| | - Kiyohiko Mabuchi
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kotaro Ozasa
- Radiation Effects Research Foundation, Epidemiology, 5-2 Hijiyama Park, Minami-ku, Hiroshima, 732-0815, Japan
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Koterov AN. Causal Criteria in Medical and Biological Disciplines: History, Essence, and Radiation Aspect. Report 1. Problem Statement, Conception of Causes and Causation, False Associations. BIOL BULL+ 2020. [DOI: 10.1134/s1062359019110165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Meulepas JM, Ronckers CM, Smets AMJB, Nievelstein RAJ, Gradowska P, Lee C, Jahnen A, van Straten M, de Wit MCY, Zonnenberg B, Klein WM, Merks JH, Visser O, van Leeuwen FE, Hauptmann M. Radiation Exposure From Pediatric CT Scans and Subsequent Cancer Risk in the Netherlands. J Natl Cancer Inst 2020; 111:256-263. [PMID: 30020493 DOI: 10.1093/jnci/djy104] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/10/2018] [Accepted: 05/04/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Computed tomography (CT), a strong diagnostic tool, delivers higher radiation doses than most imaging modalities. As CT use has increased rapidly, radiation protection is important, particularly among children. We evaluate leukemia and brain tumor risk following exposure to low-dose ionizing radiation from CT scans in childhood. METHODS For a nationwide retrospective cohort of 168 394 children who received one or more CT scans in a Dutch hospital between 1979 and 2012 who were younger than age 18 years, we obtained cancer incidence, vital status, and confounder information by record linkage with external registries. Standardized incidence ratios were calculated using cancer incidence rates from the general Dutch population. Excess relative risks (ERRs) per 100 mGy organ dose were calculated with Poisson regression. All statistical tests were two-sided. RESULTS Standardized incidence ratios were elevated for all cancer sites. Mean cumulative bone marrow doses were 9.5 mGy at the end of follow-up, and leukemia risk (excluding myelodysplastic syndrome) was not associated with cumulative bone marrow dose (44 cases). Cumulative brain dose was on average 38.5 mGy and was statistically significantly associated with risk for malignant and nonmalignant brain tumors combined (ERR/100 mGy: 0.86, 95% confidence interval = 0.20 to 2.22, P = .002, 84 cases). Excluding tuberous sclerosis complex patients did not substantially change the risk. CONCLUSIONS We found evidence that CT-related radiation exposure increases brain tumor risk. No association was observed for leukemia. Compared with the general population, incidence of brain tumors was higher in the cohort of children with CT scans, requiring cautious interpretation of the findings.
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Affiliation(s)
- Johanna M Meulepas
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Cécile M Ronckers
- Department of Paediatric Oncology, Emma Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Anne M J B Smets
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | | | - Patrycja Gradowska
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology (LIST), Esch-sur-Alzette, Luxembourg, the Netherlands
| | - Marcel van Straten
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, the Netherlands
| | - Marie-Claire Y de Wit
- Department of Neurology and Paediatric Neurology, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Bernard Zonnenberg
- Department of Internal Medicine, University Medical Center Utrecht, the Netherlands
| | - Willemijn M Klein
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes H Merks
- Department of Paediatric Oncology, Emma Children's Hospital, University Medical Center Utrecht, the Netherlands.,Academic Medical Center Amsterdam, Amsterdam, the Netherlands; Dutch Childhood Oncology Group, the Hague, the Netherlands, University Medical Center Utrecht, the Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Jánošíková L, Juričeková M, Horváthová M, Nikodemová D, Klepanec A, Šalát D. RISK EVALUATION IN THE LOW-DOSE RANGE CT FOR RADIATION-EXPOSED CHILDREN, BASED ON DNA DAMAGE. RADIATION PROTECTION DOSIMETRY 2019; 186:163-167. [PMID: 31665516 PMCID: PMC7108815 DOI: 10.1093/rpd/ncz195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/04/2019] [Indexed: 05/19/2023]
Abstract
One of the most common usages of radiation in current medical diagnosis is computed tomography (CT) using X-rays. The potential health risk of CT scans has been discussed in various studies to determine whether low-dose radiation from CT could enhance the chromosome aberration yields in pediatric patients and increase their risk of carcinogenesis. For this reason, it is of great interest to study the effects of low-dose radiation. The induction of DNA damage by a CT scan examination has been demonstrated in several reports by the γ-H2AX assay, the micronuclei assay and dicentrics measurements. However, the results of most studies showed limitations. On the other hand, epidemiological studies give contradictory results for post-natal radiation exposure in the low-dose range, so it is still difficult to draw conclusions about the effects of CT examinations and risk of carcinogenesis. This article provides an overview of previously published data and summarizes the current state of knowledge.
