Radiation Exposure from Pediatric CT Scans and Subsequent Cancer Risk: A Systematic Review and Meta-Analysis

Background: Computed tomography (CT) is now the instrument that cannot be omitted in the diagnosis of pediatric medicine, as it is fast to acquire and has high diagnostic accuracy. But CT consists of exposure to ionizing radiation and children are especially prone to the dangers of its adverse effects due to the heightened tissue radiosensitivity, and extended lifespan. Increased epidemiological evidence has caused some concerns about the relationship between pediatric CT exposure and subsequent malignancy. Objective: This systematic review and meta-analysis aimed to evaluate the association between radiation exposure from diagnostic CT scans in childhood and the subsequent risk of developing cancer. Method: An extensive literature review was performed in PubMed, Embase, Web of Science and Cochrane Library regarding studies published since January 2004 and January 2024. It was a PRISMA 2020 review with a structure built around the PECO framework, which encompasses children and adolescents (?18 years) who are exposed to CT imaging versus non-exposed groups. Only eligible studies were population-based cohort studies that provided quantitative estimates of cancer risks after exposure to CT. Random-effects meta-analysis model was applied to combine data on the basis of heterogeneity between-study. The Newcastle-Ottawa Scale was used to determine the risk of bias. Results: The quantitative synthesis included twelve cohort studies that were included in the inclusion criteria. The pooled analysis revealed a statistically significant relationship between the exposure of pediatric CT and future cancer risk, with a total pooled relative risk (RR) of 1.28 (95% CI: 1.15- 1.42). There was moderate heterogeneity between studies (I 2 = 62%). Subgroup analyses indicated greater risk estimates of brain tumors (RR = 1.67; 95% CI: 1.30-2.15) and leukemia (RR = 1.54; 95% CI: 1.21-1.95), especially after head CT examinations. The sensitivity analyses ensured that the results are sound after the exclusion of studies with moderate risk of bias. Conclusion: Pediatric CT exposure has been linked with a modest increase in cancer risk that is long term. These findings emphasize the need to reduce radiation exposure, emphasize clinical reasoning, and optimize the use of CT in children despite the low absolute risk. Evidence-based imaging strategies should be implemented to address the issue of balance between diagnostic benefit and long-term damage.