vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v22i1.2506vsp-3133Research ArticleСИСТЕМАТИЧЕСКИЙ ОБЗОРSYSTEMATIC REVIEWРиск развития опухолей головного мозга у детей, ассоциированный с проведением компьютерной томографии головы: систематический обзор литературыPediatric Brain Tumor Risk Associated with Head Computed Tomography: Systematic Literature Reviewhttps://orcid.org/0000-0001-9217-0223КузнецоваД. Р.KuznetsovaDilara R.

Кузнецова Дилара Рамилевна, студентка

450008, Уфа, ул. Ленина, д. 3

Ufa

dilara.kuznetsova@internet.ruhttps://orcid.org/0000-0002-6241-0246ГабдуллинаД. А.GabdullinaDiana A.

Уфа

Ufa

https://orcid.org/0000-0001-7916-4558МахмудоваА. Ф.MakhmudovaAlina F.

Уфа

Ufa

https://orcid.org/0000-0003-1099-0047БочкинаЕ. В.BochkinaElena V.

Москва

Moscow 

https://orcid.org/0000-0002-4918-4053ПлатоноваЕ. О.PlatonovaElizaveta O.

Уфа

Ufa

https://orcid.org/0000-0003-0441-9952ЖирновБ. О.ZhirnovBogdan O.

Уфа

Ufa

https://orcid.org/0000-0001-8405-2120АхметгарееваЭ. Э.AkhmetgareevaElnara E.

Уфа

Ufa

https://orcid.org/0000-0001-7637-2386АтангуловаЛ. С.AtangulovaLiliya S.

Уфа

Ufa

https://orcid.org/0000-0001-7670-6809ШеинР. С.SheinRuslan S.

Уфа

Ufa

https://orcid.org/0000-0001-5788-0342РахимоваК. И.RakhimovaKristina I.

Уфа

Ufa

https://orcid.org/0000-0001-5223-2215ПакальнисВ. В.PakalnisVlastilin V.

Уфа

Ufa

https://orcid.org/0000-0002-0436-8510ГаниеваЭ. Р.GanievaElza R.

Уфа

Ufa

Башкирский государственный медицинский университетРоссияBashkir State Medical UniversityRussian FederationМосковский государственный педагогический университетРоссияMoscow Pedagogical State UniversityRussian Federation2023100220232212330Copyright © Кузнецова Д.Р., Габдуллина Д.А., Махмудова А.Ф., Бочкина Е.В., Платонова Е.О., Жирнов Б.О., Ахметгареева Э.Э., Атангулова Л.С., Шеин Р.С., Рахимова К.И., Пакальнис В.В., Ганиева Э.Р., 20232023Кузнецова Д.Р., Габдуллина Д.А., Махмудова А.Ф., Бочкина Е.В., Платонова Е.О., Жирнов Б.О., Ахметгареева Э.Э., Атангулова Л.С., Шеин Р.С., Рахимова К.И., Пакальнис В.В., Ганиева Э.Р.Kuznetsova D.R., Gabdullina D.A., Makhmudova A.F., Bochkina E.V., Platonova E.O., Zhirnov B.O., Akhmetgareeva E.E., Atangulova L.S., Shein R.S., Rakhimova K.I., Pakalnis V.V., Ganieva E.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/3133

