NEJM Group

60-Second Journal Club: Risk of Pediatric & Adolescent Cancer Associated W/ Medical Imaging (RIC)

The video reviews a large retrospective cohort study examining how medical imaging radiation influences pediatric and adolescent hematologic cancer risk. Researchers followed three million children across six U.S. health systems and Ontario, Canada, tracking cancer outcomes through age 21 or 2017, and compared cumulative radiation doses from CT, fluoroscopy, angiography, and nuclear medicine against unexposed peers. During 35 million person‑years, nearly 3,000 hematologic malignancies were identified. The analysis showed a dose‑response relationship: children receiving at least 30 mGy had a relative risk more than double that of unexposed children, with cumulative incidence rising from 14.3 to 39.9 per 10,000. Risk was strongest for exposures occurring after age five and attenuated with increasing time since exposure. The presenters highlighted that the risk curve mirrors earlier European findings but provides the first North American data across multiple imaging modalities. A striking visual compared incidence rates, underscoring the steep jump at 30 mGy. The study also noted that children with Down syndrome were excluded, focusing on the general pediatric population. Clinicians are urged to incorporate these risk estimates into shared decision‑making, reserving high‑dose imaging for cases where diagnostic benefit outweighs potential harm. The findings may prompt stricter imaging protocols, dose‑reduction strategies, and increased use of alternative modalities such as MRI or ultrasound when feasible.