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CT clearance of spine may increase breast cancer risk in pediatric trauma patients
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CT clearance of the thoracic spine in pediatric trauma patients resulted in a high dose of radiation, as well as an age-dependent increase in theoretical breast cancer induction, according to results of a retrospective study.
Evaluation of the thoracic spine is crucial to exclude significant injury in pediatric blunt trauma patients, which occurs in a relatively small number of traumas but can be associated with significant neurologic injury.
Although plain radiographs have been historically used to assess the thoracic spine when imaging is required, use of CT in pediatric patients has increased exponentially in the past 2 decades due to its efficiency and greater sensitivity.
“The linkage of radiation exposure to breast cancer has motivated clinicians to avoid plain radiographs or minimize breast radiation exposure,” Kelly R. Egan, MS, and colleagues from the University of Wisconsin School of Medicine and Public Health wrote. “Diagnostic imaging, particularly CT, used to evaluate the thoracic spine in the female pediatric trauma patient results in relatively high doses of radiation absorbed by breast tissue. However, the risk of breast cancer induction from CT evaluation of the thoracic spine in female pediatric trauma patients is currently unknown.”
To calculate the radiation dose received during thoracic spine CT vs. plain radiographs, as well as the theoretical risk of breast cancer induction in a pediatric trauma population, Egan and colleagues performed a retrospective analysis of 179 female pediatric trauma patients who received either imaging procedure for clearance of the thoracic spine.
Study participants were secondarily grouped either as children (<12 years) or adolescents (12 to <18 years). Excess absolute risk (EAR) for inducing breast cancer in females from thoracic spine CT was determined by multiplying total radiation (mSv) absorbed in the breast by female cancer-induction rates based on the National Academy’s Biological Effects of Ionizing Radiation Committee’s seventh report.
According to study results, the average radiation dose to the breast from a thoracic spine CT was 41.1 mSv and 1.8 mSv for plain radiographs. The EAR for plain radiographs was 2.7 (95% CI, 2.48-2.85) excess cases of breast cancer per 10,000 studies for female children and 1.4 (95% CI, 1.14-1.55) for female adolescents.
“Thoracic spine clearance by using CT in the female pediatric trauma patient results in a high dose of radiation to the breast in comparison with plain radiographs,” Egan and colleagues wrote. “Selection of the appropriate method of imaging when required should be done with care, to minimize risk from unnecessary radiation.”
Comparatively, the breast cancer EAR for thoracic spine CT was observed to be significantly higher in children vs. adolescents — 79.6 (95% CI, 58.6–100.5) in children vs. 45.8 (95% CI, 42-49.6) in adolescents. Additionally, there was a considerably higher risk for breast cancer induction for children receiving thoracic CT compared with adolescents.
The researchers also observed that only one injury was found on CT that was missed by plain radiographs, and this injury was not treated and was deemed not clinically significant.
“The concern for missed injury is important, but physicians have an obligation to balance this with potential future risk for breast cancer induction in this vulnerable patient population,” Egan and colleagues said. “These findings support the development of protocols to encourage the prudent use of diagnostic imaging in female pediatric trauma patients.”
Disclosure: The researchers reported no relevant financial disclosures.
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