Radioprotection 2024 , 59 ( 2 ), 131 – 137 © SFRP , 2024 https :// doi . org / 10.1051 / radiopro / 2024008 Available online at : www . radioprotection . org
ARTICLE
Paediatric cancer risks associated with chest computed tomography ( CT ) scans : comparison of routine chest and COVID-19 diagnosis CT protocols
M . Keshtkar *
Medical Physics and Radiology Department , Faculty of Medicine , Infectious Diseases Research Center , Gonabad University of Medical Sciences , Gonabad , Iran .
Received : 18 September 2023 / Accepted : 1 March 2024
Abstract – The aim of this study is to compare the radiation dose and cancer incidence risk associated with two chest Computed Tomography ( CT ) protocols : routine chest CT ( RC-CT ) and COVID-19 Diagnosis CT protocol ( CD-CT ). The study included 254 pediatric patients divided into three age groups : G1 (< 5 ), G2 ( 5 –< 10 ), and G3 ( 10 – 15 ). The effective diameter , volumetric CT dose index ( CTDI vol ), dose length product ( DLP ), size specific dose estimate ( SSDE ), organ doses , and cancer incidence risk were calculated for the two protocols . Organ doses ( mSv ) and effective dose ( mSv ) were estimated using the National Cancer Institute dosimetry system for CT ( NCICT ) software . Estimation of cancer incidence risks were conducted according to the Biological Effects of Ionizing Radiation ( BEIR ) VII report . The oldest group ( G3 ) in two protocols exhibited the greatest values for CTDI vol , DLP , effective dose and SSDE . The results showed that CD-CT protocol resulted in statistically significant ( p < 0.05 ) lower organ doses and cancer incidence risk . The cancer incidence risk for both protocols did not exceed the reference levels reported in literature surveys on pediatric CT chest radiation dose for all age groups . It can be concluded that the choice of CT protocol can significantly impact the radiation dose received by pediatric patients during CT imaging , highlighting the importance of carefully selecting the appropriate protocol to minimize radiation exposure .
Keywords : Computed tomography / chest CT / paediatric / cancer risk
1 Introduction
COVID-19 , caused by the SARS-CoV-2 virus , initially emerged as a respiratory illness primarily affecting adults , but it has also been observed in pediatric populations ( Zimmermann and Curtis , 2020 ). Although children generally experience milder symptoms compared to adults , severe cases and complications , including Multisystem Inflammatory Syndrome in Children ( MIS-C ), have been reported ( Hennon et al ., 2020 ). Studies have shown that children can contract and transmit the virus , even if they are often asymptomatic or exhibit mild symptoms ( Adeyinka et al ., 2021 ). It is crucial to closely monitor and understand the impact of COVID-19 on pediatric patients to guide appropriate public health measures and medical interventions ( Howard-Jones et al ., 2022 ).
Computed Tomography ( CT ) scans have become an indispensable tool in pediatric diagnostic imaging due to their ability to provide detailed cross-sectional images of the body ( Hussain et al ., 2022 ). CT scans offer valuable information for
* Corresponding author : keshtkar . dmohammad @ yahoo . com the evaluation of various conditions in children , including trauma , neurological disorders , pulmonary diseases , abdominal pathologies , and recently COVID-19 diagnosis ( Biagas et al ., 2019 ; Kaufman et al ., 2020 ; Li et al ., 2020 ; Lin and Lin , 2016 ).
However , it is important to use CT scans judiciously in pediatric patients due to the potential risks associated with ionizing radiation exposure ( Garg et al ., 2021 ). The use of CT scans in pediatric patients is associated with potential longterm risks , particularly in terms of radiation-induced cancer ( Marcu et al ., 2021 ).
Ionizing radiation from diagnostic imaging , including CT scans , has been found to increase the lifetime risk of cancer ( Garg et al ., 2021 ; Marcu et al ., 2021 ). Several studies have investigated this risk , emphasizing the importance of minimizing radiation exposure in children ( Berrington de Gonzalez et al ., 2021 ). A population-based cohort study by Mathews et al . found that pediatric patients who underwent CT scans had a small but statistically significant increase in their risk of developing solid cancers later in life ( Mathews et al ., 2013 ). Another study by Pearce et al . estimated that exposure to radiation from two to three CT scans in childhood might lead