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Affiliation(s)
- Lenka Jánošíková
- Institute of Physiotherapy, Balneology and Medical Rehabilitation, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
- Corresponding author:
| | - Martina Juričeková
- Faculty of Health Care and Social Work, University of Trnava in Trnava, Trnava, Slovakia
| | - Martina Horváthová
- Faculty of Health Care and Social Work, University of Trnava in Trnava, Trnava, Slovakia
| | | | - Andrej Klepanec
- Institute of Physiotherapy, Balneology and Medical Rehabilitation, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| | - Dušan Šalát
- Institute of Physiotherapy, Balneology and Medical Rehabilitation, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
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Baaken D, Hammer GP, Seidenbusch MC, Schneider K, Spix C, Blettner M, Pokora R, Lorenz E. Second follow-up of a German cohort on childhood cancer incidence after exposure to postnatal diagnostic x-ray. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2019; 39:1074-1091. [PMID: 31342929 DOI: 10.1088/1361-6498/ab3506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Studies on children exposed to ionising radiation by computed tomography (CT) indicate an increased risk of leukemia and central nervous system (CNS) tumors. Evidence of the risks associated with diagnostic x-ray examinations, the most frequent examination in pediatric radiology, in which the radiation dose is up to 750 times lower compared to CT examinations, is less clear. This study presents results of the second follow-up for the risk of childhood cancer in a cohort of children (<15 years) with diagnostic x-ray exposure at a large German hospital during 1976-2003 followed for additional 10 years until 2016. With a latency period of 6 months, 92 998 children contributed 794 549 person-years. The median effective dose was 7 μSv. Hundred incident cancer cases were identified: 35 leukemia, 13 lymphomas, 12 CNS tumors, 15 blastomas, 15 sarcomas and 10 other solid tumors, consisting of six germ cells tumors, three thyroid cancers and one adrenocortical carcinoma. For all cancer cases combined the standardised incidence ratio (SIR) was 1.14 (95% confidence interval (CI) 0.93-1.39), for leukemia 1.15 (95% CI 0.63-1.61), for lymphomas 1.03 (95% CI 0.55-1.76), for CNS tumors 0.65 (95% CI 0.34-1.14), for blastomas 1.77 (95% CI 0.91-2.91), for sarcomas 1.28 (95% CI 0.71-2.11) and for other solid tumors 2.38 (95% CI 1.14-4.38). Dose-response analysis using Poisson regression revealed no significant trend for dose groups. Results did not differ substantially with a latency period of 2 years for all cancer entities and 5 years for solid tumors in sensitivity analyses. Overall, the null results of the first follow-up were confirmed. Although an association between radiation exposure and a risk for certain solid tumors like thyroid cancer is known, the significantly increased SIR in the group of other solid tumors must be critically interpreted in the context of the small number of cases and the very low doses of radiation exposure in this group.
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Affiliation(s)
- Dan Baaken
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University, Mainz, Germany
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Lee C, Journy N, Moroz BE, Little M, Harbron R, McHugh K, Pearce M, Berrington de Gonzalez A. ORGAN DOSE ESTIMATION ACCOUNTING FOR UNCERTAINTY FOR PEDIATRIC AND YOUNG ADULT CT SCANS IN THE UNITED KINGDOM. RADIATION PROTECTION DOSIMETRY 2019; 184:44-53. [PMID: 30371899 PMCID: PMC6657815 DOI: 10.1093/rpd/ncy184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/26/2018] [Accepted: 10/18/2018] [Indexed: 05/13/2023]
Abstract
Since our previous publication of organ dose for the pediatric CT cohort in the UK, there have been questions about the magnitude of uncertainty in our dose estimates. We therefore quantified shared and unshared uncertainties in empirical CT parameters extracted from 1073 CT films (1978-2008) from 36 hospitals in the study and propagated these uncertainties into organ doses using Monte Carlo random sampling and NCICT organ dose calculator. The average of 500 median brain and marrow doses for the full cohort was 35 (95% confidence interval: 30-40) mGy and 6 (5-7) mGy, respectively. We estimated that shared uncertainty contributed ~99% of coefficient of variation of median brain doses in brain scans compared to unshared uncertainty (1% contribution). We found that the previous brain doses were slightly underestimated for <1990 and overestimated for >1990 compared to the results in the current study due to the revised CTDI models based on CT films.
