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

Marilyn L Kwan^#¹, Diana L Miglioretti^#^{2

3}, Erin J A Bowles³, Sheila Weinmann^{4

5}, Robert T Greenlee⁶, Natasha K Stout⁷, Alanna Kulchak Rahm⁸, Susan A Alber², Priscila Pequeno⁹, Lisa M Moy¹⁰, Carly Stewart¹¹, Cindy Fong⁹, Charisma L Jenkins⁴, Diane Kohnhorst⁶, Casey Luce³, Joanne M Mor⁵, Julie R Munneke¹⁰, Yolanda Prado⁴, Glen Buth⁶, Stephanie Y Cheng⁹, Kamala A Deosaransingh¹⁰, Melanie Francisco⁴, Matthew Lakoma⁷, Yannica Theda Martinez⁵, Mary Kay Theis³, Emily C Marlow², Lawrence H Kushi¹⁰, James R Duncan¹², Wesley E Bolch¹³, Jason D Pole^{9

14

15}, Rebecca Smith-Bindman^{11

16

17}

Affiliations

¹ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA. Marilyn.L.Kwan@kp.org.
² Department of Public Health Sciences, University of California, Davis, CA, USA.
³ Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA.
⁴ Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
⁵ Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA.
⁶ Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA.
⁷ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
⁸ Center for Health Research, Genomic Medicine Institute, Geisinger, Danville, PA, USA.
⁹ ICES, Toronto, ON, Canada.
¹⁰ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
¹¹ Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
¹² Interventional Radiology Section, Washington University in St. Louis, St. Louis, MI, USA.
¹³ J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
¹⁴ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹⁵ Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
¹⁶ Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
¹⁷ Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.

^# Contributed equally.

PMID: 35107724
PMCID: PMC9596345
DOI: 10.1007/s10552-022-01556-z

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

Marilyn L Kwan et al. Cancer Causes Control. 2022 May.

. 2022 May;33(5):711-726.

doi: 10.1007/s10552-022-01556-z. Epub 2022 Feb 2.

Authors

Affiliations

¹ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA. Marilyn.L.Kwan@kp.org.
² Department of Public Health Sciences, University of California, Davis, CA, USA.
³ Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA.
⁴ Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
⁵ Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA.
⁶ Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA.
⁷ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
⁸ Center for Health Research, Genomic Medicine Institute, Geisinger, Danville, PA, USA.
⁹ ICES, Toronto, ON, Canada.
¹⁰ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
¹¹ Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
¹² Interventional Radiology Section, Washington University in St. Louis, St. Louis, MI, USA.
¹³ J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
¹⁴ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹⁵ Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
¹⁶ Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
¹⁷ Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.

^# Contributed equally.

PMID: 35107724
PMCID: PMC9596345
DOI: 10.1007/s10552-022-01556-z

Abstract

Purpose: The Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC) Study is quantifying the association between cumulative radiation exposure from fetal and/or childhood medical imaging and subsequent cancer risk. This manuscript describes the study cohorts and research methods.

Methods: The RIC Study is a longitudinal study of children in two retrospective cohorts from 6 U.S. healthcare systems and from Ontario, Canada over the period 1995-2017. The fetal-exposure cohort includes children whose mothers were enrolled in the healthcare system during their entire pregnancy and followed to age 20. The childhood-exposure cohort includes children born into the system and followed while continuously enrolled. Imaging utilization was determined using administrative data. Computed tomography (CT) parameters were collected to estimate individualized patient organ dosimetry. Organ dose libraries for average exposures were constructed for radiography, fluoroscopy, and angiography, while diagnostic radiopharmaceutical biokinetic models were applied to estimate organ doses received in nuclear medicine procedures. Cancers were ascertained from local and state/provincial cancer registry linkages.

Results: The fetal-exposure cohort includes 3,474,000 children among whom 6,606 cancers (2394 leukemias) were diagnosed over 37,659,582 person-years; 0.5% had in utero exposure to CT, 4.0% radiography, 0.5% fluoroscopy, 0.04% angiography, 0.2% nuclear medicine. The childhood-exposure cohort includes 3,724,632 children in whom 6,358 cancers (2,372 leukemias) were diagnosed over 36,190,027 person-years; 5.9% were exposed to CT, 61.1% radiography, 6.0% fluoroscopy, 0.4% angiography, 1.5% nuclear medicine.

Conclusion: The RIC Study is poised to be the largest study addressing risk of childhood and adolescent cancer associated with ionizing radiation from medical imaging, estimated with individualized patient organ dosimetry.

Keywords: Childhood cancer; Childhood leukemia; Computed tomography; Ionizing radiation; Medical imaging; Retrospective cohort study.

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Conflict of interest statement

Conflicts of interest/Competing interests

The authors declare that they have no conflicts of interest.

Figures

**Fig. 1.**
Study cohorts of the Radiation-Induced Cancers (RIC) Study, 1996–2016

**Figure 2.**
Radiation dose estimation approaches for imaging exams in the Radiation-Induced Cancers (RIC) Study, 1996–2016

See this image and copyright information in PMC

References

1. Smith-Bindman R, et al. , Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996–2010. JAMA, 2012. 307(22): p. 2400–9. - PMC - PubMed
1. Smith-Bindman R, et al. , Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000–2016. JAMA, 2019. 322(9): p. 843–856. - PMC - PubMed
1. BEIR VII, Health Risks from Exposure to Low Levels of Ionizing Radiation, in Committee to Assess Health Effects from Exposure to Low Levels of Ionizing Radiation. 2006, National Research Council: Washington, D.C.
1. Pearce MS, 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): p. 499–505. - PMC - PubMed
1. Preston DL, et al. , Solid cancer incidence in atomic bomb survivors exposed in utero or as young children. J Natl Cancer Inst, 2008. 100(6): p. 428–36. - PubMed

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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

Affiliations

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

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical