Grant Number:	1R01CA185687-01A1 Interpret this number
Primary Investigator:	Smith-Bindman, Rebecca
Organization:	University Of California, San Francisco
Project Title:	Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging
Fiscal Year:	2015

DESCRIPTION (provided by applicant): Over the last two decades, the use of advanced medical imaging, particularly with computed tomography (CT), has increased dramatically with over 80 million CT scans performed annually in the United States (U.S.). Integrating CT into routine care has contributed to the earlier and more accurate diagnosis of disease and injury. However, it has also markedly increased patient exposure to ionizing radiation, a well-established carcinogen. Many past studies of cancer risk have focused on specific human populations, such as Japanese atomic bomb survivors, which differ from the general US population undergoing routine medical imaging, and while most experts agree that radiation from medical imaging is associated with increased risk of cancer, the magnitude of the risk is unknown. We propose to study pregnant women and children enrolled from 1996 to 2017 in four integrated health care delivery systems: Kaiser Permanente (KP) Northern California, KP Southern California, KP Northwest, and Group Health Cooperative. We will use a stratified nested case-control study with counter-matching to comprehensively evaluate patterns of medical imaging, cumulative exposure to radiation, and subsequent risk of pediatric cancers. The cohort will include health plan members <21 y and pregnant women of any age, focusing on in utero or fetal (prenatal), childhood, and adolescent exposures. We estimate approximately 17.5 million patient-years of follow-up in this population-based study, including approximately 754 cases of pediatric leukemia and 2,779 cases of all pediatric cancers combined. The aims are to 1) evaluate patterns of medical imaging and associated radiation exposure in pregnant women and pediatric patients (<21 years); and 2) determine the risk of pediatric cancers (<21 years) associated with a) in utero or fetal exposure to medical imaging, focusing on risk of all pediatric cancers and including children born in the health systems with mothers enrolled during pregnancy; b) pediatric exposure to medical imaging, focusing on leukemia and including children born in the health systems; and c) in utero and pediatric exposures, focusing on all pediatric cancers and including children born in the health systems with mothers enrolled during pregnancy. The use of medical imaging with ionizing radiation remains high in the U.S., thus the potential harmful effects of this imaging must be understood so they can be weighed against its diagnostic benefit. This is especially critical for children, because they are particularly vulnerale to the carcinogenic effects of radiation given their rapid growth; in addition, their longer life expectancy gives them more time after exposure than adults to develop a cancer. This proposed study by an inter-disciplinary group of experienced investigators uses unparalleled data resources on U.S. exposure to medical imaging, complete capture of member health care utilization, and detailed demographic and cancer diagnosis information to examine these critical patient care and public health issues.




Medical imaging utilization and associated radiation exposure in children with down syndrome.
Authors: Marlow E.C. , Ducore J.M. , Kwan M.L. , Bowles E.J.A. , Greenlee R.T. , Pole J.D. , Rahm A.K. , Stout N.K. , Weinmann S. , Smith-Bindman R. , et al. .
Source: Plos One, 2023; 18(9), p. e0289957.
EPub date: 2023-09-06 00:00:00.0.
PMID: 37672503
Related Citations

Quantifying cancer risk from exposures to medical imaging in the Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study: research methods and cohort profile.
Authors: Kwan M.L. , Miglioretti D.L. , Bowles E.J.A. , Weinmann S. , Greenlee R.T. , Stout N.K. , Rahm A.K. , Alber S.A. , Pequeno P. , Moy L.M. , et al. .
Source: Cancer Causes & Control : Ccc, 2022-02-02 00:00:00.0; , .
EPub date: 2022-02-02 00:00:00.0.
PMID: 35107724
Related Citations

Positive predictive value and sensitivity of ICD-9-CM codes for identifying pediatric leukemia.
Authors: Weinmann S. , Francisco M.C. , Kwan M.L. , Bowles E.J.A. , Rahm A.K. , Greenlee R.T. , Stout N.K. , Pole J.D. , Kushi L.H. , Smith-Bindman R. , et al. .
Source: Pediatric Blood & Cancer, 2022 02; 69(2), p. e29383.
EPub date: 2021-11-13 00:00:00.0.
PMID: 34773439
Related Citations

