Abstract
The increasing worldwide use of paediatric computed tomography (CT) has led to increasing concerns regarding the subsequent effects of exposure to radiation. In response to this concern, the international EPI-CT project was developed to study the risk of cancer in a large multi-country cohort. In radiation epidemiology, accurate estimates of organ-specific doses are essential. In EPI-CT, data collection is split into two time periods—before and after introduction of the Picture Archiving Communication System (PACS) introduced in the 1990s. Prior to PACS, only sparse information about scanner settings is available from radiology departments. Hence, a multi-level approach was developed to retrieve information from a questionnaire, surveys, scientific publications, and expert interviews. For the years after PACS was introduced, scanner settings will be extracted from Digital Imaging and Communications in Medicine (DICOM) headers, a protocol for storing medical imaging data. Radiation fields and X-ray interactions within the body will be simulated using phantoms of various ages and Monte-Carlo-based radiation transport calculations. Individual organ doses will be estimated for each child using an accepted calculation strategy, scanner settings, and the radiation transport calculations. Comprehensive analyses of missing and uncertain dosimetry data will be conducted to provide uncertainty distributions of doses.
Highlights
The use of computed tomography (CT) scanning in paediatric radiology departments has increased rapidly worldwide over the past two decades
Since the EPI-CT study includes males and females from birth to 20 years of age, and because radiation dose greatly depends on patient size, we found it necessary to generate a CT organ dose database with phantoms with smaller age gaps and with more realistic anatomy
Organ doses will be derived based on data collected on various types of scanners used in nine countries in different time periods, together with information collected from standard examination protocols which are specific to scanner type, examination type and indication, hospital, and different ages/weights
Summary
The use of computed tomography (CT) scanning in paediatric radiology departments has increased rapidly worldwide over the past two decades. EPI-CT aims to increase the statistical power, i.e., the power to reject the hypothesis of no health effects should it be false, with the additional objective of refining the risks earlier estimated. Both goals are important for epidemiologic studies concerned with public health issues. The primary objectives of EPI-CT are to evaluate the radiation-related risk of leukaemia and solid cancers using refined individual organ dose estimates. In order to assess the risk of cancer (primarily leukaemia) as a function of radiation doses received from CT scans in childhood and adolescence, cumulative individual doses to specific relevant organs need to be estimated for all subjects in the study. During the feasibility phase of the project, named the CHILD-MED-RAD project, possibilities to retrospectively assess individual organ doses were evaluated and a methodology was proposed, as presented
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