Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study
Abstract
The aim of this cohort study was to assess the risk of developing cancer, specifically leukaemia, tumours of the central nervous system and lymphoma, before the age of 15 years in children previously exposed to computed tomography (CT) in Germany. Data for children with at least one CT between 1980 and 2010 were abstracted from 20 hospitals. Cancer cases occurring between 1980 and 2010 were identified by stochastic linkage with the German Childhood Cancer Registry (GCCR). For all cases and a sample of non-cases, radiology reports were reviewed to assess the underlying medical conditions at time of the CT. Cases were only included if diagnosis occurred at least 2 years after the first CT and no signs of cancer were recorded in the radiology reports. Standardised incidence ratios (SIR) using incidence rates from the general population were estimated. The cohort included information on 71,073 CT examinations in 44,584 children contributing 161,407 person-years at risk with 46 cases initially identified through linkage with the GCCR. Seven cases had to be excluded due to signs possibly suggestive of cancer at the time of first CT. Overall, more cancer cases were observed (O) than expected (E), but this was mainly driven by unexpected and possibly biased results for lymphomas. For leukaemia, the SIR (SIR = O/E) was 1.72 (95 % CI 0.89-3.01, O = 12), and for CNS tumours, the SIR was 1.35 (95 % CI 0.54-2.78, O = 7). Despite careful examination of the medical information, confounding by indication or reverse causation cannot be ruled out completely and may explain parts of the excess. Furthermore, the CT exposure may have been underestimated as only data from the participating clinics were available. This should be taken into account when interpreting risk estimates.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The EPI-CT study was designed to address previous methodological criticisms and limitations of similar studies.
“EPI-CT was designed to address previous methodological criticisms and limitations of similar studies12–16.”
From Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults (2023) · cites this paper as [15]
Confounding by indication was evaluated either directly from medical records or indirectly through modeling in several national EPI-CT cohorts.
“Confounding by indication was, however, evaluated either directly—from a review of medical records—or indirectly—through modeling—in several national EPI-CT cohorts15–17,33,34.”
From Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults (2023) · cites this paper as [15]
Cites
Pearce, M. S., Salotti, J. A., Little, M. P., McHugh, K., Lee, C., Kim, K. P., Howe, N. L., Ronckers, C. M., Rajaraman, P., Craft, A. W., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60815-0 · Cited by 3,735 · see citing works
Estimated Risks of Radiation-Induced Fatal Cancer from Pediatric CT
Brenner, D. J., Elliston, C. D., Hall, E. J., & Berdon, W. E. (2001) · American Journal of Roentgenology · doi:10.2214/ajr.176.2.1760289 · Cited by 3,222 · see citing works
Mathews, J. D., Forsythe, A. V., Brady, Z., Butler, M. W., Goergen, S. K., Byrnes, G. B., Giles, G. G., Wallace, A. B., Anderson, P. R., Guiver, T. A., et al. (2013) · BMJ · doi:10.1136/bmj.f2360 · Cited by 2,029 · see citing works
Solid Cancer Incidence in Atomic Bomb Survivors: 1958–1998
Preston, D. L., Ron, E., Tokuoka, S., Funamoto, S., Nishi, N., Soda, M., Mabuchi, K., & Kodama, K. (2007) · Radiation Research · doi:10.1667/rr0763.1 · Cited by 1,751 · see citing works
Statistical methods in cancer research. Volume II--The design and analysis of cohort studies.
Breslow, N. E., & Day, N. E. (1987) · PubMed · Cited by 1,684 · see citing works
International Classification of Childhood Cancer, third edition
Steliarova‐Foucher, E., Stiller, C. A., Lacour, B., & Kaatsch, P. (2005) · Cancer · doi:10.1002/cncr.20910 · Cited by 1,554 · see citing works
Miglioretti, D. L., Johnson, E., Williams, A. E., Greenlee, R. T., Weinmann, S. A., Solberg, L. I., Feigelson, H. S., Roblin, D. W., Flynn, M. J., Vanneman, N., et al. (2013) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2013.311 · Cited by 1,476 · see citing works
Sources, Effects and Risks of Ionizing Radiation
Kohn, H. I. (1989) · Radiation Research · doi:10.2307/3577647 · Cited by 1,298 · see citing works
Preston, D. L., Kusumi, S., Tomonaga, M., Izumi, S., Ron, E., Kuramoto, A., Kamada, N., Dohy, H., Matsui, T., Nonaka, H., et al. (1994) · Radiation Research · doi:10.2307/3578893 · Cited by 803 · see citing works
Statistical Methods in Cancer Research, Volume II: The Design and Analysis of Cohort Studies.