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Affiliation(s)
- Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
- Corresponding author:
| | - Neige Journy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | - Brian E Moroz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | - Mark Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | - Richard Harbron
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kieran McHugh
- Radiology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Mark Pearce
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD, USA
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Ubeda C, Vano E, Miranda P, Figueroa X. Organ and effective doses detriment to paediatric patients undergoing multiple interventional cardiology procedures. Phys Med 2019; 60:182-187. [PMID: 31000081 DOI: 10.1016/j.ejmp.2019.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/10/2019] [Accepted: 03/19/2019] [Indexed: 11/29/2022] Open
Abstract
The aims of the present study were to present the frequency of multiple interventional cardiac procedures for a certain group of patients obtained at one of the largest paediatric hospitals in Chile. In addition it has been analysed cumulative kerma area product (KAP) and cumulative air kerma (CAK), and calculated organ doses for the patient groups undergoing 2, 3 and ≥ 4 procedures, using Monte Carlo software. Effective doses were also estimated for epidemiological purposes and to permit comparison with other imaging procedures. The sample used corresponds to the last 9 years and refers to a total of 1521 paediatric patients and 1824 interventional cardiac procedures. The results for frequency were: 13.7% of patients underwent 2 procedures, 4.1% underwent 3 procedures and 1.4% underwent 4 or more procedures. The median KAP and CAK values measured for the cumulative procedures in these three groups of patients were 3.7, 5.4 and 10.8 Gy·cm2 and 59.9, 83.2 and 147.6 mGy, respectively. In terms of the most irradiated organs during interventional cardiac procedures, the highest median values (for the group of ≥4 procedures) were: active bone marrow 5.0 mGy, lungs 23.5 mGy, oesophagus 15.2 mGy, thyroid 7.8 mGy and breast 11.0 mGy. Median dose value to the heart (for the group of ≥4 procedures) was 12.7 mGy. Median values in terms of calculated effective dose for the three patient groups (with 2, 3 and ≥4 procedures) were 3.4, 5.9 and 8.7 mSv, respectively.
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Affiliation(s)
- Carlos Ubeda
- Medical Technology Department, Health Sciences Faculty, Universidad de Tarapacá, Arica, Chile.
| | - Eliseo Vano
- Radiology Department, Faculty of Medicine, Complutense University and IdIS, San Carlos Hospital, 28040 Madrid, Spain
| | - Patricia Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Ximena Figueroa
- Medical Technology Department, Health Sciences Faculty, Universidad de Tarapacá, Arica, Chile
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Habib Geryes B, Hornbeck A, Jarrige V, Pierrat N, Ducou Le Pointe H, Dreuil S. Patient dose evaluation in computed tomography: A French national study based on clinical indications. Phys Med 2019; 61:18-27. [PMID: 31151575 DOI: 10.1016/j.ejmp.2019.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/31/2019] [Accepted: 04/08/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE A national survey was performed to assess patient dose indicators based on clinical indication and on patient morphology for most common adult computed tomography (CT) examinations in France. METHODS Seventeen groups of clinical indications (GCIs) for diagnostic CT in adult patients were considered based on their frequency and on image quality requirements. Data was collected for 15-30 consecutive examinations performed between 2015 and 2017, per CT scanner and GCI. Distributions of total examination Dose-Length Product (DLP) and Volume CT Dose Index (CTDIvol) were assessed for each GCI as a function of patient gender or patient Body Mass Index (BMI) for head/neck and trunk examinations, respectively. RESULTS 6610 examinations were analysed. Median total exam DLP values were higher for men compared to women patients for head and neck examinations: difference ranged from 6% for ear trauma indication (577 vs 543 mGy·cm, p = 0.01) to 35% for brain tumour GCI (1472 vs 1093 mGy·cm, p < 0.01). For trunk examinations, total exam DLP increased consistently with patient's BMI. For normal-BMI patients, median CTDIvol and DLP differed significantly between different GCIs for single-phase CT of the chest (3 mGy and 112 mGy·cm, respectively, for chronic obstructive pulmonary disease group vs 5.8 mGy and 207 mGy·cm for pulmonary embolism group, p < 0.05) and of the abdomen-pelvis (5.6 mGy and 284 mGy·cm, respectively, in renal colic group vs 9.5 mGy and 463 mGy·cm in occlusive syndrome group, p < 0.05). CONCLUSION This study provides morphological- and clinical-based patient dose indicators in CT as a practical tool for clinical practices optimisation.
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Affiliation(s)
- Bouchra Habib Geryes
- French Society of Medical Physics (SFPM), Centre Antoine Béclère, 47 Rue de la Colonie, 75013 Paris, France; Department of Adult Radiology, Necker Enfants Malades University Hospital, 149 rue de Sèvres 75743, Paris Cedex 15, France
| | - Amaury Hornbeck
- French Society of Medical Physics (SFPM), Centre Antoine Béclère, 47 Rue de la Colonie, 75013 Paris, France; Department of Medical Physics, ALARA Expertise, 7 Allée de l'Europe, 67960 Entzheim, France; Department of Pediatric Imaging, Armand Trousseau Hospital, APHP, The MAMUTH Hospital (University Department for Innovative Therapies in Musculoskeletal Diseases), Sorbonne Université, Paris, France
| | - Valérie Jarrige
- French Society of Medical Physics (SFPM), Centre Antoine Béclère, 47 Rue de la Colonie, 75013 Paris, France; Department of Radiology, Jacques Cœur Hospital, 145 Avenue François Mitterrand, 18000 Bourges, France
| | - Noëlle Pierrat
- French Society of Medical Physics (SFPM), Centre Antoine Béclère, 47 Rue de la Colonie, 75013 Paris, France; Medical Physics Department, Curie Institute, 26 Rue d'Ulm, 75005 Paris, France
| | - Hubert Ducou Le Pointe
- French Society of Radiology (SFR), 47 Rue de la Colonie, 75013 Paris, France; Department of Pediatric Imaging, Armand Trousseau Hospital, APHP, The MAMUTH Hospital (University Department for Innovative Therapies in Musculoskeletal Diseases), Sorbonne Université, Paris, France
| | - Serge Dreuil
- French Society of Medical Physics (SFPM), Centre Antoine Béclère, 47 Rue de la Colonie, 75013 Paris, France; Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, B.P. 17, 92262 Fontenay-aux-Roses Cedex, France.
