Radiation exposure from computerized tomography and risk of childhood leukemia: Finnish register-based case-control study of childhood leukemia (FRECCLE)

Nikkilä, Atte; Raitanen, Jani; Lohi, Olli; Auvinen, Anssi

doi:10.3324/haematol.2018.187716

Cited by 41 publications

(38 citation statements)

References 35 publications

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“…In the subgroup analysis by type of imaging test, we observed higher rates in the CT group in the 0–20 years age group (2.5%). Greater efforts to decrease the number of recurrent CTs in children have to be implemented, taking into account that a recent study showed that even low doses of ionising radiation increase the risk of childhood leukaemia 24…”

Section: Discussionmentioning

confidence: 99%

Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain

2019

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ObjectivesTo calculate each patient’s cumulative radiation exposure and the recurrent tests during a 12-year study period, according to sex and age, in routine practice.DesignRetrospective cohort study.SettingA general hospital with a catchment population of 224 751 people, in the Southeast of Spain.ParticipantsPopulation belonged to the catchment area of that hospital in 2007. We collected all consecutive diagnostic imaging tests undergone by this population until 31 December 2018. We excluded: imaging tests that did not involve radiation exposure.Main outcome measuresThe cumulative effective dose and the recurrent imaging tests by sex and age at entry of study.ResultsOf the 224 751 people, 154 520 (68.8%) underwent an imaging test. The population had 1 335 752 imaging tests during the period of study: 1 110 077 (83.0%) plain radiography; 156 848 (11.8%) CT; 63 157 (4.8%) fluoroscopy and 5670 (0.4%) interventional radiography. 25.4% of the patients who had a CT, underwent five or more CTs (5.4% in the 0–20 years age group). The median total cumulative effective dose was 2.10 mSv (maximum 3980.30) and 16.30 mSv (maximum 1419.30 mSv) if we considered only doses associated with CT. Women received more effective dose than men (median 2.38 vs median 1.90, p<0.001). A total of 7142 (4.6%) patients received more than 50 mSv, with differences in men and women (p<0.001) and 2.5% of the patients in the 0–20 years age group, if we considered only doses associated with CT.ConclusionsNearly 5% of patients received doses higher than 50 mSv during the 12-year period of study and 2.5% of the patients in the 0–20 years age group, if we considered only doses associated with CT. The rate of recurrent examinations was high, especially in older patients, but also relevant in the 0–20 years age group.

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Section: Discussionmentioning

confidence: 99%

Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain

2019

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“…Data on CT examinations performed on children aged 0−15 years were obtained from radiological databases from the ten largest Finnish hospitals for another study [ 5 ]. In Finland, primary healthcare is provided through municipal health centers.…”

Section: Methodsmentioning

confidence: 99%

“…However, CT use in children has been a topic of concern and debate for several reasons. In the 1990s and early 2000s, CT utilization in children increased in many countries, and several studies showed that children who have undergone CT imaging have a higher risk of malignancy such as leukemia and brain cancer [ [1] , [2] , [3] , [4] , [5] , [6] ]. The risk of cancer after exposure to pediatric CT radiation might be relatively small in absolute terms, yet it is a public health concern because of the large population of children exposed [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Trends of computed tomography use among children in Finland

Abuhamed

Nikkilä

Lohi

et al. 2020

European Journal of Radiology Open

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Objectives CT is an essential diagnostic tool in health care. However, CT delivers relatively high levels of radiation which has been associated with an increased risk of childhood cancer. To address this, we evaluated patterns and time trends of CT use among children in Finland during the period in which changes in pediatric CT imaging practices were reported in several countries. Methods Data on CTs performed on children younger than 15 years were obtained from Finland’s largest eight hospitals. CT data included the period 1996–2010 with an estimated coverage of more than 80 % of pediatric CT imaging in Finland. Joinpoint regression was used for trends analysis. CT radiation doses were estimated based on a Finnish dosimetry survey. Results A total of 48,807 pediatric CTs were performed in 1996–2010. More boys (55.5 %) were scanned than girls (42.8 %). CT numbers increased up to 2002, then decreased significantly (-6.9 % per year, 95 % CI: -10.4 to -3.2) towards 2005 and to a lesser extent thereafter, particularly among younger children. All CT types decreased in recent years, except for chest, spine, and extremities. The frequency of head CTs related to the diagnoses of intracranial injury, migraine and headache decreased towards the end of the study period. The estimated annual average effective dose from the three most common CT examinations was 0.004 mSv per child in the population. Conclusions The frequency of pediatric CTs in Finland started to decrease after 2002. Apart from chest and orthopedic CTs, the utilization of pediatric CT imaging declined in recent years, most likely explained by improved awareness of medical radiation risks and reliance on alternative modalities such as MRI and ultrasound.

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“…Both socioeconomic status and education were known individually for each parent. Socioeconomic status was classified into five classes (self-employed, upper level employee, lower level employee, manual worker and other) and education into three levels (upper secondary, bachelor's degree, master's or doctor's degree) (55).…”

Section: Radon Exposure Predictionmentioning

confidence: 99%

Predicting residential radon concentrations in Finland: Model development, validation, and application to childhood leukemia

Nikkilä¹,

Arvela²,

Mehtonen³

et al. 2019

Scand J Work Environ Health

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Indoor radon prediction models were created based on ~80 000 measurements and modern machine learning methods were used in modelling. The performance of the models was comparable to the previously published ones. We observed a non-significant risk of childhood leukemia from indoor radon. However, the modelling involves some uncertainties.Nikkilä A, Arvela H, Mehtonen J, Raitanen J, Heinäniemi M, Auvinen A. Predicting residential radon concentrations in Finland: Model development, validation, and application to childhood leukemia.Objectives Inhaled radon gas is a known alpha-emitting carcinogen linked especially to lung cancer. Studies on higher concentrations of indoor radon and childhood leukemia have conflicting but largely negative results. In this study, we aimed to create a sophisticated statistical model to predict indoor radon concentrations and apply it to a Finnish childhood leukemia case-control dataset.Methods Prediction was based on ~80 000 indoor radon measurements, which were linked to national registries for potential indoor radon predictors based on the literature. In modelling, we used classical methods, random forests and deep neural networks. We had 1093 cases and 3279 controls from a nationwide case-control study. We estimated odds ratio (OR) for childhood leukemia using conditional logistic regression adjusted for potential confounders. ResultsThe r 2 of the final log-linear model was 0.21 for houses and 0.20 for apartments. Using random forest method, we were able to obtain slightly better fit for both houses (r 2 = 0.28) and apartments (r 2 = 0.23). In a risk analysis based on the case-control data with log-linear model, we observed a non-significant (P=0.54) increase with predicted radon concentrations [OR for the 2 nd quartile 1.08, 95% confidence interval (CI) 0.77-1.50, OR 1.10 with 95% CI 0.79-1.53 for the 3 rd , and 1.29 with 95% CI 0.93-1.77 for the highest quartile].Conclusions Our modelling and the previously published models performed similarly but involves major uncertainties, and the results should be interpreted with caution. We observed a slight non-significant increase in risk of childhood leukemia related to higher average indoor radon concentrations.

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Radiation exposure from computerized tomography and risk of childhood leukemia: Finnish register-based case-control study of childhood leukemia (FRECCLE)

Cited by 41 publications

References 35 publications

Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain

Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain

Trends of computed tomography use among children in Finland

Predicting residential radon concentrations in Finland: Model development, validation, and application to childhood leukemia

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