Компьютерная томография (КТ) головного мозга за последние полвека, начиная с ее первого клинического применения в 1971 г. для визуализации предполагаемой опухоли лобной доли, значительно трансформировала диагностическую нейрорадиологию. Безопасность КТ головы обусловлена небольшим количеством излучения, а также низкой восприимчивостью ткани головного мозга к цитотоксическому повреждению в результате воздействия ионизирующего излучения по сравнению с другими органами. Однако некоторые группы населения могут подвергаться повышенному риску. Так, дети более восприимчивы к радиационному раку, чем взрослые, и пожизненный атрибутивный риск (lifetime attributable risk; LAR) может быть более чем в 10 раз выше для младенца, чем для взрослого пациента средних лет. Авторами были рассмотрены опубликованные исследования, в которых изучались частота и смертность от внутричерепных новообразований, наблюдаемых у детей, проходивших КТ головы, по сравнению с лицами, не подвергавшимися воздействию. Проведен электронный поиск публикаций в базе данных PubMed с 1966 г. по настоящее время. Был осуществлен межсекторальный поиск документов, содержащих ключевые слова или медицинские предметные рубрики (MeSH), связанные с тремя широкими категориями: 1) компьютерная томография, 2) радиационноиндуцированные новообразования, 3) риск, заболеваемость или эпидемиология. Дальнейший поиск проводился в ручном режиме. Имеющаяся совокупность эпидемиологических данных в целом подтвердила наличие связи между КТ-исследованием головы и индукцией опухолевого роста. Текущие эпидемиологические данные подтверждают мнение о том, что риск индукции новообразований, связанный с проведением КТ головы у детей, очень мал (одно новообразование на 3000–10 000 исследований). Минимальный предполагаемый риск индукции новообразований от КТ головы у детей в значительной степени компенсируется преимуществами диагностической визуализации, учитывая клинические показания для минимизации дозы облучения. Понимание и количественная оценка рисков онкогенеза, связанных с проведением КТ, мотивировали проведение мероприятий по снижению дозы облучения для протоколов КТ у детей; такая тенденция должна продолжаться и применяться ко всем возрастным группам. Хотя решение о проведении КТ головы часто неоспоримо (травма или кровоизлияние), требуется тщательная оценка частоты исследований, особенно у пациентов, которым необходим мониторинг заболевания. В этих случаях кумулятивное воздействие может повышать минимальный риск онкогенеза. Для более адекватного понимания таких рисков необходимо проведение более крупных и усовершенствованных эпидемиологических исследований. 

Computed tomography (CT) of the brain has changed diagnostic neuroradiology significantly over the past 50 years since it was firstly used back in 1971 to visualize suspected frontal lobe tumour. The safety of head CT is determined by the small amount of radiation and the low sensibility of brain tissue to cytotoxic damage due to ionizing radiation compared to other organs. However, some population groups may be at increased risk. Thus, children are more susceptible to radiation cancer than adults and lifelong attributive risk (LAR) can be more than 10 times higher for an infant than for a middle-aged adult. The authors have reviewed published studies that examined the prevalence and mortality of intracranial tumors in children undergoing head CT in comparison to unaffected individuals. Electronic search of publications in the PubMed database from 1966 to date was carried out. We have carried out intersectoral search for documents containing keywords or medical subject headings (MeSH) related to three wide categories: 1) computed tomography, 2) radiation-induced tumors, 3) risk, morbidity or epidemiology. Further search was performed in manual mode. Available epidemiological data generally confirmed correlation between head CT and tumor growth induction. Thus, current epidemiological data accept the opinion that the risk of tumor induction associated with head CT in children is very small (one tumor per 3,000–10,000 studies). The minimal estimated risk of tumor induction due to head CT in children is mostly offset by its diagnostic imaging benefits considering the clinical indications to minimize radiation dose. Understanding and quantitative risk assessment of carcinogenesis associated with CT imaging led to dose reduction in pediatric CT protocols. This trend should continue and should be implemented in all age groups. Although the decision to perform head CT is often undeniable (injury or hemorrhage), careful assessment of studies frequency is required, especially in patients who need disease monitoring. Cumulative effect in such cases may increase the minimal risk of carcinogenesis. Larger and advanced epidemiological studies are required to better understand these risks. 

