Pediatric Nuclear Medicine Examinations and Subsequent Risk of Neoplasm: A Nationwide Population-Based Cohort Study

Mei-Kang Yuan; Shih-Chieh Chang; Mei-Chun Yuan; Ning-Ping Foo; Shan-Ho Chan; Shyh-Yau Wang; Cheng-Li Lin; Chung-Y Hsu; Chia-Hung Kao

doi:10.3389/fmed.2021.764849

Pediatric Nuclear Medicine Examinations and Subsequent Risk of Neoplasm: A Nationwide Population-Based Cohort Study

Front Med (Lausanne). 2021 Dec 20:8:764849. doi: 10.3389/fmed.2021.764849. eCollection 2021.

Authors

Mei-Kang Yuan^{1

2

3}, Shih-Chieh Chang^{4

5

6}, Mei-Chun Yuan⁷, Ning-Ping Foo^{8

9}, Shan-Ho Chan³, Shyh-Yau Wang¹, Cheng-Li Lin^{2

10}, Chung-Y Hsu¹¹, Chia-Hung Kao^{11

12

13

14}

Affiliations

¹ Department of Radiology, An Nan Hospital, China Medical University, Tainan, Taiwan.
² School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
³ Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
⁴ Division of Chest Medicine, Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan.
⁵ Department of Critical Care Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan.
⁶ Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁷ Department of Information Management, Meiho University, Pingtung, Taiwan.
⁸ Department of Emergency Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan.
⁹ Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan.
¹⁰ Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
¹¹ Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.
¹² Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan.
¹³ Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
¹⁴ Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.

Abstract

Objective: To evaluate the association between radiation exposure from repeated nuclear medicine (NM) examinations and the subsequent risk of neoplasm in pediatric patients. Methods: From 2000 to 2017, participants under 18 years of age who underwent NM scanning were identified using the Health and Welfare Data Science Center (HWDC) dataset, which was extracted from the Taiwan National Health Insurance Research Database (NHIRD). Both the exposed cohort and unexposed subjects were followed up with until the presence of any malignancy arose, including malignant brain, lymphoid and hematopoietic tumors and benign brain or other central nervous tumors. Results: There were 35,292 patients in the exposed cohort and 141,152 matched subjects in the non-exposed group. The exposed cohort had an overall higher IR (IR: incidence rate, per 100,000 person-years) of any malignancy and benign central nervous tumor than the non-exposed group [IR, 16.9 vs. 1.54; adjusted hazard ratio (HR), 10.9; 95% CI, 6.53-18.2]. Further stratifying the number of NM examinations into 1-2, 3-4, and 5 or more times revealed that the IR of pediatric neoplasms increased gradually with the increased frequency of NM examinations (IR, 11.5; adjusted HR, 7.5; 95% CI, 4.29-13.1; IR, 25.8; adjusted HR, 15.9; 95% CI, 7.00-36.1; IR, 93.8; adjusted HR, 56.4; 95% CI, 28.8-110.3). Conclusion: NM examination is significantly associated with a higher risk of pediatric neoplasms, according to our population-based data. Thorough radiation protection and dose reduction in pediatric NM procedures should be an issue of concern.

Keywords: National Health Insurance Research Database (NHIRD); malignancy; nuclear medicine (NM); pediatric neoplasms; radiation protection.