gms | German Medical Science

Background: Radioactive material and ionizing radiation are playing a central role in medical diagnostics and therapy. In contrast to radiographic examinations which are associated with a low level of radiation exposure angiographic or computed tomographic (CT) examinations are considerably associated with higher exposure. The benefit of ionizing radiation is opposed by the risk of irreparable damage of the human organism.

Situations in which the expected benefits do not outweigh the risks for paediatric patients being particular vulnerable should be determined very carefully.

Objective: Our aim was to review and critically appraise the best available evidence concerning the risk of computed tomography scanning for causing malign neoplasms in exposed children in their life course.

Methods: We conducted a systematic literature search for publications in English and German using the databases MEDLINE, Cochrane Central Register of Controlled Trails, Cochrane Database of Systematic Reviews, DAHTA-Datenbank, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, NHS Economic Evaluation Database, EMBASE, BIOSIS Previews, EMBASE Alert, SciSearch via user interface ClassicSearch and EBSCO (CINAHL Complete, Health Business Elite, SocINDEX) via user interface EBSCOhost in March 2016. Retrievals were screened by two independent reviewers. We included children up to 16 years examined by CT and with a diagnosis of malign neoplasm. The assessment of methodological quality was done by two independent reviewers concerning representativeness, risk of bias, and further limitations. Reporting quality was assessed using the RECORD checklist.

Results: The systematic searches identified four cohort studies. An increased risk of brain tumors in children after exposition to head CTs and by an increase of the number of examinations was shown. For children with predisposing factors an increased risk of tumors of the central nerve system, leukemia, and lymphoma was found. Furthermore, a general risk of malign neoplasms, and a specific risk of lymphoma after CT examinations of different parts of the body could be observed.

Discussion: Taking into consideration an unclear or high risk of bias as well as lack of comparability due to different research questions, the validity of results is limited.

Conclusion: To further examine the risk from CT-induced radiation exposure of children, additional studies with a follow-up of at least 10 years are necessary including documentation of each CT examination and its individual dosage, the body part examined, and eventually applicated contrast media. A verification of indication should be also reported stratified for the medical discipline of the indicating physician.