Cornell, R. G., Breslow, N. E., & Day, N. E. (1992) · Journal of the American Statistical Association · doi:10.2307/2290308 · Cited by 704 · see citing works
The Incidence of Leukemia, Lymphoma and Multiple Myeloma among Atomic Bomb Survivors: 1950–2001
Hsu, W.-L., Preston, D. L., Soda, M., Sugiyama, H., Funamoto, S., Kodama, K., Kimura, A., Kamada, N., Dohy, H., Tomonaga, M., et al. (2013) · Radiation Research · doi:10.1667/rr2892.1 · Cited by 409 · see citing works
Schauer, D. A., & Linton, O. (2009) · Health Physics · doi:10.1097/01.hp.0000356672.44380.b7 · Cited by 391 · see citing works
Goske, M. J., Applegate, K. E., Boylan, J., Butler, P. F., Callahan, M. J., Coley, B. D., Farley, S., Frush, D. P., Hernanz‐Schulman, M., Jaramillo, D., et al. (2008) · Pediatric Radiology · doi:10.1007/s00247-007-0743-3 · Cited by 252 · see citing works
Shah, N. B., & Platt, S. L. (2008) · Current Opinion in Pediatrics · doi:10.1097/mop.0b013e3282ffafd2 · Cited by 218 · see citing works
Huang, W.-Y., Muo, C.-H., Lin, C.-Y., Jen, Y.-M., Yang, M.-H., Lin, J.-C., Sung, F.-C., & Kao, C.-H. (2014) · British Journal of Cancer · doi:10.1038/bjc.2014.103 · Cited by 213 · see citing works
Journy, N., Rehel, J.-L., Ducou Le Pointe, H., Lee, C., Brisse, H., Chateil, J.-F., Caer-Lorho, S., Laurier, D., & Bernier, M.-O. (2015) · British Journal of Cancer · doi:10.1038/bjc.2014.526 · Cited by 202 · see citing works
Brasme, J., Morfouace, M., Grill, J., Martinot, A., Amalberti, R., Bons-Letouzey, C., & Chalumeau, M. (2012) · The Lancet Oncology · doi:10.1016/s1470-2045(12)70361-3 · Cited by 178 · see citing works
Risks from CT scans—what do recent studies tell us?
Walsh, L., Shore, R. E., Auvinen, A. P., Jung, T., & Wakeford, R. (2014) · Journal of Radiological Protection · doi:10.1088/0952-4746/34/1/e1 · Cited by 115 · see citing works
Krille, L., Zeeb, H., Jahnen, A., Mildenberger, P., Seidenbusch, M. C., Schneider, K. O., Weisser, G., Hammer, G. P., Scholz, P., & Blettner, M. (2012) · Radiation and Environmental Biophysics · doi:10.1007/s00411-012-0405-1 · Cited by 83 · see citing works
Self-citationKim, K. P., de González, A. B., Pearce, M. S., Salotti, J. A., Parker, L., McHugh, K., Craft, A. W., & Lee, C. R. (2012) · Radiation Protection Dosimetry · doi:10.1093/rpd/ncr429 · Cited by 66 · see citing works
Meta-Analysis of Cranial CT Scans in Children
Stein, S. C., Hurst, R. W., & Sonnad, S. S. (2008) · Pediatric Neurosurgery · doi:10.1159/000172967 · Cited by 56 · see citing works
A Cohort Study of Childhood Cancer Incidence after Postnatal Diagnostic X-Ray Exposure
Hammer, G. P., Seidenbusch, M. C., Schneider, K. O., Regulla, D. F., Zeeb, H., Spix, C., & Blettner, M. (2009) · Radiation Research · doi:10.1667/rr1575.1 · Cited by 55 · see citing works
Self-citationCT Scans in Young People in Great Britain: Temporal and Descriptive Patterns, 1993–2002
Pearce, M. S., Salotti, J. A., Howe, N., McHugh, K., Kim, K. P., Lee, C., Craft, A. W., de González, A. B., & Parker, L. (2012) · Radiology Research and Practice · doi:10.1155/2012/594278 · Cited by 42 · see citing works
Thierry-Chef, I., Dabin, J., Friberg, E. G., Hermen, J., Istad, T. S., Jahnen, A., Krille, L., Lee, C., Maccia, C., Nordenskjöld, A., et al. (2013) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph10020717 · Cited by 38 · see citing works
Self-citationCT scans in childhood and risk of leukaemia and brain tumours
Deng, J., Zhang, Y., Nath, R., & Bao, S. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61980-1 · Cited by 26 · see citing works
Computed tomography in children: multicenter cohort study design for the evaluation of cancer risk
Krille, L., Jahnen, A., Mildenberger, P., Schneider, K. O., Weisser, G., Zeeb, H., & Blettner, M. (2011) · European Journal of Epidemiology · doi:10.1007/s10654-011-9549-6 · Cited by 19 · see citing works
Self-citationCT scans in childhood and risk of leukaemia and brain tumours
Hauptmann, M., & Meulepas, J. M. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61983-7 · Cited by 12 · see citing works
Subword-based Semantic Retrieval of Clinical and Bibliographic Documents