компьютерная томографияКТзлокачественные новообразованияопухолевый ростдетиcomputed tomographyCTmalignant tumorstumor growthchildrenReferencesSchulz RA, Stein JA, Pelc NJ. How CT happened: the early development of medical computed tomography. J Med Imaging (Bellingham). 2021;8(5):052110. doi: https://doi.org/10.1117/1.JMI.8.5.052110Schulz RA, Stein JA, Pelc NJ. How CT happened: the early development of medical computed tomography. J Med Imaging (Bellingham). 2021;8(5):052110. doi: https://doi.org/10.1117/1.JMI.8.5.052110Hounsfield GN. Computerized transverse axial scanning (tomography). 1. Description of system. Br J Radiol. 1973; 46(552):1016–1022. doi: https://doi.org/10.1259/0007-1285-46-552-1016Hounsfield GN. Computerized transverse axial scanning (tomography). 1. Description of system. Br J Radiol. 1973; 46(552):1016–1022. doi: https://doi.org/10.1259/0007-1285- 46-552-1016Eley KA, Delso G. Imaging of Bone in the Head and Neck Region, is There More Than CT? Curr Radiol Rep. 2022;10(6):69–82. doi: https://doi.org/10.1007/s40134-022-00396-8Eley KA, Delso G. Imaging of Bone in the Head and Neck Region, is There More Than CT? Curr Radiol Rep. 2022;10(6):69–82. doi: https://doi.org/10.1007/s40134-022-00396-8Голубев Н.А., Огрызко Е.В., Тюрина Е.М. и др. Особенности развития службы лучевой диагностики в Российской Федерации за 2014–2019 года // Современные проблемы здравоохранения и медицинской статистики. — 2021. — № 2. — С. 356–376. — doi: https://doi.org/10.24412/2312-2935-2021-2-356-376Golubev NA, Ogryzko EV, Tyurina EM, et al. Features of the development of the radiation diagnostics service in the Russian Federation for 2014–2019. Current problems of health care and medical statistics. 2021;(2):356–376. (In Russ). doi: https://doi.org/10.24412/2312-2935-2021-2-356-376Addala TE, Greffier J, Hamard A, et al. Early results of ultralow-dose CT-scan for extremity traumas in emergency room. Quant Imaging Med Surg. 2022;12(8):4248–4258. doi: https://doi.org/10.21037/qims-21-848Addala TE, Greffier J, Hamard A, et al. Early results of ultralow-dose CT-scan for extremity traumas in emergency room. Quant Imaging Med Surg. 2022;12(8):4248–4258. doi: https://doi.org/10.21037/qims-21-848Miyata T, Yanagawa M, Kikuchi N, et al. The evaluation of the reduction of radiation dose via deep learning-based reconstruction for cadaveric human lung CT images. Sci Rep. 2022;12(1):12422. doi: https://doi.org/10.1038/s41598-022-16798-9Miyata T, Yanagawa M, Kikuchi N, et al. The evaluation of the reduction of radiation dose via deep learning-based reconstruction for cadaveric human lung CT images. Sci Rep. 2022;12(1):12422. doi: https://doi.org/10.1038/s41598-022-16798-9Барковский А.Н., Братилова А.А., Кормановская Т.А. и др. Динамика доз облучения населения Российской Федерации за период с 2003 по 2018 г. // Радиационная гигиена. — 2019. — Т. 12. — № 4. — С. 96–122. — doi: https://doi.org/10.21514/1998-426X-2019-12-4-96-122Barkovsky AN, Bratilova AA, Kormanovskaya TA, et al. Trends in the doses of the population of the Russian Federation in 2003–2018. Radiatsionnaya Gygiena = Radiation Hygiene. 2019;12(4):96–122. (In Russ). doi: https://doi.org/10.21514/1998-426X-2019-12-4-96-122Морозова М.А., Лапшин В.Б., Доренский С.В., Сыроешкин А.В. Дозиметрия при авиаперелётах // Гелиогеофизические исследования. — 2014. — № 10. — С. 45–92.Morozova MA, Lapshin VB, Dorensky SV, Syroeshkin AV. Dosimetry for passenger air service. Heliogeophysical research. 2014;(10):45–92. (In Russ).Котеров А.Н., Ушенкова Л.