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Bernier MO, Baysson H, Pearce MS, Moissonnier M, Cardis E, Hauptmann M, Struelens L, Dabin J, Johansen C, Journy N, Laurier D, Blettner M, Le Cornet L, Pokora R, Gradowska P, Meulepas JM, Kjaerheim K, Istad T, Olerud H, Sovik A, Bosch de Basea M, Thierry-Chef I, Kaijser M, Nordenskjöld A, Berrington de Gonzalez A, Harbron RW, Kesminiene A. Cohort Profile: the EPI-CT study: a European pooled epidemiological study to quantify the risk of radiation-induced cancer from paediatric CT. Int J Epidemiol 2019; 48:379-381g. [PMID: 30388267 PMCID: PMC6469297 DOI: 10.1093/ije/dyy231] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 01/13/2023] Open
Affiliation(s)
- Marie-Odile Bernier
- Laboratory of Epidemiology, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Hélène Baysson
- Laboratory of Epidemiology, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Mark S Pearce
- Institute of Health & Society
- NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, Newcastle upon Tyne, UK
| | | | - Elisabeth Cardis
- Barcelona Institute for Global Health ISGlobal, ISGlobal, Barcelona, Spain
- Radiation Programme, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Michael Hauptmann
- Department of Epidemiology and Statistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lara Struelens
- Radiation Protection Dosimetry and Calibration Department, Belgian Nuclear Research Centre SCK-CEN, Mol, Belgium
| | - Jeremie Dabin
- Radiation Protection Dosimetry and Calibration Department, Belgian Nuclear Research Centre SCK-CEN, Mol, Belgium
| | | | - Neige Journy
- Laboratory of Epidemiology, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Dominique Laurier
- Laboratory of Epidemiology, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lucian Le Cornet
- Section of Environment and Radiation, IARC, Lyon, France
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Roman Pokora
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Patrycja Gradowska
- Department of Epidemiology and Statistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Johanna M Meulepas
- Department of Epidemiology and Statistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Tore Istad
- Norwegian Radiation Protection Authority, Østerås, Norway
| | - Hilde Olerud
- Norwegian Radiation Protection Authority, Østerås, Norway
- Department of Physics, University in Oslo, Oslo, Norway
| | - Aste Sovik
- Norwegian Radiation Protection Authority, Østerås, Norway
| | | | - Isabelle Thierry-Chef
- Section of Environment and Radiation, IARC, Lyon, France
- Barcelona Institute for Global Health ISGlobal, ISGlobal, Barcelona, Spain
- Radiation Programme, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Magnus Kaijser
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Arvid Nordenskjöld
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Clinical Epidemiological Unit, Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Richard W Harbron
- Institute of Health & Society
- NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, Newcastle upon Tyne, UK
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Doss M. Are We Approaching the End of the Linear No-Threshold Era? J Nucl Med 2018; 59:1786-1793. [PMID: 30262515 DOI: 10.2967/jnumed.118.217182] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/24/2018] [Indexed: 12/12/2022] Open
Abstract
The linear no-threshold (LNT) model for radiation-induced cancer was adopted by national and international advisory bodies in the 1950s and has guided radiation protection policies worldwide since then. The resulting strict regulations have increased the compliance costs for the various uses of radiation, including nuclear medicine. The concerns about low levels of radiation due to the absence of a threshold have also resulted in adverse consequences. Justification of the LNT model was based on the concept that low levels of radiation increase mutations and that increased mutations imply increased cancers. This concept may not be valid. Low-dose radiation boosts defenses such as antioxidants and DNA repair enzymes. The boosted defenses would reduce the endogenous DNA damage that would have occurred in the subsequent period, and so the result would be reduced DNA damage and mutations. Whereas mutations are necessary for causing cancer, they are not sufficient since the immune system eliminates cancer cells or keeps them under control. The immune system plays an extremely important role in preventing cancer, as indicated by the substantially increased cancer risk in immune-suppressed patients. Hence, since low-dose radiation enhances the immune system, it would reduce cancers, resulting in a phenomenon known as radiation hormesis. There is considerable evidence for radiation hormesis and against the LNT model, including studies of atomic bomb survivors, background radiation, environmental radiation, cancer patients, medical radiation, and occupational exposures. Though Commentary 27 published by the National Council on Radiation Protection and Measurements concluded that recent epidemiologic studies broadly support the LNT model, a critical examination of the studies has shown that they do not. Another deficiency of Commentary 27 is that it did not consider the vast available evidence for radiation hormesis. Other advisory body reports that have supported the LNT model have similar deficiencies. Advisory bodies are urged to critically evaluate the evidence supporting both sides and arrive at an objective conclusion on the validity of the LNT model. Considering the strength of the evidence against the LNT model and the weakness of the evidence for it, the present analysis indicates that advisory bodies would be compelled to reject the LNT model. Hence, we may be approaching the end of the LNT model era.