Schulz, S., Müller, M. L., Dzeyk, W., Prinzen, L., Pacheco, E. J., Cancian, P. S., Nohama, P., Markó, K., & Daumke, P. (2010) · Methods of Information in Medicine · doi:10.3414/me9303 · Cited by 11 · see citing works
Panorama responds to editorial on fMRI for vegetative and minimally conscious states
Walsh, F., Simmonds, F., Young, G. B., & Owen, A. M. (2013) · BMJ · doi:10.1136/bmj.e8702 · Cited by 7 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Radiation exposure from pediatric CT scans and subsequent cancer risk in The Netherlands
Meulepas, J. M., Ronckers, C. M., Smets, A. M. J. B., Nievelstein, R. A. J., Gradowska, P., Lee, C., Jahnen, A., van Straten, M., de Wit, M.-C. Y., Zonnenberg, B., et al. (2019) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djy104 · Cited by 360 · see citing works
Self-citationBosch de Basea, M., Thierry-Chef, I., Harbron, R., Hauptmann, M., Byrnes, G., Bernier, M.-O., Le Cornet, L., Dabin, J., Ferro, G., Istad, T. S., et al. (2023) · Nature Medicine · doi:10.1038/s41591-023-02620-0 · Cited by 349 · see citing works
Self-citationOstrom, Q. T., Price, M., Ryan, K. J., Edelson, J. L., Neff, C., Cioffi, G., Waite, K. A., Kruchko, C. A., & Barnholtz‐Sloan, J. S. (2022) · Neuro-Oncology · doi:10.1093/neuonc/noac161 · Cited by 324 · see citing works
Pediatric Exposures to Ionizing Radiation: Carcinogenic Considerations
Kutanzi, K. R., Lumen, A., Koturbash, I., & Miousse, I. R. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13111057 · Cited by 287 · see citing works
Hauptmann, M., Byrnes, G., Cardis, E., Bernier, M.-O., Blettner, M., Dabin, J., Engels, H., Istad, T. S., Johansen, C., Kaijser, M., et al. (2023) · The Lancet Oncology · doi:10.1016/s1470-2045(22)00655-6 · Cited by 273 · see citing works
Self-citationde Gonzalez, A. B., Salotti, J. A., McHugh, K., Little, M. P., Harbron, R. W., Lee, C., Ntowe, E., Braganza, M. Z., Parker, L., Rajaraman, P., et al. (2016) · British Journal of Cancer · doi:10.1038/bjc.2015.415 · Cited by 244 · see citing works
Journy, N., Rehel, J.-L., Ducou Le Pointe, H., Lee, C., Brisse, H., Chateil, J.-F., Caer-Lorho, S., Laurier, D., & Bernier, M.-O. (2015) · British Journal of Cancer · doi:10.1038/bjc.2014.526 · Cited by 202 · see citing works
Answers to Common Questions About the Use and Safety of CT Scans
McCollough, C. H., Bushberg, J. T., Fletcher, J. G., & Eckel, L. J. (2015) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2015.07.011 · Cited by 198 · see citing works
Shore, R. E., Beck, H. L., Boice, J. D., Caffrey, E., Davis, S., Grogan, H. A., Mettler, F. A., Preston, R. J., Till, J. E., Wakeford, R., et al. (2018) · Journal of Radiological Protection · doi:10.1088/1361-6498/aad348 · Cited by 171 · see citing works
Radiation Dose Reduction at Pediatric CT: Use of Low Tube Voltage and Iterative Reconstruction
Nagayama, Y., Oda, S., Nakaura, T., Tsuji, A., Urata, J., FURUSAWA, M., Utsunomiya, D., Funama, Y., Kidoh, M., & Yamashita, Y. (2018) · Radiographics · doi:10.1148/rg.2018180041 · Cited by 158 · see citing works
Siegel, J. A., Pennington, C. W., & Sacks, B. (2016) · Journal of Nuclear Medicine · doi:10.2967/jnumed.116.180182 · Cited by 155 · see citing works
Krille, L., Dreger, S., Schindel, R., Albrecht, T., Asmussen, M., Barkhausen, J., Berthold, J. D., Chavan, A., Claussen, C. D., Forsting, M., et al. (2017) · Radiation and Environmental Biophysics · doi:10.1007/s00411-017-0694-5 · Cited by 130 · see citing works
Self-citationEarly life ionizing radiation exposure and cancer risks: systematic review and meta-analysis
Abalo, K., Rage, E., Leuraud, K., Richardson, D. B., Pointe, H. D. L., Laurier, D., & Bernier, M. (2020) · Pediatric Radiology · doi:10.1007/s00247-020-04803-0 · Cited by 126 · see citing works
CT Radiation: Key Concepts for Gentle and Wise Use
Kalra, M. K., Sodickson, A. D., & Mayo-Smith, W. W. (2015) · Radiographics · doi:10.1148/rg.2015150118 · Cited by 122 · see citing works
It Is Time to Move Beyond the Linear No-Threshold Theory for Low-Dose Radiation Protection
Cardarelli, J., & Ulsh, B. A. (2018) · Dose-Response · doi:10.1177/1559325818779651 · Cited by 120 · see citing works
Sacks, B., Meyerson, G., & Siegel, J. A. (2016) · Biological Theory · doi:10.1007/s13752-016-0244-4 · Cited by 112 · see citing works