Н. Минимальные дозы ионизирующей радиации, учащающие смертность от болезней системы кровообращения: существует ли риск от множественных компьютерных томографий на фоне пандемии COVID-19? // Российский кардиологический журнал. — 2022. — Т. 27. — № 3. — C. 4905. — doi: https://doi.org/10.15829/1560-4071-2022-4905Koterov AN, Ushenkova LN. Low-dose ionizing radiation as a factor increasing cardiovascular mortality: is there a risk from multiple computed tomographies in the context of COVID-19 pandemic? Russian Journal of Cardiology. 2022;27(3):4905. (In Russ). doi: https://doi.org/10.15829/1560-4071-2022-4905Бирюков Д.В., Самойлов А.А., Фролова О.Б. К вопросу о взаимосвязи характеристик территорий с локальным радиоактивным загрязнением и необходимости их реабилитации // Радиация и риск (Бюллетень Национального радиационно-эпидемиологического регистра). — 2022. — Т. 31. — № 1. — C. 105–114. — doi: https://doi.org/10.21870/0131-3878-2022-31-1-105-114Biryukov DV, Samoylov AA, Frolova OB. On the issue of the relationship between the characteristics of areas with dispersed radioactive contamination and the need for their remediation. Radiation & Risk (Bulletin of the National Radiation and Epidemiological Registry). 2022;31(1):105–114. (In Russ). doi: https://doi.org/10.21870/0131-3878-2022-31-1-105-114Mares V, Farah J, De Saint-Hubert M, et al. Neutron Radiation Dose Measurements in a Scanning Proton Therapy Room: Can Parents Remain Near Their Children During Treatment? Front Oncol. 2022;12:903706. doi: https://doi.org/10.3389/fonc.2022.903706Mares V, Farah J, De Saint-Hubert M, et al. Neutron Radiation Dose Measurements in a Scanning Proton Therapy Room: Can Parents Remain Near Their Children During Treatment? Front Oncol. 2022;12:903706. doi: https://doi.org/10.3389/fonc.2022.903706Hong JY, Han K, Jung JH, Kim JS. Association of Exposure to Diagnostic Low-Dose Ionizing Radiation With Risk of Cancer Among Youths in South Korea. JAMA Netw Open. 2019;2(9):e1910584. doi: https://doi.org/10.1001/jamanetworkopen.2019.10584Hong JY, Han K, Jung JH, Kim JS. Association of Exposure to Diagnostic Low-Dose Ionizing Radiation With Risk of Cancer Among Youths in South Korea. JAMA Netw Open. 2019;2(9):e1910584. doi: https://doi.org/10.1001/jamanetworkopen.2019.10584Габдуллина М.О., Жолдыбай Ж.Ж., Айнакулова А.С., Ашимбеков С.Ж. Применение мультиспиральной компьютерной томографии у пациентов детского возраста (литературный обзор) // Вестник Казахского национального медицинского университета. — 2020. — № 2. — С. 140–143.Gabdullina MO, Zholdybaj ZhZh, Ainakulova AS, Ashimbekov SZh. The usege of multispiral computed tomography among pediatric age patients (literature review). Vestnik Kazahskogo nacionalnogo medicinskogo universiteta. 2020;(2):140–143. (In Russ).Andersson M, Eckerman K, Pawel D, et al. Improved age- and gender-specific radiation risk models applied on cohorts of Swedish patients. Radiat Prot Dosimetry. 2021;195(3-4):334–338. doi: https://doi.org/10.1093/rpd/ncab075Andersson M, Eckerman K, Pawel D, et al. Improved age- and gender-specific radiation risk models applied on cohorts of Swedish patients. Radiat Prot Dosimetry. 2021;195(3-4):334–338. doi: https://doi.org/10.1093/rpd/ncab075Martin CJ, Barnard M. How much should we be concerned about cumulative effective doses in medical imaging? J Radiol Prot. 2022;42(1). doi: https://doi.org/10.1088/1361-6498/ac31c1Martin CJ, Barnard M. How much should we be concerned about cumulative effective doses in medical imaging? J Radiol Prot. 2022;42(1). doi: https://doi.org/10.1088/1361-6498/ac31c1Little MP, Patel A, Lee C, et al. Impact of Reverse Causation on Estimates of Cancer Risk Associated With Radiation Exposure From Computerized Tomography: A Simulation Study Modeled on Brain Cancer. Am J Epidemiol. 