Pediatric computed tomography scan and subsequent risk of malignancy: a nationwide population-based cohort study in Korea using National Cancer Institute dosimetry system for computed tomography (NCICT).
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BACKGROUND: Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort. METHODS: This nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose. RESULTS: From 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose-response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139-1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291-1.486), thyroid cancer (HR 1.248, 95% CI: 1.218-1.278), brain cancer (HR 1.201, 95% CI: 1.177-1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240-1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053-1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062-1.112), also showed increased risks. CONCLUSIONS: This study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children.