Radiation epidemiology and recent paediatric computed tomography studies
Boice, J. D. (2015) · Annals of the ICRP · doi:10.1177/0146645315575877 · Cited by 111 · see citing works
Risk of Brain Tumor Induction from Pediatric Head CT Procedures: A Systematic Literature Review
Sheppard, J. P., Nguyen, T., Alkhalid, Y., Beckett, J. S., Salamon, N., & Yang, I. (2018) · Brain Tumor Research and Treatment · doi:10.14791/btrt.2018.6.e4 · Cited by 90 · see citing works
Lee, K. H., Lee, S., Park, J. H., Lee, S.-S., Kim, H. Y., Lee, W. J., Cha, E. S., Kim, K. P., Lee, W., Lee, J. Y., et al. (2021) · JAMA Surgery · doi:10.1001/jamasurg.2020.6357 · Cited by 88 · see citing works
Schultz, C. H., Fairley, R., Murphy, L. S.-L., & Doss, M. (2020) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x1900520x · Cited by 85 · see citing works
CT Radiation Dose Management: A Comprehensive Optimization Process for Improving Patient Safety
Parakh, A., Kortesniemi, M., & Schindera, S. T. (2016) · Radiology · doi:10.1148/radiol.2016151173 · Cited by 73 · see citing works
Bernier, M., Baysson, H., Pearce, M. S., Moissonnier, M., Cardis, E., Hauptmann, M., Struelens, L., Dabin, J., Johansen, C., Journy, N., et al. (2018) · International Journal of Epidemiology · doi:10.1093/ije/dyy231 · Cited by 70 · see citing works
Self-citationLittle, M. P., Wakeford, R., Bouffler, S. D., Abalo, K., Hauptmann, M., Hamada, N., & Kendall, G. M. (2021) · Environment International · doi:10.1016/j.envint.2021.106983 · Cited by 68 · see citing works
Aging and age-related health effects of ionizing radiation
Tong, J., & Hei, T. K. (2020) · Radiation Medicine and Protection · doi:10.1016/j.radmp.2020.01.005 · Cited by 64 · see citing works
Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology
Ferrero, A., Takahashi, N., Vrtiska, T. J., Krambeck, A. E., Lieske, J. C., & McCollough, C. H. (2019) · Nature Reviews Urology · doi:10.1038/s41585-019-0148-8 · Cited by 63 · see citing works
Epidemiological studies of CT scans and cancer risk: the state of the science
de González, A. B., Pasqual, E., & Veiga, L. H. S. (2021) · British Journal of Radiology · doi:10.1259/bjr.20210471 · Cited by 63 · see citing works
Rigsby, C. K., McKenney, S. E., Hill, K. D., Chelliah, A., Einstein, A. J., Han, B., Robinson, J. D., Sammet, C. L., Slesnick, T. C., & Frush, D. P. (2018) · Pediatric Radiology · doi:10.1007/s00247-017-3991-x · Cited by 62 · see citing works
Marcotte, E. L., Spector, L. G., Mendes-de-Almeida, D. P., & Nelson, H. H. (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2021.639479 · Cited by 58 · see citing works
Childhood CT scans and cancer risk: impact of predisposing factors for cancer on the risk estimates
Journy, N., Roué, T., Cardis, E., Pointe, H. D. L., Brisse, H. J., Chateil, J., Laurier, D., & Bernier, M. (2016) · Journal of Radiological Protection · doi:10.1088/0952-4746/36/1/n1 · Cited by 55 · see citing works
Nikkilä, A., Raitanen, J. A., Lohi, O., & Auvinen, A. P. (2018) · Haematologica · doi:10.3324/haematol.2018.187716 · Cited by 51 · see citing works
Flügge, T. V., Groß, C., Ludwig, U., Schmitz, J., Nahles, S., Heiland, M., & Nelson, K. (2023) · Dentomaxillofacial Radiology · doi:10.1259/dmfr.20220333 · Cited by 50 · see citing works
Musey, P. I., Bellolio, F., Upadhye, S., Chang, A. M., Diercks, D. B., Gottlieb, M. A., Hess, E. P., Kontos, M. C., Mumma, B. E., Probst, M. A., et al. (2021) · Academic Emergency Medicine · doi:10.1111/acem.14296 · Cited by 49 · see citing works
Onyije, F. M., Dolatkhah, R., Olsson, A. C., Bouaoun, L., Deltour, I., Erdmann, F., Bonaventure, A., Scheurer, M. E., Clavel, J., & Schüz, J. (2023) · Cancer Epidemiology · doi:10.1016/j.canep.2023.102510 · Cited by 45 · see citing works
Geryes, B. H., Hornbeck, A., Jarrige, V., Pierrat, N., Pointe, H. D. L., & Dreuil, S. (2019) · Physica Medica · doi:10.1016/j.ejmp.2019.04.004 · Cited by 45 · see citing works
Childhood cancer risks estimates following CT scans: an update of the French CT cohort study
Foucault, A., Ancelet, S., Dreuil, S., Caër-Lorho, S., Ducou Le Pointe, H., Brisse, H., Chateil, J.-F., Lee, C., Leuraud, K., & Bernier, M.-O. (2022) · European Radiology · doi:10.1007/s00330-022-08602-z · Cited by 39 · see citing works