2022;191(1):173–181. doi: https://doi.org/10.1093/aje/kwab247Little MP, Patel A, Lee C, et al. Impact of Reverse Causation on Estimates of Cancer Risk Associated With Radiation Exposure From Computerized Tomography: A Simulation Study Modeled on Brain Cancer. Am J Epidemiol. 2022;191(1):173–181. doi: https://doi.org/10.1093/aje/kwab247Schabl L, Küppers J, Jhala T, et al. Global Irradiation in Children Treated for Hydrocephalus and Its Change over Time-A Single Institutional Analysis. Children (Basel). 2022;9(7):1062. doi: https://doi.org/10.3390/children9071062Schabl L, Küppers J, Jhala T, et al. Global Irradiation in Children Treated for Hydrocephalus and Its Change over Time-A Single Institutional Analysis. Children (Basel). 2022;9(7):1062. doi: https://doi.org/10.3390/children9071062LaQuaglia MJ, Anderson M, Goodhue CJ, et al. Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan. J Trauma Acute Care Surg. 2021;91(3):566–570. doi: https://doi.org/10.1097/TA.0000000000003318LaQuaglia MJ, Anderson M, Goodhue CJ, et al. Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan. J Trauma Acute Care Surg. 2021;91(3):566–570. doi: https://doi.org/10.1097/TA.0000000000003318Ranstam J, Wagner P. Systematic reviews, meta-analyses, randomized trials, and observational studies. Acta Orthop. 2022;93: 1–2. doi: https://doi.org/10.1080/17453674.2021.1975398Ranstam J, Wagner P. Systematic reviews, meta-analyses, randomized trials, and observational studies. Acta Orthop. 2022;93: 1–2. doi: https://doi.org/10.1080/17453674.2021.1975398Pflugbeil S, Pflugbeil C, Schmitz-Feuerhake I. Risk estimates for meningiomas and other late effects after diagnostic X-ray exposure of the skull. Radiat Prot Dosimetry. 2011;147(1-2):305–309. doi: https://doi.org/10.1093/rpd/ncr344Pflugbeil S, Pflugbeil C, Schmitz-Feuerhake I. Risk estimates for meningiomas and other late effects after diagnostic X-ray exposure of the skull. Radiat Prot Dosimetry. 2011;147(1-2):305–309. doi: https://doi.org/10.1093/rpd/ncr344Chodick G, Ronckers CM, Shalev V, Ron E. Excess lifetime cancer mortality risk attributable to radiation exposure from computed tomography examinations in children. Isr Med Assoc J. 2007; 9(8):584–587.Chodick G, Ronckers CM, Shalev V, Ron E. Excess lifetime cancer mortality risk attributable to radiation exposure from computed tomography examinations in children. Isr Med Assoc J. 2007; 9(8):584–587.Miglioretti DL, Johnson E, Williams A, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013;167(8):700–707. doi: https://doi.org/10.1001/jamapediatrics.2013.311Miglioretti DL, Johnson E, Williams A, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013;167(8):700–707. doi: https://doi.org/10.1001/jamapediatrics.2013.311Pokora R, Krille L, Dreger S, et al. Computed Tomography in Germany. Dtsch Arztebl Int. 2016;113(43):721–728. doi: https://doi.org/10.3238/arztebl.2016.0721Pokora R, Krille L, Dreger S, et al. Computed Tomography in Germany. Dtsch Arztebl Int. 2016;113(43):721–728. doi: https://doi.org/10.3238/arztebl.2016.0721Kojimahara N, Yoshitake T, Ono K, et al. Computed tomography of the head and the risk of brain tumours during childhood and adolescence: results from a case-control study in Japan. J Radiol Prot. 2020;40:1010–1023. doi: https://doi.org/10.1088/1361-6498/abacffKojimahara N, Yoshitake T, Ono K, et al. Computed tomography of the head and the risk of brain tumours during childhood and adolescence: results from a case-control study in Japan. J Radiol Prot. 2020;40:1010–1023. doi: https://doi.org/10.1088/1361-6498/abacffJourny N, Ancelet S, Rehel JL, et al. Predicted cancer risks induced by computed tomography examinations during childhood, by a quantitative risk assessment approach. Radiat Environ Biophys. 