title: Leukemia and brain tumors among children after radiation exposure from CT scans: design and methodological opportunities of the Dutch Pediatric CT Study.
abstract: Computed tomography (CT) scans are indispensable in modern medicine; however, the spectacular rise in global use coupled with relatively high doses of ionizing radiation per examination have raised radiation protection concerns. Children are of particular concern because they are more sensitive to radiation-induced cancer compared with adults and have a long lifespan to express harmful effects which may offset clinical benefits of performing a scan. This paper describes the design and methodology of a nationwide study, the Dutch Pediatric CT Study, regarding risk of leukemia and brain tumors in children after radiation exposure from CT scans. It is a retrospective record-linkage cohort study with an expected number of 100,000 children who received at least one electronically archived CT scan covering the calendar period since the introduction of digital archiving until 2012. Information on all archived CT scans of these children will be obtained, including date of examination, scanned body part and radiologist's report, as well as the machine settings required for organ dose estimation. We will obtain cancer incidence by record linkage with external databases. In this article, we describe several approaches to the collection of data on archived CT scans, the estimation of radiation doses and the assessment of confounding. The proposed approaches provide useful strategies for data collection and confounder assessment for general retrospective record-linkage studies, particular those using hospital databases on radiological procedures for the assessment of exposure to ionizing or non-ionizing radiation.
authors.affiliation: Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Meulepas
authors.forename: Cécile M
authors.initials: CM
authors.lastname: Ronckers
authors.forename: Anne M J B
authors.initials: AM
authors.lastname: Smets
authors.forename: Rutger A J
authors.initials: RA
authors.lastname: Nievelstein
authors.forename: Andreas
authors.initials: A
authors.lastname: Jahnen
authors.forename: Choonsik
authors.initials: C
authors.lastname: Lee
authors.forename: Mariëtte
authors.initials: M
authors.lastname: Kieft
authors.forename: Johan S
authors.initials: JS
authors.lastname: Laméris
authors.forename: Marcel
authors.initials: M
authors.lastname: van Herk
authors.forename: Marcel J W
authors.initials: MJ
authors.lastname: Greuter
authors.forename: Cécile R L P N
authors.initials: CR
authors.lastname: Jeukens
authors.forename: Marcel
authors.initials: M
authors.lastname: van Straten
authors.forename: Otto
authors.initials: O
authors.lastname: Visser
authors.forename: Flora E
authors.initials: FE
authors.lastname: van Leeuwen
authors.forename: Michael
authors.initials: M
authors.lastname: Hauptmann
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007938:Leukemia / Q000453:epidemiology*; D008297:Male; D008498:Medical Record Linkage; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D010372:Pediatrics; D011829:Radiation Dosage; D011839:Radiation, Ionizing; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult
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