Let’s talk about radiation dose and radiation protection in children
Granata, C., Sofia, C., Francavilla, M., Kardoš, M., Kasznia-Brown, J., Nievelstein, R. A. J., Olteanu, B. S., Owens, C. M., Salerno, S., Sorantin, E., et al. (2024) · Pediatric Radiology · doi:10.1007/s00247-024-06009-0 · Cited by 40 · see citing works
Reduction in radiation doses from paediatric CT scans in Great Britain
Lee, C., Pearce, M. S., Salotti, J. A., Harbron, R. W., Little, M. P., McHugh, K., Chapple, C.-L., & de González, A. B. (2016) · British Journal of Radiology · doi:10.1259/bjr.20150305 · Cited by 36 · see citing works
Harbron, R. W., Chapple, C.-L., O’Sullivan, J., Lee, C., McHugh, K., Higueras, M., & Pearce, M. S. (2018) · European Journal of Epidemiology · doi:10.1007/s10654-018-0357-0 · Cited by 36 · see citing works
A New Era of Low-Dose Radiation Epidemiology
Kitahara, C. M., Linet, M. S., Rajaraman, P., Ntowe, E., & de González, A. B. (2015) · Current Environmental Health Reports · doi:10.1007/s40572-015-0055-y · Cited by 37 · see citing works
NEED FOR INDIVIDUAL CANCER RISK ESTIMATES IN X-RAY AND NUCLEAR MEDICINE IMAGING
Mattsson, S. (2016) · Radiation Protection Dosimetry · doi:10.1093/rpd/ncw034 · Cited by 34 · see citing works
Background gamma radiation and childhood cancer in Germany: an ecological study
Spix, C., Grosche, B., Bleher, M., Kaatsch, P., Scholz-Kreisel, P., & Blettner, M. (2017) · Radiation and Environmental Biophysics · doi:10.1007/s00411-017-0689-2 · Cited by 34 · see citing works
Self-citationTahmasebzadeh, A., Paydar, R., Soltani‐Kermanshahi, M., Maziar, A., & Reiazi, R. (2021) · International Journal of Radiation Biology · doi:10.1080/09553002.2021.1931527 · Cited by 32 · see citing works
Dose Estimation for the European Epidemiological Study on Pediatric Computed Tomography (EPI-CT)
Thierry-Chef, I., Ferro, G., Le Cornet, L., Dabin, J., Istad, T. S., Jahnen, A., Lee, C., Maccia, C., Malchair, F., Olerud, H. M., et al. (2021) · Radiation Research · doi:10.1667/rade-20-00231.1 · Cited by 31 · see citing works
Self-citationShyu, J. Y., & Sodickson, A. D. (2015) · British Journal of Radiology · doi:10.1259/bjr.20150868 · Cited by 30 · see citing works
Suchyta, M. A., Gibreel, W. O., Hunt, C. H., Gorny, K. R., Bernstein, M. A., & Mardini, S. (2018) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000004396 · Cited by 30 · see citing works
Meulepas, J. M., Ronckers, C. M., Merks, J., Weijerman, M. E., Lubin, J. H., & Hauptmann, M. (2016) · Journal of Radiological Protection · doi:10.1088/0952-4746/36/4/953 · Cited by 29 · see citing works
Radiation exposure by medical X-ray applications
Buchberger, B., Scholl, K., Krabbe, L. M., Spiller, L., & Lux, B. (2022) · PubMed Central · doi:10.3205/000308 · Cited by 28 · see citing works
Little, M. P., Wakeford, R., Bouffler, S. D., Abalo, K., Hauptmann, M., Hamada, N., & Kendall, G. M. (2022) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2022.154723 · Cited by 27 · see citing works
Ionizing radiations epidemiology does not support the LNT model
Ricci, P. F., & Tharmalingam, S. (2019) · Chemico-Biological Interactions · doi:10.1016/j.cbi.2018.11.014 · Cited by 27 · see citing works
Till, J. E., Beck, H. L., Grogan, H. A., & Caffrey, E. (2017) · International Journal of Radiation Biology · doi:10.1080/09553002.2017.1337280 · Cited by 25 · see citing works
Garg, M. K., Karami, V., Moazen, J., Kwee, T. C., Bhalla, A. S., Shahbazi‐Gahrouei, D., & Shao, Y. J. (2022) · Diagnostics · doi:10.3390/diagnostics12123043 · Cited by 25 · see citing works
A Critical Assessment of the Linear No-Threshold Hypothesis
Siegel, J. A., Brooks, A. L., Fisher, D. R., ZANZONICO, P. B., Doss, M., O’Connor, M. K., Silberstein, E. B., Welsh, J. S., & Greenspan, B. S. (2019) · Clinical Nuclear Medicine · doi:10.1097/rlu.0000000000002613 · Cited by 25 · see citing works
Ionising radiation as a risk factor for lymphoma: a review
Harbron, R. W., & Pasqual, E. (2020) · Journal of Radiological Protection · doi:10.1088/1361-6498/abbe37 · Cited by 24 · see citing works
Marron, M., Brackmann, L. K., Schwarz, H., Hummel-Bartenschlager, W., Zahnreich, S., Galetzka, D., Schmitt, I. M., Grad, C., Drees, P., Hopf, J. C., et al. (2021) · JMIR Research Protocols · doi:10.2196/32395 · Cited by 24 · see citing works