2014; 53(1):39–54. doi: https://doi.org/10.1007/s00411-013-0491-8Journy N, Ancelet S, Rehel JL, et al. Predicted cancer risks induced by computed tomography examinations during childhood, by a quantitative risk assessment approach. Radiat Environ Biophys. 2014; 53(1):39–54. doi: https://doi.org/10.1007/s00411-013-0491-8Feng ST, Law MW, Huang B, et al. Radiation dose and cancer risk from pediatric CT examinations on 64-slice CT: a phantom study. Eur J Radiol. 2010;76(2):19–23. doi: https://doi.org/10.1016/j.ejrad.2010.03.005Feng ST, Law MW, Huang B, et al. Radiation dose and cancer risk from pediatric CT examinations on 64-slice CT: a phantom study. Eur J Radiol. 2010;76(2):19–23. doi: https://doi.org/10.1016/j.ejrad.2010.03.005Stein SC, Hurst RW, Sonnad SS. Meta-analysis of cranial CT scans in children. A mathematical model to predict radiationinduced tumors. Pediatr Neurosurg. 2008;44(6):448–457. doi: https://doi.org/10.1159/000172967Stein SC, Hurst RW, Sonnad SS. Meta-analysis of cranial CT scans in children. A mathematical model to predict radiationinduced tumors. Pediatr Neurosurg. 2008;44(6):448–457. doi: https://doi.org/10.1159/000172967Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289–296. doi: https://doi.org/10.2214/ajr.176.2.1760289Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289–296. doi: https://doi.org/10.2214/ajr.176.2.1760289Mathews JD, Forsythe AV, Brady Z, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013;346:f2360. doi: https://doi.org/10.1136/bmj.f2360Mathews JD, Forsythe AV, Brady Z, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013;346:f2360. doi: https://doi.org/10.1136/bmj.f2360Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499–505. doi: https://doi.org/10.1016/S0140-6736(12)60815-0Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499–505. doi: https://doi.org/10.1016/S0140-6736(12)60815-0Huang WY, Muo CH, Lin CY, et al. Paediatric head CT scan and subsequent risk of malignancy and benign brain tumour: a nationwide population-based cohort study. Br J Cancer. 2014;110(9): 2354–2560. doi: https://doi.org/10.1038/bjc.2014.103Huang WY, Muo CH, Lin CY, et al. Paediatric head CT scan and subsequent risk of malignancy and benign brain tumour: a nationwide population-based cohort study. Br J Cancer. 2014;110(9): 2354–2560. doi: https://doi.org/10.1038/bjc.2014.103Journy N, Rehel JL, Ducou Le Pointe H, et al. Are the studies on cancer risk from CT scans biased by indication? Elements of answer from a large-scale cohort study in France. Br J Cancer. 2015;112(1):185–193. doi: https://doi.org/10.1038/bjc.2014.526Journy N, Rehel JL, Ducou Le Pointe H, et al. Are the studies on cancer risk from CT scans biased by indication? Elements of answer from a large-scale cohort study in France. Br J Cancer. 2015;112(1):185–193. doi: https://doi.org/10.1038/bjc.2014.526Krille L, Dreger S, Schindel R, et al. Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study. Radiat Environ Biophys. 2015;54(1):1–12. doi: https://doi.org/10.1007/s00411-014-0580-3Krille L, Dreger S, Schindel R, et al. Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study. Radiat Environ Biophys. 