Epidemiological studies of CT scans and cancer risk: the state of the science

2021 ◽  
Vol 94 (1126) ◽  
pp. 20210471 ◽  
Author(s):  
Amy Berrington de Gonzalez ◽  
Elisa Pasqual ◽  
Lene Veiga
Keyword(s):  
Brain Tumors ◽  
Effective Dose ◽  
Dose Response ◽  
Public Health Problem ◽  
Epidemiological Studies ◽  
Ct Scans ◽  
Medical Record Linkage ◽  
Cancer Risks ◽  
Organ Doses ◽  
Study Methodology

20 years ago, 3 manuscripts describing doses and potential cancer risks from CT scans in children raised awareness of a growing public health problem. We reviewed the epidemiological studies that were initiated in response to these concerns that assessed cancer risks from CT scans using medical record linkage. We evaluated the study methodology and findings and provide recommendations for optimal study design for new efforts. We identified 17 eligible studies; 13 with published risk estimates, and 4 in progress. There was wide variability in the study methodology, however, which made comparison of findings challenging. Key differences included whether the study focused on childhood or adulthood exposure, radiosensitive outcomes (e.g. leukemia, brain tumors) or all cancers, the exposure metrics (e.g. organ doses, effective dose or number of CTs) and control for biases (e.g. latency and exclusion periods and confounding by indication). We were able to compare results for the subset of studies that evaluated leukemia or brain tumors. There were eight studies of leukemia risk in relation to red bone marrow (RBM) dose, effective dose or number of CTs; seven reported a positive dose–response, which was statistically significant (p < 0.05) in four studies. Six of the seven studies of brain tumors also found a positive dose–response and in five, this was statistically significant. Mean RBM dose ranged from 6 to 12 mGy and mean brain dose from 18 to 43 mGy. In a meta-analysis of the studies of childhood exposure the summary ERR/100 mGy was 1.78 (95%CI: 0.01–3.53) for leukemia/myelodisplastic syndrome (n = 5 studies) and 0.80 (95%CI: 0.48–1.12) for brain tumors (n = 4 studies) (p-heterogeneity >0.4). Confounding by cancer pre-disposing conditions was unlikely in these five studies of leukemia. The summary risk estimate for brain tumors could be over estimated, however, due to reverse causation. In conclusion, there is growing evidence from epidemiological data that CT scans can cause cancer. The absolute risks to individual patients are, however, likely to be small. Ongoing large multicenter cohorts and future pooling efforts will provide more precise risk quantification.

scholarly journals Assessment of Organ and Effective Doses Received by Paediatric Patients Undergoing Computed Tomography Examinations in Three Hospitals in Brazzaville, Congo Republic: An Urgent Necessity for Regulatory Control

2021 ◽  
pp. 527-550
Author(s):  
J. Bazoma ◽  
G. B. Dallou ◽  
P. Ondo Meye ◽  
C. Bouka Biona ◽  
Saïdou ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Effective Dose ◽  
Absorbed Dose ◽  
Regulatory Control ◽  
Ct Scans ◽  
Radiological Protection ◽  
Age Group ◽  
Organ Doses ◽  
Paediatric Patients ◽  
Effective Doses

The present study aimed at estimating organ and effective doses from computed tomography (CT) scans of paediatric patients in three hospitals in Brazzaville, Congo Republic. A total of 136 data on paediatric patients, from 0.25 (3 months) to 15 years old, who underwent head, chest, abdomen – pelvis (AP) and chest – abdomen – pelvis (CAP) CT scans was considered. The approach followed in the present study to compute organ doses was to use pre-calculated volume CT dose index (CTDIvol) – and 100 milliampere-second (mAs) – normalized organ doses determined by Monte Carlo (MC) simulation. Effective dose were then derived using the international commission on radiological protection (ICRP) publications 60 and 103 formalism. For comparison purposes, effective dose were also computed using dose-length product (DLP) – to – effective dose conversion factors. A relatively high variation in organ and effective doses was observed in each age group due to the dependence of patient dose on the practice of technicians who perform the CT scan within the same facility or from one facility to another, patient size and lack of adequate training of technicians. In the particular case of head scan, the brain and the eye lens were delivered maximum absorbed doses of 991.81 mGy and 1176.51 mGy, respectively (age group 10-15 y). The maximum absorbed dose determined for the red bone marrow was 246.08 mGy (age group 1-5 y). This is of concern as leukaemia and brain tumours are the most common childhood cancers and as the ICRP recommended absorbed dose threshold for induction of cataract is largely exceeded. Effective doses derived from MC calculations and ICRP publications 60 and 103 tissues weighting factors showed a 0.40-17.61 % difference while the difference between effective doses derived by the use of k- factors and those obtained by MC calculations ranges from 0.06 to 224.87 %. The study has shown that urgent steps should be taken in order to significantly reduce doses to paediatric patients to levels observed in countries where dose reduction techniques are successfully applied.

scholarly journals Epidemiological Studies of Low-Dose Ionizing Radiation and Cancer: Rationale and Framework for the Monograph and Overview of Eligible Studies

2020 ◽  
Vol 2020 (56) ◽  
pp. 97-113 ◽  
Author(s):  
Amy Berrington de Gonzalez ◽  
Robert D Daniels ◽  
Elisabeth Cardis ◽  
Harry M Cullings ◽  
Ethel Gilbert ◽  
...  
Keyword(s):  
Ionizing Radiation ◽  
Dose Response ◽  
Low Dose ◽  
Biological Effects ◽  
Epidemiological Studies ◽  
Solid Cancer ◽  
Systematic Bias ◽  
Cancer Risks ◽  
Low Dose Radiation ◽  
Dose Uncertainty