Self-citationJourny, N., Dreuil, S., Boddaert, N., Chateil, J., Defez, D., Pointe, H. D. L., Garcier, J., Guersen, J., Geryes, B. H., Jahnen, A., et al. (2017) · European Radiology · doi:10.1007/s00330-017-5001-y · Cited by 23 · see citing works
Self-citationBelmans, N., Gilles, L., Vermeesen, R., Virág, P., Hedesiu, M. C., Salmon, B. J. R., Baatout, S., Lucas, S., Lambrichts, I., Jacobs, R., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-58746-5 · Cited by 22 · see citing works
Li, I.-G., Yang, Y., Li, Y., & Tsai, Y. (2020) · Scientific Reports · doi:10.1038/s41598-020-64805-8 · Cited by 22 · see citing works
Baysson, H., Journy, N., Roué, T., Pointe, H. D. L., Étard, C., & Bernier, M. (2016) · Bulletin du Cancer · doi:10.1016/j.bulcan.2015.11.003 · Cited by 21 · see citing works
Dovales, A. C. M., da Rosa, L. A. R., Kesminiene, A., Pearce, M. S., & Veiga, L. H. S. (2016) · Journal of Radiological Protection · doi:10.1088/0952-4746/36/3/547 · Cited by 21 · see citing works
Computed Tomography in Germany
Pokora, R. M., Krille, L., Dreger, S., Lee, C., Günster, C., Zeeb, H., & Blettner, M. (2016) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2016.0721 · Cited by 21 · see citing works
Self-citationDIAGNOSTIC REFERENCE LEVELS IN CARDIAC COMPUTED TOMOGRAPHY ANGIOGRAPHY: A SYSTEMATIC REVIEW
Alhailiy, A. B., Brennan, P., McEntee, M. F., Kench, P. L., & Ryan, E. A. (2017) · Radiation Protection Dosimetry · doi:10.1093/rpd/ncx075 · Cited by 21 · see citing works
Kiani, M., & Chaparian, A. (2022) · European Journal of Radiology · doi:10.1016/j.ejrad.2022.110657 · Cited by 22 · see citing works
JCS 2021 Guideline on Radiation Safety in Cardiology
Kozuma, K., Chikamori, T., Hashimoto, J., Honye, J., Ikeda, T., Ishiwata, S., Kato, M., Kondo, H., Matsubara, K., Matsumoto, K., et al. (2022) · Circulation Journal · doi:10.1253/circj.cj-21-0379 · Cited by 20 · see citing works
Little, M. P., Wakeford, R., Zablotska, L. B., Borrego, D., Griffin, K., Allodji, R. S., de Vathaire, F., Lee, C., Brenner, A. V., Miller, J. S., et al. (2023) · British Journal of Cancer · doi:10.1038/s41416-023-02387-8 · Cited by 19 · see citing works
Bone-Selective MRI as a Nonradiative Alternative to CT for Craniofacial Imaging
Zhang, R., Lee, H., Zhao, X., Song, H. K., Vossough, A., Wehrli, F. W., & Bartlett, S. P. P. (2020) · Academic Radiology · doi:10.1016/j.acra.2020.03.001 · Cited by 18 · see citing works
Yu, S., Zhang, L., Zheng, J., Xu, Y., Chen, Y., & Song, Z. (2016) · Clinical Radiology · doi:10.1016/j.crad.2016.08.004 · Cited by 17 · see citing works
Onischenko, G. G., Popova, A. Y., Романович, И. К., Водоватов, А. В., Башкетова, Н. С., Istorik, O. A., Чипига, Л. А., Shatskiy, I. G., Sarycheva, S. S., Библин, А. М., et al. (2019) · Radiacionnaâ gigiena · doi:10.21514/1998-426x-2019-12-2-6-24 · Cited by 17 · see citing works
Children, medical radiation and the environment: An important dialogue
Frush, D. P., & Pérez, M. D. R. (2017) · Environmental Research · doi:10.1016/j.envres.2017.04.002 · Cited by 17 · see citing works
Esser, M., Hess, S., Teufel, M., Kraus, M. S., Schneeweiß, S., Gatidis, S., Schaefer, J. F., & Tsiflikas, I. (2018) · RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren · doi:10.1055/a-0628-7222 · Cited by 17 · see citing works
Harbron, R. W., Thierry-Chef, I., Pearce, M. S., Bernier, M., Dreuil, S., Rage, E., Andreassi, M. G., Picano, E., Dreger, S., Zeeb, H., et al. (2020) · Journal of Radiological Protection · doi:10.1088/1361-6498/aba66d · Cited by 16 · see citing works
Self-citationAbalo, K., Malekzadeh-Milani, S. G., Hascoët, S., Dreuil, S., Feuillet, T., Cohen, S., Dauphin, C., Filippo, S. D., Douchin, S., Godart, F. R., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-048576 · Cited by 16 · see citing works
Kwan, M. L., Miglioretti, D. L., Bowles, E. J. A., Weinmann, S. A., Greenlee, R. T., Stout, N. K., Rahm, A. K., Alber, S. A., Pequeno, P., Moy, L. M., et al. (2022) · Cancer Causes & Control · doi:10.1007/s10552-022-01556-z · Cited by 15 · see citing works
Doses for post-Chernobyl epidemiological studies: are they reliable?
