Share This Article:

Estimated additional lifetime risk of cancer attributable to diagnostic CT in a pediatric bone marrow transplant cohort: Experience at a single academic institution

DOI: 10.4236/ojcd.2012.21002    4,425 Downloads   9,259 Views   Citations


Purpose: To determine the frequency of CT procedures in a cohort of bone marrow transplant patients and estimate the effective dose from each CT procedure as well as rough estimates of lifetime attributable risk (LAR) of cancer (both incidence and mortality). Background: Pediatric patients who undergo bone marrow transplant benefit greatly from the diagnostic power of computed tomography, but due to the need for frequent imaging, these patients are repeatedly exposed to the carcinogenic potential of ionizing radiation. Methods: CT Imaging and patient parameters were collected from a retrospective cohort of bone marrow transplant patients. Dosimetry was estimated as a function of age, dose length product (DLP), and scan region based on published DLP to effective dose tables. Lifetime attributable risk (LAR) of cancer as a function of age, gender, and organ specific dose was derived from BEIR VII phase 2 estimates. Results: 44 patients with bone marrow transplant were included and ranged in age from 7 months to 20 years (average age, 9 years). The average number of CT studies per patient was 3.2 over the 15 month period. The average effective dose for each study was 5.9 +/– 4.5 mSv. Cumulative effective dose to each patient was 20 +/– 32 mSv. It was estimated that in this cohort, the CT imaging performed over a 15-month period on a 64-slice scanner led to a lifetime additional risk of cancer incidence of 5 in 1000 and a lifetime additional risk of cancer mortality of 2 in 1000. Conclusion: Diagnostic CT is important in the assessment and management of ill patients following bone marrow transplant. The risk of ionizing radiation leading to additional development of cancer merits using as low a CT technique as reasonable to achieve a diagnostic study.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Swanson, J. , Alessio, A. and Chapman, T. (2012) Estimated additional lifetime risk of cancer attributable to diagnostic CT in a pediatric bone marrow transplant cohort: Experience at a single academic institution. Open Journal of Clinical Diagnostics, 2, 4-9. doi: 10.4236/ojcd.2012.21002.