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Affiliation(s)
- Mohan Doss
- Diagnostic Imaging, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Indirect adjustment of relative risks of an exposure with multiple categories for an unmeasured confounder. Ann Epidemiol 2018; 28:801-807. [PMID: 30297163 DOI: 10.1016/j.annepidem.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE With observational epidemiologic studies, there is often concern that an unmeasured variable might confound an observed association. Investigators can assess the impact from such unmeasured variables on an observed relative risk (RR) by utilizing externally sourced information and applying an indirect adjustment procedure, for example, the "Axelson adjustment." Although simple and easy to use, this approach applies to exposure and confounder variables that are binary. Other approaches eschew specific values and provide only bounds on the potential bias. METHODS For both multiplicative and additive RR models, we present formulae for indirect adjustment of observed RRs for unmeasured potential confounding variables when there are multiple categories. In addition, we suggest an alternative strategy to identify the characteristics that the confounder must have to explain fully the observed association. RESULTS AND CONCLUSIONS We provide examples involving studies of pediatric computer tomography scanning and leukemia and nuclear radiation workers and smoking to demonstrate that with externally sourced information, an investigator can assess whether confounding from unmeasured factors is likely to occur.
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Shore RE, Beck HL, Boice JD, Caffrey EA, Davis S, Grogan HA, Mettler FA, Preston RJ, Till JE, Wakeford R, Walsh L, Dauer LT. Implications of recent epidemiologic studies for the linear nonthreshold model and radiation protection. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:1217-1233. [PMID: 30004025 DOI: 10.1088/1361-6498/aad348] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The recently published NCRP Commentary No. 27 evaluated the new information from epidemiologic studies as to their degree of support for applying the linear nonthreshold (LNT) model of carcinogenic effects for radiation protection purposes (NCRP 2018 Implications of Recent Epidemiologic Studies for the Linear Nonthreshold Model and Radiation Protection, Commentary No. 27 (Bethesda, MD: National Council on Radiation Protection and Measurements)). The aim was to determine whether recent epidemiologic studies of low-LET radiation, particularly those at low doses and/or low dose rates (LD/LDR), broadly support the LNT model of carcinogenic risk or, on the contrary, demonstrate sufficient evidence that the LNT model is inappropriate for the purposes of radiation protection. An updated review was needed because a considerable number of reports of radiation epidemiologic studies based on new or updated data have been published since other major reviews were conducted by national and international scientific committees. The Commentary provides a critical review of the LD/LDR studies that are most directly applicable to current occupational, environmental and medical radiation exposure circumstances. This Memorandum summarises several of the more important LD/LDR studies that incorporate radiation dose responses for solid cancer and leukemia that were reviewed in Commentary No. 27. In addition, an overview is provided of radiation studies of breast and thyroid cancers, and cancer after childhood exposures. Non-cancers are briefly touched upon such as ischemic heart disease, cataracts, and heritable genetic effects. To assess the applicability and utility of the LNT model for radiation protection, the Commentary evaluated 29 epidemiologic studies or groups of studies, primarily of total solid cancer, in terms of strengths and weaknesses in their epidemiologic methods, dosimetry approaches, and statistical modelling, and the degree to which they supported a LNT model for continued use in radiation protection. Recommendations for how to make epidemiologic radiation studies more informative are outlined. The NCRP Committee recognises that the risks from LD/LDR exposures are small and uncertain. The Committee judged that the available epidemiologic data were broadly supportive of the LNT model and that at this time no alternative dose-response relationship appears more pragmatic or prudent for radiation protection purposes.
