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

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.

CT scan exposure in children with ventriculo-peritoneal shunts: single centre experience and review of the literature

“…Despite these findings appearing reassuring, there is strong epidemiological evidence linking CT scanning in childhood with an increased risk of malignancy. [8,31] Confidently attributing cancer to childhood CT radiation exposure is difficult; however, numerous studies aiming to assess this risk have been published. (Table 1) These include three population studies, reporting patient exposure and outcome data, as well as studies calculating a predicted risk based on the previous population studies or those relating to Japanese Bomb survivors or the BIER reports [8,13,20,25].…”

“…The review identified that a single CT head scan in childhood carries a 2.4-fold increased risk of developing a brain tumour compared to children who have not been exposed to a CT head scan. Whilst the increased relative risk is significant, the estimated risk of developing radiationinduced cancer corresponds to around one per 1800 paediatric head CTs [31].…”

Outpatient Management of Headache after Pediatric Emergency Department Visit: Are we Missing Anything?

“…A head CT in the PED setting is not typically indicated, especially due to substantial radiation exposure and cost-effectiveness considerations. 3 When a child presents to the PED with an acute headache the attending physician will first focus on ruling out emergencies and identifying red flags suggestive of an intracranial tumor, especially if the child presents without fever or signs of meningitis. 4 The next priority is pain management, followed by a decision by the emergency physician whether the patient requires further evaluation or can be discharged home.…”

Multi‐centre study found that strict adherence to guidelines led to computed tomography scans being overused in children with minor head injuries

“…We acknowledge that the high number of CTs in our study was not without risk. First, although the cumulative risk of developing a radiation‐induced malignancy later in life was small, the relative risk has been shown to more than double . Second, in our cohort, nontraumatic incidental findings were present in 10% of CT scans not related to MHI.…”