Pediatric computed tomography scan and subsequent risk of malignancy: a nationwide population-based cohort study in Korea using National Cancer Institute dosimetry system for computed tomography (NCICT)
Background Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for...
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| Published in | BMC medicine Vol. 23; no. 1; pp. 355 - 11 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
BioMed Central
01.07.2025
BioMed Central Ltd BMC |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1741-7015 1741-7015 |
| DOI | 10.1186/s12916-025-04235-3 |
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| Abstract | Background
Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort.
Methods
This nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose.
Results
From 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose–response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139–1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291–1.486), thyroid cancer (HR 1.248, 95% CI: 1.218–1.278), brain cancer (HR 1.201, 95% CI: 1.177–1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240–1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053–1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062–1.112), also showed increased risks.
Conclusions
This study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children. |
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| AbstractList | Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort. This nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose. From 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose-response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139-1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291-1.486), thyroid cancer (HR 1.248, 95% CI: 1.218-1.278), brain cancer (HR 1.201, 95% CI: 1.177-1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240-1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053-1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062-1.112), also showed increased risks. This study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children. Background Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort. Methods This nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose. Results From 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose-response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139-1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291-1.486), thyroid cancer (HR 1.248, 95% CI: 1.218-1.278), brain cancer (HR 1.201, 95% CI: 1.177-1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240-1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053-1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062-1.112), also showed increased risks. Conclusions This study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children. Keywords: Computed tomography, Neoplasms, Cohort studies, Pediatrics Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort. This nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose. From 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose-response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139-1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291-1.486), thyroid cancer (HR 1.248, 95% CI: 1.218-1.278), brain cancer (HR 1.201, 95% CI: 1.177-1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240-1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053-1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062-1.112), also showed increased risks. This study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children. BackgroundComputed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort.MethodsThis nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose.ResultsFrom 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose–response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139–1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291–1.486), thyroid cancer (HR 1.248, 95% CI: 1.218–1.278), brain cancer (HR 1.201, 95% CI: 1.177–1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240–1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053–1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062–1.112), also showed increased risks.ConclusionsThis study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children. Background Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort. Methods This nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose. Results From 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose–response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139–1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291–1.486), thyroid cancer (HR 1.248, 95% CI: 1.218–1.278), brain cancer (HR 1.201, 95% CI: 1.177–1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240–1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053–1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062–1.112), also showed increased risks. Conclusions This study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children. Abstract Background Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort. Methods This nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose. Results From 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose–response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139–1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291–1.486), thyroid cancer (HR 1.248, 95% CI: 1.218–1.278), brain cancer (HR 1.201, 95% CI: 1.177–1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240–1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053–1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062–1.112), also showed increased risks. Conclusions This study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children. Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort.BACKGROUNDComputed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher radiation doses and increased vulnerability. This study enhances prior research by using organ-specific radiation dose calculations for a more precise cancer risk assessment, investigating the associations between pediatric cancers and radiation doses in a large population cohort.This nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose.METHODSThis nationwide cohort study analyzed National Health Insurance Service claims data from 2007 to 2015 with a focus on individuals < 20 years of age who underwent CT scans. We used the International Classification of Diseases Tenth Revision codes to identify an exposed cohort and excluded subjects with congenital anomalies or previous cancer diagnoses. The study had a 2-year lag period to minimize selection bias and reverse causation effects. We calculated the exposed organ dose for each organ during each CT scan using the national CT dose survey data and the National Cancer Institute for Computed Tomography (NCICT) dose calculator. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer incidence according to organ-specific radiation dose.From 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose-response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139-1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291-1.486), thyroid cancer (HR 1.248, 95% CI: 1.218-1.278), brain cancer (HR 1.201, 95% CI: 1.177-1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240-1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053-1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062-1.112), also showed increased risks.RESULTSFrom 2007 to 2015, 1,540,633 children underwent CT scans, with 1,380,896 being included in the final analysis. A significant dose-response relationship was observed: for every one standard deviation increase in organ-specific radiation dose, the overall cancer risk increased (HR 1.155, 95% CI: 1.139-1.171). Among solid malignancies, associations were observed for urinary cancer (HR 1.385, 95% CI: 1.291-1.486), thyroid cancer (HR 1.248, 95% CI: 1.218-1.278), brain cancer (HR 1.201, 95% CI: 1.177-1.225), and digestive system cancer (HR 1.285, 95% CI: 1.240-1.331). Hematologic malignancies, including leukemia (HR 1.074, 95% CI: 1.053-1.100) and other myeloid tumors (HR 1.087, 95% CI: 1.062-1.112), also showed increased risks.This study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children.CONCLUSIONSThis study revealed a significant relationship between increased radiation doses during CT and the potential risk of various cancers in pediatric patients. Although CT is an invaluable diagnostic tool for which the risks are not high using the current diagnostic doses, a risk/benefit analysis is appropriate, especially for children. |
| ArticleNumber | 355 |
| Audience | Academic |
| Author | Jung, Jin-Hyung Hwang, YoonJoong Hong, Jae-Young Soh, Jaewan Han, Kyungdo Lee, Choonsik Han, Sangsoo Park, Jiwon Nah, Sangun |
| Author_xml | – sequence: 1 givenname: Sangsoo surname: Han fullname: Han, Sangsoo organization: Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital – sequence: 2 givenname: Jaewan surname: Soh fullname: Soh, Jaewan organization: Department of Orthopaedic Surgery, Hanyang University Guri Hospital – sequence: 3 givenname: Sangun surname: Nah fullname: Nah, Sangun organization: Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital – sequence: 4 givenname: Kyungdo surname: Han fullname: Han, Kyungdo organization: Department of Statistics and Actuarial Science, Soongsil University – sequence: 5 givenname: Jin-Hyung surname: Jung fullname: Jung, Jin-Hyung organization: Department of Statistics and Actuarial Science, Soongsil University – sequence: 6 givenname: Jiwon surname: Park fullname: Park, Jiwon organization: Department of Orthopedics, Division of Spinal Surgery, College of Medicine, Korea University – sequence: 7 givenname: YoonJoong surname: Hwang fullname: Hwang, YoonJoong organization: Department of Orthopedics, Division of Spinal Surgery, College of Medicine, Korea University – sequence: 8 givenname: Choonsik surname: Lee fullname: Lee, Choonsik organization: Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute – sequence: 9 givenname: Jae-Young surname: Hong fullname: Hong, Jae-Young email: osspine@korea.ac.kr organization: Department of Orthopedics, Division of Spinal Surgery, College of Medicine, Korea University |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/40597324$$D View this record in MEDLINE/PubMed |
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| Keywords | Pediatrics Computed tomography Neoplasms Cohort studies |
| Language | English |
| License | 2025. The Author(s). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
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Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to... Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to higher... Background Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to... BackgroundComputed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns due to... Abstract Background Computed tomography (CT) has advanced medical diagnostics by offering detailed anatomical imaging, but its use in children raises concerns... |
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| SubjectTerms | Abdomen Adolescent Age Biomedicine Brain cancer Brain tumors Cancer Care and treatment Child Child, Preschool Children Cohort analysis Cohort Studies Complications and side effects Computed tomography Confidence intervals Congenital anomalies Congenital defects Congenital diseases CT imaging Diagnostic imaging Digestive system Dosimetry Drug dosages Family income Female Genetic disorders Genital cancers Health aspects Health risks Humans Infant Infant, Newborn Leukemia Lymphoma Male Malignancy Medical diagnosis Medical imaging Medicine Medicine & Public Health National Cancer Institute (U.S.) National health insurance Neoplasms Neoplasms - epidemiology Neoplasms - etiology Neoplasms, Radiation-Induced - epidemiology Neoplasms, Radiation-Induced - etiology Neuroimaging Oncology, Experimental Patients Pediatric research Pediatrics Physiological aspects Population studies Radiation Radiation Dosage Republic of Korea - epidemiology Review boards Risk Assessment Risk factors Statistical analysis Thyroid Thyroid cancer Thyroid gland Tomography Tomography, X-Ray Computed - adverse effects Tumors Young Adult |
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| Title | Pediatric computed tomography scan and subsequent risk of malignancy: a nationwide population-based cohort study in Korea using National Cancer Institute dosimetry system for computed tomography (NCICT) |
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