Pediatric Medical Imaging and Hematologic Cancer Risk: NEJM Study

Katkıda BulunanlarProf. Dr. Mustafa ÖzdoğanYazar

Yayın tarihi18 Eyl 2025

2 dk okuma

Çocuklarda Hematolojik Kanserlerin yüzde 10 Tıbbi Görüntüleme Kaynaklı Olabilir mi NEJM çalışması

Bu Makalede

NEJM study of 3.7 million children: cumulative bone-marrow radiation dose is linked to a small but significant increase in hematologic cancer risk.

Key takeaway: Exposure ≥30 mGy was associated with a 1.76× higher risk; about 10.1% of cases could be attributable to higher-dose imaging (e.g., CT). (1 head CT ≈ 13.7 mGy)

📊 Cohort & Follow-up

3,724,623 children; 35.7M person-years (mean 10.1y).

🧪 Outcomes

2961 hematologic cancers: 79.3% lymphoid, 15.5% myeloid/acute leukemia, 4.4% histiocytic/dendritic.

📈 Excess Incidence

Among ≥30 mGy (mean 57 mGy), excess by age 21 ≈ 25.6 per 10,000.

% Attributable

10.1% (95% CI 5.8–14.2) attributable to imaging-related radiation.

📏 Dose Guide (mGy)

Chest X-ray: ~0.1 mGy (ionizing)
Head CT: ~13.7 mGy (ionizing)
Abdominal CT: ~15–20 mGy (ionizing)
Ultrasound & MRI: No ionizing radiation

Remember: Risk relates to cumulative dose — repeated CTs add up.

📈 Dose–Risk Relationship

As cumulative radiation dose increases, the risk of hematological cancer also increases

As cumulative bone-marrow dose increases, relative risk rises. 30 mGy ≈ 1.76× vs. 0 mGy. Circles show estimates; blue band indicates statistical uncertainty.

⚡ Uses Ionizing Radiation

X-ray
CT (Computed Tomography)
Nuclear medicine (e.g., PET, scintigraphy)

🛡️ No Ionizing Radiation

Ultrasound
MRI (Magnetic Resonance Imaging)

🎯 Practical Actions (ALARA)

Justify each CT: will it change management?
Optimize pediatric protocols; avoid repeats; size-based settings.
Prefer US/MRI when clinically adequate.
Track cumulative dose; communicate risks to families clearly.

📋 Relative Risk by Dose Band

Cumulative Dose (mGy)	RR vs 0 mGy	95% CI
1–<5	1.41	1.11–1.78
15–<20	1.82	1.33–2.43
50–<100	3.59	2.22–5.44
Per 100 mGy: ERR ≈ 2.54 (95% CI 1.70–3.51). 30 vs 0 mGy: RR ≈ 1.76 (95% CI 1.51–2.05).

Source

Smith-Bindman R, Alber SA, Kwan ML, et al. Medical Imaging and Pediatric and Adolescent Hematologic Cancer Risk. NEJM, Sept 17, 2025. DOI: 10.1056/NEJMoa2502098

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