Abstract Whether low-dose ionizing radiation can cause cancer is a critical and long-debated question in radiation protection. Since the Biological Effects of Ionizing Radiation report by the National Academies in 2006, new publications from large, well-powered epidemiological studies of low doses have reported positive dose-response relationships. It has been suggested, however, that biases could explain these findings. We conducted a systematic review of epidemiological studies with mean doses less than 100 mGy published 2006–2017. We required individualized doses and dose-response estimates with confidence intervals. We identified 26 eligible studies (eight environmental, four medical, and 14 occupational), including 91 000 solid cancers and 13 000 leukemias. Mean doses ranged from 0.1 to 82 mGy. The excess relative risk at 100 mGy was positive for 16 of 22 solid cancer studies and 17 of 20 leukemia studies. The aim of this monograph was to systematically review the potential biases in these studies (including dose uncertainty, confounding, and outcome misclassification) and to assess whether the subset of minimally biased studies provides evidence for cancer risks from low-dose radiation. Here, we describe the framework for the systematic bias review and provide an overview of the eligible studies.

scholarly journals Essential concepts for interpreting the dose-response of low-level arsenic exposure in epidemiological studies

Toxicology ◽  
2021 ◽  
Vol 457 ◽  
pp. 152801
Author(s):  
Joyce S. Tsuji ◽  
Kristin P. Lennox ◽  
Heather N. Watson ◽  
Ellen T. Chang
Keyword(s):  
Dose Response ◽  
Arsenic Exposure ◽  
Epidemiological Studies ◽  
Low Level

scholarly journals Radiation Risks in Cis-Lunar Space for a Solar Particle Event Similar to the February 1956 Event

Aerospace ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 107
Author(s):  
Fahad A. Zaman ◽  
Lawrence W. Townsend
Keyword(s):  
Effective Dose ◽  
Energy Transport ◽  
Radiation Transport ◽  
Organ Doses ◽  
Solar Particle Events ◽  
Solar Particle ◽  
Transport Code ◽  
On Line ◽  
Critical Organ ◽  
In Cis

Solar particle events (SPEs) can pose serious threats for future crewed missions to the Moon. Historically, there have been several extreme SPEs that could have been dangerous for astronauts, and thus analyzing their potential risk on humans is an important step towards space exploration. In this work, we study the effects of a well-known SPE that occurred on 23 February 1956 on a mission in cis-Lunar space. Estimates of the proton fluence spectra of the February 1956 event were obtained from three different parameterized models published within the past 12 years. The studied geometry consists of a female phantom in the center of spherical spacecraft shielded by aluminum area densities ranging from 0.4 to 40 g cm−2. The effective dose, along with lens, skin, blood forming organs, heart, and central nervous system doses, were tallied using the On Line Tool for the Assessment of Radiation In Space (OLTARIS), which utilizes the High Z and Energy TRansport code (HZETRN), a deterministic radiation transport code. Based on the parameterized models, the results herein show that thicknesses comparable to a spacesuit might not protect against severe health consequences from a February 1956 category event. They also show that a minimum aluminum shielding of around 20 g cm−2 is sufficient to keep the effective dose and critical organ doses below NASA’s permissible limits for such event. In addition, except for very thin shielding, the input models produced results that were within good agreement, where the doses obtained from the three proton fluence spectra tended to converge with slight differences as the shielding thickness increases.

Radiation exposure during the treatment of spinal deformities

2021 ◽  
pp. 1-7
Author(s):  
Jwalant S. Mehta ◽  
Kirsten Hodgson ◽  
Lu Yiping ◽  
James Swee Beng Kho ◽  
Ravindra Thimmaiah ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Ionizing Radiation ◽  
Effective Dose ◽  
Spinal Deformity ◽  
Background Radiation ◽  
Ct Scans ◽  
Intraoperative Fluoroscopy ◽  
The Difference ◽  
Risk Of Cancer ◽  
Surgical Group

Aims To benchmark the radiation dose to patients during the course of treatment for a spinal deformity. Methods Our radiation dose database identified 25,745 exposures of 6,017 children (under 18 years of age) and adults treated for a spinal deformity between 1 January 2008 and 31 December 2016. Patients were divided into surgical (974 patients) and non-surgical (5,043 patients) cohorts. We documented the number and doses of ionizing radiation imaging events (radiographs, CT scans, or intraoperative fluoroscopy) for each patient. All the doses for plain radiographs, CT scans, and intraoperative fluoroscopy were combined into a single effective dose by a medical physicist (milliSivert (mSv)). Results There were more ionizing radiation-based imaging events and higher radiation dose exposures in the surgical group than in the non-surgical group (p < 0.001). The difference in effective dose for children between the surgical and non-surgical groups was statistically significant, the surgical group being significantly higher (p < 0.001). This led to a higher estimated risk of cancer induction for the surgical group (1:222 surgical vs 1:1,418 non-surgical). However, the dose difference for adults was not statistically different between the surgical and non-surgical groups. In all cases the effective dose received by all cohorts was significantly higher than that from exposure to natural background radiation. Conclusion The treatment of spinal deformity is radiation-heavy. The dose exposure is several times higher when surgical treatment is undertaken. Clinicians should be aware of this and review their practices in order to reduce the radiation dose where possible.

Sign in / Sign up

Export Citation Format

Share Document