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Affiliation(s)
- R E Shore
- New York University School of Medicine, New York, United States of America. Radiation Effects Research Foundation, Hiroshima, Japan
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Sadigh G, Kadom N, Karthik P, Sengupta D, Strauss KJ, Frush D, Applegate KE. Noncontrast Head CT in Children: National Variation in Radiation Dose Indices in the United States. AJNR Am J Neuroradiol 2018; 39:1400-1405. [PMID: 29976832 DOI: 10.3174/ajnr.a5719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Radiologists should manage the radiation dose for pediatric patients to maintain reasonable diagnostic confidence. We assessed the variation in estimated radiation dose indices for pediatric noncontrast head CT in the United States. MATERIALS AND METHODS Radiation dose indices for single-phase noncontrast head CT examinations in patients 18 years of age and younger were retrospectively reviewed between July 2011 and June 2016 using the American College of Radiology CT Dose Index Registry. We used the reported volume CT dose index stratified by patient demographics and imaging facility characteristics. RESULTS The registry included 295,296 single-phase pediatric noncontrast head CT studies from 1571 facilities (56% in male patients and 53% in children older than 10 years of age). The median volume CT dose index was 33 mGy (interquartile range = 22-47 mGy). The volume CT dose index increased as age increased. The volume CT dose index was lower in children's hospitals (median, 26 mGy) versus academic hospitals (median, 32 mGy) and community hospitals (median, 40 mGy). There was a lower volume CT dose index in level I and II trauma centers (median, 27 and 32 mGy, respectively) versus nontrauma centers (median, 40 mGy) and facilities in metropolitan locations (median, 30 mGy) versus those in suburban and rural locations (median, 41 mGy). CONCLUSIONS Considerable variation in the radiation dose index for pediatric head CT exists. Median dose indices and practice variations at pediatric facilities were both lower compared with other practice settings. Decreasing dose variability through proper management of CT parameters in pediatric populations using benchmarks generated by data from registries can potentially decrease population exposure to ionizing radiation.
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Affiliation(s)
- G Sadigh
- From the Department of Radiology and Imaging Sciences (G.S., N.K.,), Emory University School of Medicine, Atlanta, Georgia
| | - N Kadom
- From the Department of Radiology and Imaging Sciences (G.S., N.K.,), Emory University School of Medicine, Atlanta, Georgia
| | - P Karthik
- American College of Radiology (P.K., D.S.), Reston, Virginia
| | - D Sengupta
- American College of Radiology (P.K., D.S.), Reston, Virginia
| | - K J Strauss
- Department of Radiology (K.J.S.), University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - D Frush
- Department of Radiology (D.F.), Duke University Medical Center, Durham, North Carolina
| | - K E Applegate
- Department of Radiology (K.E.A.), University of Kentucky, Lexington, Kentucky
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Cardarelli JJ, Ulsh BA. It Is Time to Move Beyond the Linear No-Threshold Theory for Low-Dose Radiation Protection. Dose Response 2018; 16:1559325818779651. [PMID: 30013457 PMCID: PMC6043938 DOI: 10.1177/1559325818779651] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/18/2018] [Accepted: 05/01/2018] [Indexed: 02/03/2023] Open
Abstract
The US Environmental Protection Agency (USEPA) is the primary federal agency responsible for promulgating regulations and policies to protect people and the environment from ionizing radiation. Currently, the USEPA uses the linear no-threshold (LNT) model to estimate cancer risks and determine cleanup levels in radiologically contaminated environments. The LNT model implies that there is no safe dose of ionizing radiation; however, adverse effects from low dose, low-dose rate (LDDR) exposures are not detectable. This article (1) provides the scientific basis for discontinuing use of the LNT model in LDDR radiation environments, (2) shows that there is no scientific consensus for using the LNT model, (3) identifies USEPA reliance on outdated scientific information, and (4) identifies regulatory reliance on incomplete evaluations of recent data contradicting the LNT. It is the time to reconsider the use of the LNT model in LDDR radiation environments. Incorporating the latest science into the regulatory process for risk assessment will (1) ensure science remains the foundation for decision making, (2) reduce unnecessary burdens of costly cleanups, (3) educate the public on the real effects of LDDR radiation exposures, and (4) harmonize government policies with the rest of the radiation scientific community.
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Ideguchi R, Yoshida K, Ohtsuru A, Takamura N, Tsuchida T, Kimura H, Uetani M, Kudo T. The present state of radiation exposure from pediatric CT examinations in Japan-what do we have to do? JOURNAL OF RADIATION RESEARCH 2018; 59:ii130-ii136. [PMID: 29420748 PMCID: PMC5941147 DOI: 10.1093/jrr/rrx095] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/23/2017] [Indexed: 06/08/2023]
Abstract
The use of computed tomography (CT) has increased dramatically over the past several decades and has resulted in a concurrent increase in medical exposure to ionizing radiation. Several recent studies have examined the link between medical radiation and the risk of cancer, especially in children. The cancer risk associated medical exposure has not been definitively confirmed. However, we have to reduce unwarranted medical radiation exposure in pediatric patients. Justification and optimization are of great importance in order to minimize these risks, and the standardization of CT usage is essential. However, in Japan no clinical guidelines for the use of CT have been commonly agreed upon, especially in children. Furthermore, the CT-associated radiation exposure in Japan varies widely among the different facilities. Further studies based on a nationwide survey in Japan will be required in order to establish simple and useful clinical guidelines.
