Quantifying and Contextualizing Radiation Doses in Common Pediatric Medical Imaging Examinations

Carly Stewart; Susan Alber; Malini Mahendra; Cameron Kofler; Trung Tran; Sean Domal; Erin J A Bowles; Sheila Weinmann; Robert T Greenlee; Natasha K Stout; Priscila Pequeno; Lisa M Moy; James R Duncan; Jason D Pole; Wesley E Bolch; Marilyn L Kwan; Diana L Miglioretti; Rebecca Smith-Bindman

doi:10.1016/j.jpedcp.2025.200166

Quantifying and Contextualizing Radiation Doses in Common Pediatric Medical Imaging Examinations

J Pediatr Clin Pract. 2025 Jul 23:17:200166. doi: 10.1016/j.jpedcp.2025.200166. eCollection 2025 Sep.

Authors

Carly Stewart¹, Susan Alber², Malini Mahendra^{3

4}, Cameron Kofler^{5

6}, Trung Tran^{5

7}, Sean Domal^{5

8}, Erin J A Bowles⁹, Sheila Weinmann^{10

11}, Robert T Greenlee¹², Natasha K Stout¹³, Priscila Pequeno¹⁴, Lisa M Moy¹⁵, James R Duncan¹⁶, Jason D Pole^{14

17

18}, Wesley E Bolch⁵, Marilyn L Kwan¹⁵, Diana L Miglioretti^{2

9}, Rebecca Smith-Bindman^{1

4

19}

Affiliations

¹ Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
² Department of Public Health Sciences, University of California, Davis, CA.
³ Department of Pediatrics, University of California, San Francisco, CA.
⁴ Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.
⁵ J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL.
⁶ Department of Radiology, The University of Chicago, Chicago, IL.
⁷ Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN.
⁸ Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX.
⁹ Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA.
¹⁰ Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
¹¹ Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, HI.
¹² Marshfield Clinic Research Institute, Marshfield Clinic, Health System, Marshfield, WI.
¹³ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
¹⁴ ICES, Toronto, Ontario, Canada.
¹⁵ Division of Research, Kaiser Permanente Northern California, Pleasanton, CA.
¹⁶ Interventional Radiology Section, Washington University in St. Louis, St. Louis, MI.
¹⁷ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹⁸ Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
¹⁹ Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.

Abstract

Objective: To provide organ and effective radiation doses for common pediatric imaging examinations, which may help clinicians understand site-specific cancer risk, compare exposure across imaging modalities, and make informed care decisions.

Study design: Within a large multicenter retrospective cohort, imaging utilization and associated radiation doses were estimated for children enrolled from birth into one of six US health care systems. Doses are described for examinations performed from 2012 to 2017. For computed tomography (CT), doses were estimated using examination-level technical parameters, patient height and weight, and Monte Carlo simulations. For fluoroscopy, angiography, nuclear medicine, and radiography, dose maps were developed by patient age, sex, size, and year through Monte Carlo simulations using technical parameters collected from patient examinations. The mean dose and standard deviation (SD) were calculated for each examination type, and each modality's contribution to the cohort's cumulative effective dose was calculated.

Results: Eight hundred thirty-five thousand six hundred forty-three imaging examinations in 278 909 patients are included. Radiographs were the most commonly performed exam but made up 6% of radiation dose exposure. CT exams made up 4% of imaging exams but accounted for 80% of exposure. Head CT was the most common CT exam (44% of all CT). For head CT, the average radiation dose to the bone marrow (associated with hematologic cancer risk) was 9.8 mGy (SD = 6.7) and to the brain (associated with brain cancer risk) was 39 mGy (SD = 14.8).

Conclusions: CT radiation doses to the bone marrow and brain fell within ranges associated with increased hematologic and brain cancer risk, and are highest in the youngest children.Keywords: Organ dose; effective dose; pediatric imaging; pediatric radiology; computed tomography; fluoroscopy; angiography; nuclear medicine; radiography; x-ray.