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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

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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.

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Data availability

The data that support the findings of this study are not openly available due to institutional data sharing policies and are available from the corresponding author upon reasonable request as well as appropriate institutional review board approvals and data sharing agreements.

Code availability

Not applicable.

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Acknowledgments

We thank Dr. Jonathan Ducore, MD, MPH and Dr. Stacy Month, MD for their pediatric oncology consultation in reviewing our classification of childhood cancers. We also thank our study staff who performed film CT abstraction and database programming support: Zobeyda Otero, Aleyda Solorzano Pinto, Kiara Bell, Andrea Volz, Mary Lyons, Donna Gleason, Arthur Truong, Ali Moin, Mohammed Mamun, Diane Kohnhorst, and Deborah Seger.

Funding

This study was supported by the National Cancer Institute at the National Institutes of Health (R01CA185687 and R50CA211115). The Ontario, Canada portion of the study was also supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Author information

Author notes

  1. Marilyn L. Kwan and Diana L. Miglioretti are co-first author.

Authors and Affiliations

  1. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA

    Marilyn L. Kwan, Lisa M. Moy, Julie R. Munneke, Kamala A. Deosaransingh & Lawrence H. Kushi

  2. Department of Public Health Sciences, University of California, Davis, CA, USA

    Diana L. Miglioretti, Susan A. Alber & Emily C. Marlow

  3. Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA

    Diana L. Miglioretti, Erin J. A. Bowles, Casey Luce & Mary Kay Theis

  4. Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA

    Sheila Weinmann, Charisma L. Jenkins, Yolanda Prado & Melanie Francisco

  5. Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA

    Sheila Weinmann, Joanne M. Mor & Yannica Theda Martinez

  6. Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA

    Robert T. Greenlee, Diane Kohnhorst & Glen Buth

  7. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA

    Natasha K. Stout & Matthew Lakoma

  8. Center for Health Research, Genomic Medicine Institute, Geisinger, Danville, PA, USA

    Alanna Kulchak Rahm

  9. ICES, Toronto, ON, Canada

    Priscila Pequeno, Cindy Fong, Stephanie Y. Cheng & Jason D. Pole

  10. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    Carly Stewart & Rebecca Smith-Bindman

  11. Interventional Radiology Section, Washington University in St. Louis, St. Louis, MI, USA

    James R. Duncan

  12. J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA

    Wesley E. Bolch

  13. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Jason D. Pole

  14. Centre for Health Services Research, The University of Queensland, Brisbane, Australia

    Jason D. Pole

  15. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA

    Rebecca Smith-Bindman

  16. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA

    Rebecca Smith-Bindman

Authors
  1. Marilyn L. Kwan
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  31. Rebecca Smith-Bindman
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Contributions

All authors whose names appear on the submission: (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Marilyn L. Kwan.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by institutional review boards at each participating study site. Given this is a minimal risk, medical record review study, participant informed consent was waived.

Consent to participate

This study was approved by institutional review boards at each participating study site. Given this is a minimal risk, medical record review study, participant informed consent was waived.

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Not applicable.

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Kwan, M.L., Miglioretti, D.L., Bowles, E.J.A. et al. 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. Cancer Causes Control 33, 711–726 (2022). https://doi.org/10.1007/s10552-022-01556-z

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