Abstract
Objective: To evaluate the association between radiation exposure from repeated nuclear medicine (NM) examinations and the subsequent risk of neoplasm in pediatric patients.Methods: From 2000 to 2017, participants under 18 years of age who underwent NM scanning were identified using the Health and Welfare Data Science Center (HWDC) dataset, which was extracted from the Taiwan National Health Insurance Research Database (NHIRD). Both the exposed cohort and unexposed subjects were followed up with until the presence of any malignancy arose, including malignant brain, lymphoid and hematopoietic tumors and benign brain or other central nervous tumors.Results: There were 35,292 patients in the exposed cohort and 141,152 matched subjects in the non-exposed group. The exposed cohort had an overall higher IR (IR: incidence rate, per 100,000 person-years) of any malignancy and benign central nervous tumor than the non-exposed group [IR, 16.9 vs. 1.54; adjusted hazard ratio (HR), 10.9; 95% CI, 6.53–18.2]. Further stratifying the number of NM examinations into 1-2, 3-4, and 5 or more times revealed that the IR of pediatric neoplasms increased gradually with the increased frequency of NM examinations (IR, 11.5; adjusted HR, 7.5; 95% CI, 4.29–13.1; IR, 25.8; adjusted HR, 15.9; 95% CI, 7.00–36.1; IR, 93.8; adjusted HR, 56.4; 95% CI, 28.8–110.3).Conclusion: NM examination is significantly associated with a higher risk of pediatric neoplasms, according to our population-based data. Thorough radiation protection and dose reduction in pediatric NM procedures should be an issue of concern.
Highlights
Radiation hazards to patients and medical workers exposed to radiological examinations have raised worldwide concerns in recent decades [1,2,3]
The date for the first nuclear medicine (NM) examination was defined as the index date and the start of follow-up set at 2 years after the index date
From 2000 to 2017, the cohort consisted of 35,292 patients with NM scans and 141,152 patients without NM scans
Summary
Radiation hazards to patients and medical workers exposed to radiological examinations have raised worldwide concerns in recent decades [1,2,3]. Children have a higher risk for adverse effects from radiation exposure than adults, and the subsequent lifelong estimated cancer risks due to repeated radiological examination should not be ignored [6, 7]. Several studies have revealed evidence of higher cancer risk after repeated CT scan exposure in pediatric patients [11,12,13,14,15]. Our encrypted identification and medical records of participants were representatively extracted from the NHIRD, which has the advantage of being one of the largest national databases in the world. This population-based study was designed to investigate the possible association between pediatric neoplasms and diagnostic NM procedures
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