title: The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk.
abstract: OBJECTIVE
  Increased use of computed tomography (CT) in pediatrics raises concerns about cancer risk from exposure to ionizing radiation.
  
  
  OBJECTIVE
  To quantify trends in the use of CT in pediatrics and the associated radiation exposure and cancer risk.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Seven US health care systems.
  
  
  METHODS
  The use of CT was evaluated for children younger than 15 years of age from 1996 to 2010, including 4 857 736 child-years of observation. Radiation doses were calculated for 744 CT scans performed between 2001 and 2011.
  
  
  METHODS
  Rates of CT use, organ and effective doses, and projected lifetime attributable risks of cancer. RESULTS The use of CT doubled for children younger than 5 years of age and tripled for children 5 to 14 years of age between 1996 and 2005, remained stable between 2006 and 2007, and then began to decline. Effective doses varied from 0.03 to 69.2 mSv per scan. An effective dose of 20 mSv or higher was delivered by 14% to 25% of abdomen/pelvis scans, 6% to 14% of spine scans, and 3% to 8% of chest scans. Projected lifetime attributable risks of solid cancer were higher for younger patients and girls than for older patients and boys, and they were also higher for patients who underwent CT scans of the abdomen/pelvis or spine than for patients who underwent other types of CT scans. For girls, a radiation-induced solid cancer is projected to result from every 300 to 390 abdomen/pelvis scans, 330 to 480 chest scans, and 270 to 800 spine scans, depending on age. The risk of leukemia was highest from head scans for children younger than 5 years of age at a rate of 1.9 cases per 10 000 CT scans. Nationally, 4 million pediatric CT scans of the head, abdomen/pelvis, chest, or spine performed each year are projected to cause 4870 future cancers. Reducing the highest 25% of doses to the median might prevent 43% of these cancers.
  
  
  CONCLUSIONS
  The increased use of CT in pediatrics, combined with the wide variability in radiation doses, has resulted in many children receiving a high-dose examination. Dose-reduction strategies targeted to the highest quartile of doses could dramatically reduce the number of radiation-induced cancers.
authors.affiliation: Group Health Research Institute, University of Washington, Seattle, WA, USA. dmiglioretti@ucdavis.edu
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Eric
authors.initials: E
authors.lastname: Johnson
authors.forename: Andrew
authors.initials: A
authors.lastname: Williams
authors.forename: Robert T
authors.initials: RT
authors.lastname: Greenlee
authors.forename: Sheila
authors.initials: S
authors.lastname: Weinmann
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.forename: Heather Spencer
authors.initials: HS
authors.lastname: Feigelson
authors.forename: Douglas
authors.initials: D
authors.lastname: Roblin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Flynn
authors.forename: Nicholas
authors.initials: N
authors.lastname: Vanneman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith-Bindman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000209:etiology*; D011829:Radiation Dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*