2015;54(1):1–12. doi: https://doi.org/10.1007/s00411-014-0580-3Berrington de Gonzalez A, Salotti JA, McHugh K, et al. Relation ship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions. Br J Cancer. 2016;114(4):388–394. doi: https://doi.org/10.1038/bjc.2015.415Berrington de Gonzalez A, Salotti JA, McHugh K, et al. Relation ship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions. Br J Cancer. 2016;114(4):388–394. doi: https://doi.org/10.1038/bjc.2015.415Koral K, Blackburn T, Bailey AA, et al. Strengthening the argument for rapid brain MR imaging: estimation of reduction in lifetime attributable risk of developing fatal cancer in children with shunted hydrocephalus by instituting a rapid brain MR imaging protocol in lieu of Head CT. AJNR Am J Neuroradiol. 2012;33(10):1851–1854. doi: https://doi.org/10.3174/ajnr.A3076Koral K, Blackburn T, Bailey AA, et al. Strengthening the argument for rapid brain MR imaging: estimation of reduction in lifetime attributable risk of developing fatal cancer in children with shunted hydrocephalus by instituting a rapid brain MR imaging protocol in lieu of Head CT. AJNR Am J Neuroradiol. 2012;33(10):1851–1854. doi: https://doi.org/10.3174/ajnr.A3076Aw-Zoretic J, Seth D, Katzman G, Sammet S. Estimation of effective dose and lifetime attributable risk from multiple head CT scans in ventriculoperitoneal shunted children. Eur J Radiol. 2014;83(10):1920–1924. doi: https://doi.org/10.1016/j.ejrad.2014.07.006Aw-Zoretic J, Seth D, Katzman G, Sammet S. Estimation of effective dose and lifetime attributable risk from multiple head CT scans in ventriculoperitoneal shunted children. Eur J Radiol. 2014;83(10):1920–1924. doi: https://doi.org/10.1016/j.ejrad. 2014.07.006King MA, Kanal KM, Relyea-Chew A, et al. Radiation exposure from pediatric head CT: a bi-institutional study. Pediatr Radiol. 2009;39(10): 1059–1065. doi: https://doi.org/10.1007/s00247-009-1327-1King MA, Kanal KM, Relyea-Chew A, et al. Radiation exposure from pediatric head CT: a bi-institutional study. Pediatr Radiol. 2009;39(10): 1059–1065. doi: https://doi.org/10.1007/s00247-009-1327-1Sheppard JP, Nguyen T, Alkhalid Y, et al. Risk of Brain Tumor Induction from Pediatric Head CT Procedures: A Systematic Literature Review. Brain Tumor Res Treat. 2018;(1):1–7. doi: https://doi.org/10.14791/btrt.2018.6.e4Sheppard JP, Nguyen T, Alkhalid Y, et al. Risk of Brain Tumor Induction from Pediatric Head CT Procedures: A Systematic Literature Review. Brain Tumor Res Treat. 2018;(1):1–7. doi: https://doi.org/10.14791/btrt.2018.6.e4Kocher DC, Apostoaei AI, Hoffman FO, Trabalka JR. Probability Distribution of Dose and Dose-Rate Effectiveness Factor for use in Estimating Risks of Solid Cancers From Exposure to Low-Let Radiation. Health Phys. 2018;114(6):602–622. doi: https://doi.org/10.1097/HP.0000000000000838Kocher DC, Apostoaei AI, Hoffman FO, Trabalka JR. Probability Distribution of Dose and Dose-Rate Effectiveness Factor for use in Estimating Risks of Solid Cancers From Exposure to Low-Let Radiation. Health Phys. 2018;114(6):602–622. doi: https://doi.org/10.1097/HP.0000000000000838Milder CM, Kendall GM, Arsham A, et al. Summary of Radiation Research Society Online 66th Annual Meeting, Symposium on “Epidemiology: Updates on epidemiological low dose studies”, including discussion. Int J Radiat Biol. 2021;97(6):866–873. doi: https://doi.org/10.1080/09553002.2020.1867326Milder CM, Kendall GM, Arsham A, et al. Summary of Radiation Research Society Online 66th Annual Meeting, Symposium on “Epidemiology: Updates on epidemiological low dose studies”, including discussion. Int J