weekly_question 19/5/2024

[Admin]

A fourteen-year-old girl presents to the Emergency Room for evaluation for appendicitis. You tell her parents that you would like the child to have an ultrasound to aid in the diagnosis, but her father states that he would prefer that you save time and proceed straight to a CT scan. What information would you pass along to parents regarding the risks of cancer associated with the use of CT in children?

A There is an increased risk for developing leukemia.

B Cancers associated with CT scans occur late in life.

C There is increased risk for developing abdominopelvic tumors.

D There is no cancer risk associated with CT scans in children.

[Admin]

correct answer
A There is an increased risk for developing leukemia.

There are currently a number of studies documenting the increased risk of cancer associated with ionizing radiation and CT scan in particular. Most studies document that these cancers occur early in life and are more common in scans performed in children less than 16 years of age.

Li used the Taiwanese national health insurance database to determine risk for intracranial malignancy in children less than 16 years of age that had undergone CT scans.[1] They built in a lag time from the time of the scan to the time of cancer occurrence to try to exclude children who were potentially getting scanned during treatment for a brain tumor. They also excluded any child that had had a nuclear medicine study for the same reason. These investigators found a significantly increased risk of future intracranial malignancy associated with head CT scan [OR 1.56 (1.04-2.33), p=0.031].

Another group studied the incidence of hematologic and solid tumors in children undergoing perioperative CT scans for appendicitis. Lee et al. from South Korea utilized the National Health Insurance Service database to study this issue. They also utilized a lag time in their study. They found that perioperative CT for appendicitis was associated with an increased rate ratio for developing leukemia of 1.4 (1.04-1.87, 95% CI, p< 0.0125). There was no increased risk of developing abdominopelvic tumors.

Marcu and colleagues made suggestions for changes in an effort to mitigate the cancer risk including: (i) dose reduction by using non-ionizing modalities for imaging; (ii) use of CT selectively; (iii) use of dedicated scan protocols; (iv) accurate dose calculations for each patient; (v) create registries for pediatric exposure.

[Bilal]

A

[Tarek Sabra]

A

[Ismailmohamed]

A

[zeedu5050]

A

[Eliane]

🙂A

[Audrey]

B

[Dr Lu]

A

[Halah]

B

[Dr.Shumaila]

B

[ndayong]

B

[Bashar Qassas]

B

[Admin]

correct answer
A There is an increased risk for developing leukemia.

There are currently a number of studies documenting the increased risk of cancer associated with ionizing radiation and CT scan in particular. Most studies document that these cancers occur early in life and are more common in scans performed in children less than 16 years of age.

Li used the Taiwanese national health insurance database to determine risk for intracranial malignancy in children less than 16 years of age that had undergone CT scans.[1] They built in a lag time from the time of the scan to the time of cancer occurrence to try to exclude children who were potentially getting scanned during treatment for a brain tumor. They also excluded any child that had had a nuclear medicine study for the same reason. These investigators found a significantly increased risk of future intracranial malignancy associated with head CT scan [OR 1.56 (1.04-2.33), p=0.031].

Another group studied the incidence of hematologic and solid tumors in children undergoing perioperative CT scans for appendicitis. Lee et al. from South Korea utilized the National Health Insurance Service database to study this issue. They also utilized a lag time in their study. They found that perioperative CT for appendicitis was associated with an increased rate ratio for developing leukemia of 1.4 (1.04-1.87, 95% CI, p< 0.0125). There was no increased risk of developing abdominopelvic tumors.

Marcu and colleagues made suggestions for changes in an effort to mitigate the cancer risk including: (i) dose reduction by using non-ionizing modalities for imaging; (ii) use of CT selectively; (iii) use of dedicated scan protocols; (iv) accurate dose calculations for each patient; (v) create registries for pediatric exposure.

[Faisal Ali]

C