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Affiliation(s)
- Reiko Ideguchi
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Koji Yoshida
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Akira Ohtsuru
- Department of Radiation Health Management, Fukushima Medical University
| | - Noboru Takamura
- Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | | | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui
| | - Masataka Uetani
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University
| | - Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
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Gomolka M, Oestreicher U, Rößler U, Samaga D, Endesfelder D, Lang P, Neumaier K, Belka C, Niemeyer M, Kiechle M, Hasbargen U, Hübener C, Kirlum HJ, Kulka U, Rosenberger A, Walsh L, Baatout S, Kesminiene A, Lindholm C. Age-dependent differences in DNA damage after in vitro CT exposure. Int J Radiat Biol 2018; 94:272-281. [PMID: 29319401 DOI: 10.1080/09553002.2018.1419302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/13/2017] [Accepted: 12/04/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Age dependent radiation sensitivity for DNA damage after in vitro blood exposure by computer tomography (CT) was investigated. MATERIALS AND METHODS Radiation biomarkers (dicentrics and gammaH2AX) in blood samples of newborns, children under five years and adults after sham exposure (0 mGy), low-dose (41 mGy) and high-dose (978 mGy) in vitro CT exposure were analyzed. RESULTS Significantly higher levels of dicentric induction were found for the single and combined newborns/children group compared to adults, by a factor of 1.48 (95% CI 1.30-1.68), after exposure to 978 mGy. Although a significant dose response for damage induction and dose-dependent repair was found, the gammaH2AX assay did not show an age-dependent increase in DNA damage in newborns/children compared to adults. This was the case for the gammaH2AX levels after repair time intervals of 30 minutes and 24 hours, after correcting for the underlying background damage. For the low dose of 41 mGy, the power of the dicentric assay was also not sufficient to detect an age-dependent effect in the sample size investigated. CONCLUSION A 1.5-fold increased level of dicentric aberrations is detected in newborns and children under five years after 1 Gy radiation exposure.
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Affiliation(s)
- Maria Gomolka
- a Bundesamt für Strahlenschutz, BfS , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - Ursula Oestreicher
- a Bundesamt für Strahlenschutz, BfS , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - Ute Rößler
- a Bundesamt für Strahlenschutz, BfS , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - Daniel Samaga
- a Bundesamt für Strahlenschutz, BfS , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - David Endesfelder
- a Bundesamt für Strahlenschutz, BfS , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - Peter Lang
- b LMU, Klinik und Poliklinik für Strahlentherapie und Radioonkologie , München , Germany
| | - Klement Neumaier
- b LMU, Klinik und Poliklinik für Strahlentherapie und Radioonkologie , München , Germany
| | - Claus Belka
- b LMU, Klinik und Poliklinik für Strahlentherapie und Radioonkologie , München , Germany
| | - Markus Niemeyer
- c TUM, Klinikum Rechts der Isar, Frauenklinik , München , Germany
| | - Marion Kiechle
- c TUM, Klinikum Rechts der Isar, Frauenklinik , München , Germany
| | - Uwe Hasbargen
- d LMU, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Campus Großhadern , München , Germany
| | - Christoph Hübener
- d LMU, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Campus Großhadern , München , Germany
| | | | - Ulrike Kulka
- a Bundesamt für Strahlenschutz, BfS , Ingolstädter Landstrasse 1 , Neuherberg , Germany
| | - Albert Rosenberger
- f Universitätsmedizin Göttingen, Institut für Genetische Epidemiologie , Humboldtallee 32 , Göttingen , Germany
| | - Linda Walsh
- a Bundesamt für Strahlenschutz, BfS , Ingolstädter Landstrasse 1 , Neuherberg , Germany
- g Medical Physics Group, University of Zurich , Switzerland
| | - Sarah Baatout
- h Belgian Nuclear Research Center, SCK-CEN , Mol , Belgium
| | | | - Carita Lindholm
- j Radiation and Nuclear Safety Authority , STUK , Helsinki , Finland
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Journy NMY, Dreuil S, Boddaert N, Chateil JF, Defez D, Ducou-le-Pointe H, Garcier JM, Guersen J, Habib Geryes B, Jahnen A, Lee C, Payen-de-la-Garanderie J, Pracros JP, Sirinelli D, Thierry-Chef I, Bernier MO. Individual radiation exposure from computed tomography: a survey of paediatric practice in French university hospitals, 2010-2013. Eur Radiol 2018; 28:630-641. [PMID: 28836026 DOI: 10.1007/s00330-017-5001-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/12/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe computed tomography (CT) scanning parameters, volume CT dose index (CTDIvol) and dose-length product (DLP) in paediatric practice and compare them to current diagnostic reference levels (DRLs). METHODS The survey was conducted in radiology departments of six major university hospitals in France in 2010-2013. Data collection was automatised to extract and standardise information on scanning parameters from DICOM-header files. CTDIvol and DLP were estimated based on Monte Carlo transport simulation and computational reference phantoms. RESULTS CTDIvol and DLP were derived for 4,300 studies, four age groups and 18 protocols. CTDIvol was lower in younger patients for non-head scans, but did not vary with age for routine head scans. Ratios of 95th to 5th percentile CTDIvol values were 2-4 for most body parts, but 5-7 for abdominal examinations and 4-14 for mediastinum CT with contrast, depending on age. The 75th percentile CTDIvol values were below the national DRLs for chest (all ages) and head and abdominal scans (≥10 years). CONCLUSION The results suggest the need for a better optimisation of scanning parameters for routine head scans and infrequent protocols with patient age, enhanced standardisation of practices across departments and revision of current DRLs for children. KEY POINTS • CTDIvol varied little with age for routine head scans. • CTDIvol was lowest in youngest children for chest or abdominal scans. • Individual and inter-department variability warrant enhanced standardisation of practices. • Recent surveys support the need for revised diagnostic reference levels. • More attention should be given to specific protocols (sinuses, neck, spine, mediastinum).
