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CT, nuclear medicine contribute most radiation to pediatric oncology patients

Ahmed B. Pediatrics. 2010;doi:10.1542/peds.2009-2675.

Computed tomography and nuclear medicine procedures contributed most of the cumulative effective dose of radiation, with the total cumulative effective dose varying widely depending on the patient’s diagnosis, clinical course and the imaging modality used, a retrospective cohort study of pediatric oncology patients found.

Bilal Ahmed, MD, and colleagues studied the imaging histories of 150 children with leukemia (n=30), lymphomas (n=30), brain tumors (n=30), neuroblastomas (n=30) or assorted solid tumors (n=30). Any procedure involving radiation was recorded, including radiography, CT, nuclear medicine studies, fluoroscopy and interventional procedures. Using this information, the researchers estimated the cumulative effective dose for each patient.

Overall, individual cumulative effective dose estimates ranged from less than 1 mSv to 642 mSv. The median was 61 mSv. Of all procedures, CT and nuclear medicine contributed the most radiation. Although only 30% of the procedures were CT, they accounted for 52% of the total cumulative effective dose. Only 20% of procedures were nuclear medicine studies, yet they accounted for 46% of the total cumulative effective dose.

The researchers noted wide variability in cumulative effective dose estimates in the different tumor groups. Neuroblastoma had the highest cumulative effective dose, with a median of 213 millisieverts (range: 36 mSv-489 mSv). Lymphoma was second, with a median of 191 mSv (range: 10 mSv-642 mSv). Leukemia patients had the lowest median cumulative effective dose at 5 mSv (range: 0.2 mSv-57 mSv), according to the study.

“Approaches to ensure that exposure of this vulnerable population to diagnostic imaging radiation is appropriate and is minimized where possible center around the two principles of radiation protection, that is, justification for a procedure and optimization of its performance,” the researchers wrote. “It is hoped that increasing awareness of the cumulative diagnostic radiation exposure to which pediatric oncology patients are exposed will encourage strategies to reduce radiation burdens wherever possible.”

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