Radiat Biol. 2021;97(6):866–873. doi: https://doi.org/10.1080/09553002.2020.1867326Jaffurs D, Denny A. Diagnostic pediatric computed tomographic scans of the head: actual dosage versus estimated risk. Plast Reconstr Surg. 2009;124(4):1254–1260. doi: https://doi.org/10.1097/PRS.0b013e3181b59d2dJaffurs D, Denny A. Diagnostic pediatric computed tomographic scans of the head: actual dosage versus estimated risk. Plast Reconstr Surg. 2009;124(4):1254–1260. doi: https://doi.org/10.1097/PRS.0b013e3181b59d2dRosen NS. Taking care of children. AJR Am J Roentgenol. 2001; 177(3):715-7. doi: https://doi.org/10.2214/ajr.177.3.1770715bRosen NS. Taking care of children. AJR Am J Roentgenol. 2001; 177(3):715-7. doi: https://doi.org/10.2214/ajr.177.3.1770715bBingyang B, Gang W, Zhiqing S, et al. A Preliminary Study of Personalized Head CT Scan in Pediatric Patients. Dose Response. 2021;19(1):1559325820985660. doi: https://doi.org/10.1177/1559325820985660Bingyang B, Gang W, Zhiqing S, et al. A Preliminary Study of Personalized Head CT Scan in Pediatric Patients. Dose Response. 2021;19(1):1559325820985660. doi: https://doi.org/10.1177/1559325820985660Arrangoiz R, Opreanu RC, Mosher BD, et al. Reduction of radiation dose in pediatric brain CT is not associated with missed injuries or delayed diagnosis. Am Surg. 2010;76(11):1255–1259.Arrangoiz R, Opreanu RC, Mosher BD, et al. Reduction of radiation dose in pediatric brain CT is not associated with missed injuries or delayed diagnosis. Am Surg. 2010;76(11):1255–1259.Machingaidze PR, Buys H, Kilborn T, Muloiwa R. Clinical use and indications for head computed tomography in children presenting with acute medical illness in a low- and middle-income setting. PLoS One. 2020;15(9):e0239731. doi: https://doi.org/10.1371/journal.pone.0239731Machingaidze PR, Buys H, Kilborn T, Muloiwa R. Clinical use and indications for head computed tomography in children presenting with acute medical illness in a low- and middle-income setting. PLoS One. 2020;15(9):e0239731. doi: https://doi.org/10.1371/journal.pone.0239731Barreto IL, Tuna IS, Rajderkar DA, et al. Pediatric craniosynostosis computed tomography: an institutional experience in reducing radiation dose while maintaining diagnostic image quality. Pediatr Radiol. 2022;52(1):85–96. doi: https://doi.org/10.1007/s00247-021-05205-6Barreto IL, Tuna IS, Rajderkar DA, et al. Pediatric craniosynostosis computed tomography: an institutional experience in reducing radiation dose while maintaining diagnostic image quality. Pediatr Radiol. 2022;52(1):85–96. doi: https://doi.org/10.1007/s00247-021-05205-6Mazzei-Abba A, Folly CL, Coste A, et al. Epidemiological studies of natural sources of radiation and childhood cancer: current challenges and future perspectives. J Radiol Prot. 2020;40(1):1–23. doi: https://doi.org/10.1088/1361-6498/ab5a38Mazzei-Abba A, Folly CL, Coste A, et al. Epidemiological studies of natural sources of radiation and childhood cancer: current challenges and future perspectives. J Radiol Prot. 2020;40(1):1–23. doi: https://doi.org/10.1088/1361-6498/ab5a38Strauss KJ, Kaste SC. The ALARA concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients — a white paper executive summary. AJR Am J Roentgenol. 2006;187(3): 818–819. doi: https://doi.org/10.2214/AJR.06.0543Strauss KJ, Kaste SC. The ALARA concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients — a white paper executive summary. AJR Am J Roentgenol. 2006;187(3): 818–819. doi: https://doi.org/10.2214/AJR.06.0543

The authors declare that there are no conflicts of interest present.