[1] Feng, S.-T., Law, M.W.-M., Huang, B., Ng, S., Li, Z.-P., Meng, Q.-F. and Khong, P.-L. (2010) Radiation dose and cancer risk from pediatric CT examinations on 64-slice CT: A phantom study. European Journal of Radiology, 76, 19-23. doi:10.1016/j.ejrad.2010.03.005
[2] Papadakis, A.E., Perisinakis, K. and Damilakis, J. (2008) Automatic ex-posure control in pediatric and adult multidetector CT examinations: A phantom study on dose reduction and image quality. Medical Physics, 35, 4567-4566. doi:10.1118/1.2977535
[3] Amis, E.S., Butler, P.F., Applegate, K.E., Birnbaum, S.B., Brateman, L.F., Hevezi, J.M., Mettler, F.A., Morin, R.L., Pentecost, M.J., Smith, G.G., et al. (2007) American College of Radiology white paper on radiation dose in medicine. Journal of the American College of Radiology, 4, 272-284. doi:10.1016/j.jacr.2007.03.002
[4] Brenner, D.J. and Elliston, C.D. (2004) Estimated radiation risks potentially associated with full-body CT screening. Radiology, 232, 735-738. doi:10.1148/radiol.2323031095
[5] Brenner, D.J. and Hall, E.J. (2007) Computed tomography—An increasing source of radiation exposure. The New England Journal of Medicine, 357, 2277-2284. doi:10.1056/NEJMra072149
[6] Goske, M.J., Applegate, K.E., Boylan, J., Butler, P.F., Callahan, M.J., Coley, B.D., Farley, S., Frush, D.P., Hernanz-Schulman, M., Jaramillo, D., et al. (2008) The image gently campaign: Working together to change practice. American Journal of Roentgenology, 190, 273-274. doi:10.2214/AJR.07.3526
[7] Linton, O.W., Mettler, F.A. Jr. (2003) National conference on dose reduction in CT, with an emphasis on pediatric patients. American Journal of Roentgenology, 181, 321-329.
[8] The National Research Council’s Committees on the Biological Effects of Ionizing Radiations Committee (2006) Health risks from exposure to low levels of ionizing radiation—BEIR VII phase 2. The National Academies Press, Washington DC.
[9] Anderson, G. and Horvath, J. (2004) The growing burden of chronic disease in America. Public Health Reports, 119, 263-270.
[10] Newa-check, P.W. and Taylor, W.R. (1992) Childhood chronic illness: Prevalence, severity, and impact. American Journal of Public Health, 82, 364-371. doi:10.2105/AJPH.82.3.364
[11] Alessio, A.M. and Phillips, G.S. (2010) A pediatric CT dose and risk estimator. Pediatric Radiology, 40, 1816-1821. doi:10.1007/s00247-010-1761-0
[12] Shrimpton, P. (1997) Reference doses for computed tomograpny. In: Board, N.R.P., Ed., Radiological Protection Bulletin, Chilton, England, pp. 16-19.
[13] Einstein, A.J., Hen-zlova, M.J. and Rajagopalan, S. (2007) Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. The Journal of the American Medical Association, 298, 317-323. doi:10.1001/jama.298.3.317
[14] Shrimpton, P. (2009) Effective dose and dose-length product in CT. Radiology, 250, 604-605. doi:10.1148/radiol.2502081340
[15] Thomas, K.E. and Wang, B. (2008) Age-specific effecttive doses for pediatric MSCT examinations at a large children’s hospital using DLP conversion coefficients: A simple estimation method. Pediatric Radiology, 38, 645656. doi:10.1007/s00247-008-0794-0
[16] Shrimpton, P.C. and Jones, D.G. (1993) Normalised organ doses for x ray computed tomography calculated using monte carlo techniques and a mathematical anthropomorphic phantom. Radiation Protection Dosimetry, 49, 241-243.
[17] Khursheed, A., Hillier, M.C., Shrimpton, P.C. and Wall, B.F. (2002) Influence of patient age on normalized effective doses calculated for CT examinations. British Journal of Radiology, 75, 819-830.
[18] Huda, W., Ogden, K.M. and Khorasani, M.R. (2008) Converting dose-length product to effective dose at CT. Radiology, 248, 995-1003. doi:10.1148/radiol.2483071964
[19] International Com-mission on Radiological Protection publication 103 (2007) The 2007 recommendations of the international commission on radiological protecttion. Annals of the ICRP, 37, 1-332.
[20] Frush, D.P., Soden, B., Frush, K.S. and Lowry, C. (2002) Improved pediatric multidetector body CT using a sizebased color-coded format. Ameri-can Journal of Roentgenology, 178, 721-726.
[21] Huang, B., Law, M.W.-M., Mak, H.K.-F., Kwok, S.P.-F. and Khong, P.-L. (2009) Pediatric 64-MDCT coronary angiography with ECG-modulated tube current: Radiation dose and cancer risk. American Journal of Roentgenology, 193, 539-544. doi:10.2214/AJR.08.1920
[22] Huda, W. (2007) Radiation doses and risks in chest computed tomography examinations. Proceedings of the American Thoracic Society, 4, 316-320. doi:10.1513/pats.200611-172HT
[23] Pierobon, J., Webber, C.E., Nayiager, T., Barr, R.D., Moran, G.R. and Gulenchyn, K.Y. (2011) Radiation doses originating from diagnostic procedures during the treatment and follow-up of children and adolescents with malignant lymphoma. Journal of Radiological Protection, 31, 83-93. doi:10.1088/0952-4746/31/1/005
[24] Chawla, S.C., Federman, N., Zhang, D., Nagata, K., Nuthakki, S., McNitt-Gray, M. and Boechat, M.I. (2009) Estimated cumulative radiation dose from PET/CT in children with malignancies: A 5-year retrospective review. Pediatric Radiology, 40, 681-686. doi:10.1007/s00247-009-1434-z
[25] Karmazyn, B., Frush, D.P., Applegate, K.E., Maxfield, C., Cohen, M.D. and Jones, R.P. (2009) CT with a computer-simulated dose reduction technique for detection of pediatric nephroureterolithiasis: Comparison of standard and re-duced radiation doses. American Journal of Roentgenology, 192, pp. 143-149. doi:10.2214/AJR.08.1391
[26] Hara, A.K., Paden, R.G., Silva, A.C., Kujak, J.L., Lawder, H.J. and Pavlicek, W. (2009) Iterative reconstruction technique for reducing body radiation dose at CT: Feasibility study. American Journal of Roentgenology, 193, 764-771. doi:10.2214/AJR.09.2397
[27] Hricak, H., Brenner, D.J., Adelstein, S.J., Frush, D.P., Hall, E.J., Howell, R.W., McCollough, C.H., Mettler, F.A., Pearce, M.S., Suleiman, O.H. et al. (2011) Managing radiation use in medical im-aging: A multifaceted challenge. Radiology, 258, 889-905. doi:10.1148/radiol.10101157
[28] Lasio, G.M., Whiting, B.R. and Williamson, J.F. (2007) Statistical reconstruc-tion for x-ray computed tomography using en-ergy-integrating detectors. Physics in medicine and biology, 52, 2247-2266. doi:10.1088/0031-9155/52/8/014
[29] Linet, M.S., Kim, K.P. and Rajaraman, P. (2009) Children’s exposure to diagnostic medical radiation and cancer risk: Epidemi-ologic and dosimetric considerations. Pediatric Radiology, 39, 4-26. doi:10.1007/s00247-008-1026-3
[30] Tubiana, M. (2008) Computed tomography and radiation exposure. The New England Journal of Medicine, 358, 852-853.
[31] Huang, B., Law, M.W.-M. and Khong, P.-L. (2009) Whole-body PET/CT scanning: Estimation of radiation dose and cancer risk. Radiology, 251, 166-174. doi:10.1148/radiol.2511081300

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.