Drozdovitch, V., Chumak, V. V., Kesminiene, A., Ostroumova, E., & Bouville, A. C. (2016) · Journal of Radiological Protection · doi:10.1088/0952-4746/36/3/r36 · Cited by 15 · see citing works
Han, S., Soh, J., Nah, S., Han, K., Jung, J., Park, J., Hwang, Y. S., Lee, C., & Hong, J. (2025) · BMC Medicine · doi:10.1186/s12916-025-04235-3 · Cited by 14 · see citing works
Lee, C., Journy, N., Moroz, B. E., Little, M. P., Harbron, R. W., McHugh, K., Pearce, M. S., & de González, A. B. (2018) · Radiation Protection Dosimetry · doi:10.1093/rpd/ncy184 · Cited by 14 · see citing works
A multi-provincial survey and analysis of radiation doses from pediatric CT in China
Kang, T., Zhang, Z., Zhang, Y., Chen, E., & Niu, Y. (2021) · Radiation Medicine and Protection · doi:10.1016/j.radmp.2021.02.001 · Cited by 14 · see citing works
Meulepas, J. M., Ronckers, C. M., Merks, J. H. M., Weijerman, M. E., Lubin, J. H., & Hauptmann, M. (2015) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-15-0636 · Cited by 14 · see citing works
RetractedZaehringer, C., Euler, A., Karwacki, G. M., Hohmann, J., Pansini, M., Szucs‐Farkas, Z., & Schindera, S. T. (2016) · Clinical Radiology · doi:10.1016/j.crad.2016.02.014 · Cited by 14 · see citing works
Stern, H. C., Seidenbusch, M. C., Hapfelmeier, A., Meierhofer, C., Naumann, S., Schmid, I., Spix, C., & Ewert, P. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9020315 · Cited by 14 · see citing works
Self-citationTao, S. M., Wang, L.-L., Li, M., Wang, J., Gu, H. M., & Zhang, L. J. (2024) · Mutation Research/Reviews in Mutation Research · doi:10.1016/j.mrrev.2024.108517 · Cited by 13 · see citing works
Journy, N., McHugh, K., Harbron, R. W., Pearce, M. S., & de González, A. B. (2016) · British Journal of Radiology · doi:10.1259/bjr.20160532 · Cited by 13 · see citing works
Validation of Semantic Analyses of Unstructured Medical Data for Research Purposes
Pokora, R. M., Cornet, L. L., Daumke, P., Mildenberger, P., Zeeb, H., & Blettner, M. (2019) · Das Gesundheitswesen · doi:10.1055/a-1007-8540 · Cited by 13 · see citing works
Self-citationBaaken, D., Hammer, G. P., Seidenbusch, M. C., Schneider, K. O., Spix, C., Blettner, M., Pokora, R. M., & Lorenz, E. (2019) · Journal of Radiological Protection · doi:10.1088/1361-6498/ab3506 · Cited by 13 · see citing works
Self-citationKadowaki, Y., Hamada, N., Kai, M., & Furukawa, K. (2020) · International Journal of Cancer · doi:10.1002/ijc.33436 · Cited by 13 · see citing works
Tan, X., Shah, M. T. B. M., Chong, S., Ong, Y.-K. G., Ang, P. H., Zakaria, N. D. B., Lee, K. P., & Pek, J. H. (2021) · BMC Emergency Medicine · doi:10.1186/s12873-021-00502-7 · Cited by 12 · see citing works
Park, J. H., Salminen, P. T. P., Tannaphai, P., & Lee, K. H. (2022) · Korean Journal of Radiology · doi:10.3348/kjr.2021.0596 · Cited by 12 · see citing works
Analysis of Hemogram of Radiation Workers in Tangshan, China
Qian, Q., Cao, X., Liu, H., Shen, F., Wang, Q., Tong, J., & Qian, Q. (2016) · Journal of Clinical Laboratory Analysis · doi:10.1002/jcla.21922 · Cited by 12 · see citing works
Johnsen, B., Fasmer, K. E., Boye, K., Rosendahl, K., Trovik, C. S., Biermann, M., & Aukland, S. M. (2016) · Pediatric Radiology · doi:10.1007/s00247-016-3720-x · Cited by 12 · see citing works
Journy, N., Laurier, D., & Bernier, M. (2015) · British Journal of Cancer · doi:10.1038/bjc.2015.105 · Cited by 12 · see citing works
Fast determination of indoor radon (222Rn) concentration using liquid scintillation counting
Bem, H., Długosz‐Lisiecka, M., Janiak, S., Mazurek, D., & Szajerski, P. (2017) · Journal of Radioanalytical and Nuclear Chemistry · doi:10.1007/s10967-017-5226-x · Cited by 11 · see citing works
Lee, S., Kim, H. Y., Lee, K. H., Cho, J., Lee, C., Kim, K. P., Hwang, J. H., & Park, J. H. (2022) · European Radiology · doi:10.1007/s00330-024-10646-2 · Cited by 11 · see citing works
Sukegawa, S., Masui, M., Kanno, T., Miki, M., Nakamoto, H., & Furuki, Y. (2019) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000006101 · Cited by 11 · see citing works
