Body CT Scanning in Young Adults: Examination Indications, Patient Outcomes, and Risk of Radiation-induced Cancer

Abstract

To quantify patient outcome and predicted cancer risk from body computed tomography (CT) in young adults and identify common indications for the imaging examination. This retrospective multicenter study was HIPAA compliant and approved by the institutional review boards of three institutions, with waiver of informed consent. The Research Patient Data Registry containing patient medical and billing records of three university-affiliated hospitals in a single metropolitan area was queried for patients 18-35 years old with a social security record who underwent chest or abdominopelvic CT from 2003 to 2007. Patients were analyzed according to body part imaged and scanning frequency. Mortality status and follow-up interval were recorded. The Biologic Effects of Ionizing Radiation VII method was used to calculate expected cancer incidence and death. Examination indication was determined with associated ICD-9 diagnostic code; 95% confidence intervals for percentages were calculated, and the binomial test was used to compare the difference between percentages. In 21 945 patients, 16 851 chest and 24 112 abdominopelvic CT scans were obtained. During the average 5.5-year (± 0.1 [standard deviation]) follow-up, 7.1% (575 of 8057) of chest CT patients and 3.9% (546 of 13 888) of abdominal CT patients had died. In comparison, the predicted risk of dying from CT-induced cancer was 0.1% (five of 8057, P < .01) and 0.1% (eight of 12 472, P < .01), respectively. The most common examination indications were cancer and trauma for chest CT and abdominal pain, trauma, and cancer for abdominopelvic CT. Among patients without a cancer diagnosis in whom only one or two scans were obtained, mortality and predicted risk of radiation-induced cancer death were 3.6% (215 of 5914) and 0.05% (three of 5914, P < .01) for chest CT and 1.9% (219 of 11 291) and 0.1% (six of 11 291, P < .01) for abdominopelvic CT. Among young adults undergoing body CT, risk of death from underlying morbidity is more than an order of magnitude greater than death from long-term radiation-induced cancer.