Risk of Brain Tumor Induction from Pediatric Head CT Procedures: A Systematic Literature Review

John P Sheppard; Thien Nguyen; Yasmine Alkhalid; Joel S Beckett; Noriko Salamon; Isaac Yang

doi:10.14791/btrt.2018.6.e4

Risk of Brain Tumor Induction from Pediatric Head CT Procedures: A Systematic Literature Review

Brain Tumor Res Treat. 2018 Apr;6(1):1-7. doi: 10.14791/btrt.2018.6.e4.

Authors

John P Sheppard¹, Thien Nguyen¹, Yasmine Alkhalid¹, Joel S Beckett¹, Noriko Salamon², Isaac Yang^{1

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Affiliations

¹ Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
² Department of Radiological Sciences, Section of Neuroradiology, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
³ Department of Head and Neck Surgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
⁴ Department of Radiation Oncology, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
⁵ Jonsson Comprehensive Cancer Center, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
⁶ Los Angeles Biomedical Research Institute, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
⁷ Harbor-UCLA Medical Center, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, CA, USA. iyang@mednet.ucla.edu.

Abstract

Head computed tomography (CT) is instrumental for managing patients of all ages. However, its low dose radiation may pose a low but non-zero risk of tumor induction in pediatric patients. Here, we present a systematic literature review on the estimated incidence of brain tumor induction from head CT exams performed on children and adolescents. MEDLINE was searched using an electronic protocol and bibliographic searches to identify articles related to CT, cancer, and epidemiology or risk assessment. Sixteen studies that predicted or measured head CT-related neoplasm incidence or mortality were identified and reviewed. Epidemiological studies consistently cited increased tumor incidence in pediatric patients (ages 0-18) exposed to head CTs. Excess relative risk of new brain tumor averaged 1.29 (95% confidence interval, 0.66-1.93) for pediatric patients exposed to one or more head CTs. Tumor incidence increased with number of pediatric head CTs in a dose-dependent manner, with measurable excess incidence even after a single scan. Converging evidence from epidemiological studies supported a small excess risk of brain tumor incidence after even a single CT exam in pediatric patients. However, refined epidemiological methods are needed to control for confounding variables that may contribute to reverse causation, such as patients with pre-existing cancer or cancer susceptibility. CT remains an invaluable technology that should be utilized so long as there is clinical indication for the study and the radiation dose is as small as reasonably achievable.

Keywords: Brain tumor; Epidemiology; Patient safety; Pediatrics; Radiometry; Tomography, X-ray computed.

Publication types

Review