title: Radiation dose and excess risk of cancer in children undergoing neuroangiography.
abstract: OBJECTIVE
  The primary goal of this study was to determine the radiation dose received during diagnostic and interventional neuroangiographic procedures in a group of pediatric patients. A second goal was to approximate the total average radiation dose from all angiographic and CT studies that pediatric patients underwent during the study period and to estimate the increased risk of cancer incidence in this patient group.
  
  
  METHODS
  The study subjects were pediatric patients who had undergone one or more neuroangiographic procedures at Harborview Medical Center between December 1, 2004, and April 30, 2008. Recorded radiation doses were converted to entrance skin dose (ESD) and effective dose (ED) to indicate deterministic and stochastic damage, respectively. The Biologic Effects of Ionizing Radiation (BEIR) VII, phase 2, report was used to estimate the expected increased risk of cancer in the study population.
  
  
  RESULTS
  For diagnostic and therapeutic procedures, a mean ED of 10.4 and 34.0 mSv per procedure was calculated, respectively. The ESD values proved too low to cause deterministic harm. The estimated number of excess cases of malignancy projected from the total average radiation exposure was 890.6 per 100,000 exposed male children and 1,222.5 per 100,000 exposed females, an overall increase of approximately 1% to the lifetime attributable risk of cancer.
  
  
  CONCLUSIONS
  Although both angiography and CT have revolutionized the practice of medicine and confer benefits to patients, it is important that we continue to investigate the possible adverse effects of these technologies. Protocols that minimize radiation dose without compromising a study should be implemented.
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA. colin.raelson@mssm.edu
authors.forename: Colin A
authors.initials: CA
authors.lastname: Raelson
authors.forename: Kalpana M
authors.initials: KM
authors.lastname: Kanal
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Kim
authors.forename: Brent K
authors.initials: BK
authors.lastname: Stewart
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000209:etiology* / Q000517:prevention & control; D009485:Neuroradiography; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011834:Radiation Monitoring / Q000379:methods*; D011835:Radiation Protection / Q000379:methods; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000528:radiation effects; D014057:Tomography, X-Ray Computed