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Childhood Radiation Exposure From Cardiac Catheterizations
Study Questions:
What is the estimated risk of developing cancer in relation to typical radiation doses received from cardiac catheterization procedures during childhood?
Methods:
Data from five hospitals in the United Kingdom were used for the present analysis. A total of 2,749 procedures were used to estimate radiation doses. Monte Carlo simulations were used to examine the lifetime attributable risk (LAR) of cancer incidence, which was estimated using models developed by the Biological Effects of Ionizing Radiation Committee, based on both normal life expectancy, and as a function of attained age, from 20 to 80 years, to take reduced life expectancy into account.
Results:
Highest estimated radiation doses were for the lungs, esophagus, and breasts. The radiation-related risks from these procedures were dominated by lung and breast cancer (for females). Assuming normal life expectancy, central LAR estimates for cancer incidence, based on median doses, ranged from <1 in 2,000 for atrial septal defect occlusions to as high as 1 in 150 for valve replacements. For a reduced life expectancy of 50 years, estimated risks were lower by a factor of around 7. For conditions with especially poor survival (age 20 years), such as hypoplastic left heart syndrome, estimated cancer risks attributable to radiation were <1 in 20,000.
Conclusions:
The investigators concluded that based on recent UK radiation dose levels, the risk of cancer following cardiac catheterizations is relatively low and strongly modified by survival and the type of procedure. The risk of breast cancer, especially following pulmonary artery angioplasty and valve replacements, is the greatest concern.
Perspective:
Treatment of childhood cardiac conditions frequently requires the need for cardiac catheterizations; thus, in most cases, the benefits outweigh the risk. However, to reduce risk of cancer later in life, efforts to minimize radiation exposure including duration are warranted.
Keywords: Angioplasty, Breast Neoplasms, Cardiac Catheterization, Cardiotoxicity, Heart Septal Defects, Atrial, Heart Defects, Congenital, Heart Valve Diseases, Hypoplastic Left Heart Syndrome, Life Expectancy, Pediatrics, Radiation Dosage, Radiation, Ionizing, Risk Assessment
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