Leukemia Risk in a Cohort of 3.9 Million Children With and Without Down Syndrome.
Authors: Marlow E.C. , Ducore J. , Kwan M.L. , Cheng S.Y. , Bowles E.J.A. , Greenlee R.T. , Pole J.D. , Rahm A.K. , Stout N.K. , Weinmann S. , et al. .
Source: The Journal Of Pediatrics, 2021-03-05 00:00:00.0; , .
EPub date: 2021-03-05 00:00:00.0.
PMID: 33684394
Related Citations

Long-term medical imaging use in children with central nervous system tumors.
Authors: Bowles E.J.A. , Miglioretti D.L. , Kwan M.L. , Bartels U. , Furst A. , Cheng S.Y. , Lau C. , Greenlee R.T. , Weinmann S. , Marlow E.C. , et al. .
Source: Plos One, 2021; 16(4), p. e0248643.
EPub date: 2021-04-21 00:00:00.0.
PMID: 33882069
Related Citations

Trends in Imaging for Suspected Pulmonary Embolism Across US Health Care Systems, 2004 to 2016.
Authors: Wang R.C. , Miglioretti D.L. , Marlow E.C. , Kwan M.L. , Theis M.K. , Bowles E.J.A. , Greenlee R.T. , Rahm A.K. , Stout N.K. , Weinmann S. , et al. .
Source: Jama Network Open, 2020-11-02 00:00:00.0; 3(11), p. e2026930.
EPub date: 2020-11-02 00:00:00.0.
PMID: 33216141
Related Citations

A Scalable Database of Organ Doses for Common Diagnostic Fluoroscopy Procedures of Children: Procedures of Historical Practice for Use in Radiation Epidemiology Studies.
Authors: Marshall E.L. , Rajderkar D. , Brown J.L. , Stepusin E.J. , Borrego D. , Duncan J. , Sammet C.L. , Munneke J.R. , Kwan M.L. , Miglioretti D.L. , et al. .
Source: Radiation Research, 2019 12; 192(6), p. 649-661.
EPub date: 2019-10-14 00:00:00.0.
PMID: 31609677
Related Citations

Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016.
Authors: Smith-Bindman R. , Kwan M.L. , Marlow E.C. , Theis M.K. , Bolch W. , Cheng S.Y. , Bowles E.J.A. , Duncan J.R. , Greenlee R.T. , Kushi L.H. , et al. .
Source: Jama, 2019-09-03 00:00:00.0; 322(9), p. 843-856.
PMID: 31479136
Related Citations

A scalable database of organ doses for common diagnostic fluoroscopy examinations of children: procedures of current practice at the University of Florida.
Authors: Marshall E.L. , Rajderkar D. , Brown J.L. , Stepusin E.J. , Borrego D. , Bolch W.E. .
Source: Physics In Medicine And Biology, 2019-07-05 00:00:00.0; 64(13), p. 135023.
EPub date: 2019-07-05 00:00:00.0.
PMID: 31013486
Related Citations

Trends in Medical Imaging During Pregnancy in the United States and Ontario, Canada, 1996 to 2016.
Authors: Kwan M.L. , Miglioretti D.L. , Marlow E.C. , Aiello Bowles E.J. , Weinmann S. , Cheng S.Y. , Deosaransingh K.A. , Chavan P. , Moy L.M. , Bolch W.E. , et al. .
Source: Jama Network Open, 2019-07-03 00:00:00.0; 2(7), p. e197249.
EPub date: 2019-07-03 00:00:00.0.
PMID: 31339541
Related Citations

Who Gets To Decide?
Authors: Smith-Bindman R. , Kwan M.L. , Miglioretti D.L. .
Source: Radiology, 2016 Feb; 278(2), p. 635-6.
PMID: 26789608
Related Citations