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Affiliation(s)
- Neige M Y Journy
- Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France.
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA.
| | - Serge Dreuil
- Unité d'expertise en radioprotection médicale, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | - Nathalie Boddaert
- Service de radiologie pédiatrique, INSERM U1000, UMR 1163, Institut Imagine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75743, Paris Cedex 15, France
- PRES Sorbonne Paris, Cité Université René Descartes, 190 avenue de France, 75013, Paris, France
| | - Jean-François Chateil
- Service de radiologie et d'imagerie anténatale, de l'enfant et de la femme, Groupe Hospitalier Pellegrin, Centre Hospitalier Universitaire de Bordeaux, place Amélie Raba-Léon, 33000, Bordeaux, France
| | - Didier Defez
- Service de Physique Médicale, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Benite, France
| | - Hubert Ducou-le-Pointe
- Service de Radiologie, Hôpital d'Enfants Armand-Trousseau, 26 avenue du Dr A. Netter, 75012, Paris, France
| | - Jean-Marc Garcier
- Service de radiologie, Centre Hospitalier Universitaire Estaing, 1 place Lucie-Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Joël Guersen
- Pôle Imagerie et Radiologie Interventionnelle, Centre Hospitalier Universitaire Gabriel Montpied, 58 rue Montalembert, 63003, Clermont Ferrand cedex 1, France
| | - Bouchra Habib Geryes
- Direction des affaires médicales, de la qualité et la relation avec les usagers, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75743, Paris Cedex 15, France
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology (LIST), 5 avenue des Hauts-Fourneaux, L-4362, Esch/Alzette, Luxembourg, Luxembourg
| | - Choonsik Lee
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA
| | | | - Jean-Pierre Pracros
- Service d'imagerie pédiatrique, Hôpital Femme Mère Enfants, Groupe Hospitalier Est, 59 Boulevard Pinel, 69500, Bron, France
| | - Dominique Sirinelli
- Service de radiologie pediatrique, Hôpital Clocheville, Centre Hospitalier Régional Universitaire de Tours, 49 boulevard Béranger, 37000, Tours, France
| | - Isabelle Thierry-Chef
- Section of Environment and Cancer, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon cedex 08, France
| | - Marie-Odile Bernier
- Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
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Abstract
BACKGROUND Radiation exposure is a well-known risk factor for thyroid cancer. However, the specific effects of diagnostic radiation exposure on thyroid cancer risk are controversial. The purpose of this study was to perform a systematic review and meta-analysis to assess the effects of diagnostic radiation exposure on thyroid cancer risk. METHODS The PubMed and EMBASE databases were searched to identify eligible studies. Summary odds ratio (OR) estimates and confidence intervals (CIs) were used to compute the risk of thyroid cancer using fixed- and random-effects models. Subgroup and sensitivity analyses were performed to evaluate the potential heterogeneity. RESULTS Nine studies from 12 publications were included in the meta-analysis. Overall exposure to diagnostic radiation exposure was associated with a significantly increased thyroid cancer risk (OR = 1.52 [CI 1.13-2.04]). The subgroup and sensitivity analyses revealed similar results. By type of exposure, exposure to computed tomography scans (OR = 1.46 [CI 1.27-1.68]) or dental x-rays (OR = 1.69 [CI 1.17-2.44]) were associated with an increased thyroid cancer risk. Head and neck (OR = 1.31 [CI 1.02-1.69]) and chest (OR = 1.71 [CI 1.09-2.69]) exposure to diagnostic radiation was associated with an increased thyroid cancer risk. CONCLUSIONS The results of this meta-analysis indicate that diagnostic radiation exposure is associated with an increased thyroid cancer risk. Therefore, to the extent that it will not compromise the information being sought, radiation exposure to the thyroid should be minimized during diagnostic examinations.
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Affiliation(s)
- Mi Ah Han
- 1 Department of Preventive Medicine, College of Medicine, Chosun University , Korea
| | - Jin Hwa Kim
- 2 Department of Internal Medicine, College of Medicine, Chosun University , Korea
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