Bosch de Basea, M., Espinosa, A., Gil, M., Figuerola, J., Pardina, M., Vilar, J., & Cardis, E. (2018) · PLOS ONE · doi:10.1371/journal.pone.0196449 · Cited by 10 · see citing works
The Think A-Head campaign: an introduction to ImageGently 2.0
Frush, D. P., Benjamin, L. S., Kadom, N., Macias, C. G., Snow, S. K., Gaskill, S. J., Palmer, E., & Strauss, K. J. (2016) · Pediatric Radiology · doi:10.1007/s00247-016-3739-z · Cited by 10 · see citing works
Hill’s Temporality Criterion: Reverse Causation and Its Radiation Aspect
Koterov, A. N., Ushenkova, L. N., & Biryukov, A. P. (2020) · Biology Bulletin · doi:10.1134/s1062359020120031 · Cited by 10 · see citing works
Walker, D., Bendel, A. E., Stiller, C. A., Indelicato, D. J., Smith, S. J., Murray, M. J., & Bleyer, A. (2016) · Pediatric oncology · doi:10.1007/978-3-319-33679-4_14 · Cited by 10 · see citing works
Elmahdi, A., Abuzaid, M., Babikir, E., & Sulieman, A. (2018) · Polish Journal of Radiology · doi:10.12659/pjr.902502 · Cited by 10 · see citing works
Understanding the problem of a parent’s fear of their child getting cancer from CT scan radiation
Cohen, M. D. (2016) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2016.04.003 · Cited by 9 · see citing works
Harbron, R. W. (2016) · Radiography · doi:10.1016/j.radi.2016.08.007 · Cited by 9 · see citing works
Lacy, T., Ding, A., Minkemeyer, V. M., Frush, D. P., & Samei, E. (2020) · Academic Radiology · doi:10.1016/j.acra.2020.01.018 · Cited by 9 · see citing works
- Authors
- Krille, L., Dreger, S., Schindel, R., Albrecht, T., Asmussen, M., Barkhausen, J., Berthold, J. D., Chavan, A., Claussen, C., Forsting, M., Gianicolo, E. A. L., Jablonka, K., Jahnen, A., Langer, M., Laniado, M., Lotz, J., Mentzel, H. J., Queißer-Wahrendorf, A., Rompel, O., Schlick, I., Schneider, K., Schumacher, M., Seidenbusch, M., Spix, C., Spors, B., Staatz, G., Vogl, T., Wagner, J., Weisser, G., Zeeb, H., & Blettner, M.
- Affiliations
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- University of Bremen (DE)
- Vivantes Klinikum (DE)
- Städtisches Klinikum Karlsruhe (DE)
- University Hospital Schleswig-Holstein (DE)
- Medizinische Hochschule Hannover (DE)
- Klinikum Oldenburg (DE)
- Universitätsklinikum Tübingen (DE)
- Essen University Hospital (DE)
- Klinikum Bremen-Mitte (DE)
- Centre de recherche public Henri-Tudor (LU)
- University Medical Center Freiburg (DE)
- University Hospital Carl Gustav Carus (DE)
- Universitätsmedizin Göttingen (DE)
- Jena University Hospital (DE)
- Johannes Gutenberg University Mainz (DE)
- Universitätsklinikum Erlangen (DE)
- Nuremberg Hospital (DE)
- LMU Klinikum (DE)
- University of Freiburg (DE)
- Charité – Universitätsmedizin Berlin (DE)
- Goethe University Frankfurt (DE)
- Klinikum im Friedrichshain (DE)
- University Medical Centre Mannheim (DE)
- Corresponding author
- Blettner, M.
- ORCID
- Venue
- Radiation and Environmental Biophysics
- Published
- 2015-01-08
- Volume
- 54
- Issue
- 1
- Pages
- 1-12
- ISSN
- 0301-634X (ISSN-L)
- 1432-2099
- OpenAlex
- W4252769413
- Cited by
- 184
- References
- 29
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 12 · 2023: 13 · 2022: 16 · 2021: 21 · 2020: 16 · 2019: 16 · 2018: 22 · 2017: 14 · 2016: 27 · 2015: 10
- FWCI
- 19.69
- Type
- journal article
- Language
- en
- Update notices
- correction (2017-06-13)
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Radiation and Environmental Biophysics (publishedVersion)
- PubMed (publishedVersion)
- GRO (submittedVersion)
- Funders
- World Health Organization
- Bundesministerium für Bildung und Forschung
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- childhood cancer, computed tomography, ionizing radiation exposure, leukemia, central nervous system tumors, lymphoma, cancer incidence, confounding by indication, reverse causality, radiation-induced cancer risk, German Childhood Cancer Registry
- MeSH terms
- Adolescent, Child, Child, Preschool, Female, Germany, Humans, Infant, Infant, Newborn, Male, Neoplasms, Radiation-Induced, Radiation, Ionizing, Risk, Tomography, X-Ray Computed, Cohort Studies, Incidence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review