Evaluating Organ Doses and Cancer Risk Estimation in Pediatric Abdominal and Chest CT Imaging: A Multicenter Study in Iraq
Abstract
Purpose : Computed tomography (CT) is an essential diagnostic imaging modality in pediatric medicine; however, exposure to ionizing radiation poses a potential risk of radiation-induced malignancy. This multicenter study evaluated organ-specific radiation doses and estimated lifetime cancer risks in pediatric patients undergoing chest and abdominal CT imaging across multiple Iraqi healthcare centers.
Material & Methods: Data from 200 pediatric patients (100 chest CT, 100 abdominal CT) were collected from three hospitals in Dohuk, Mosul, Anbar, and Baghdad, Iraq. CT acquisition parameters (kilo-voltage (kVp), pitch, slice thickness, scan length) and dose metrics (CTDIvol, DLP, effective dose) were recorded. Organ doses to lungs, thyroid, breast, and heart were estimated using imPACT software based on scanner-reported parameters. Lifetime Attributable Risk of cancer incidence was calculated using BEIR VII risk models with linear interpolation for pediatric age groups (1–5, 6–10, 11–15 years).
Results: Radiation dose metrics increased significantly with age. Mean CTDIvol ranged from 8.1 ± 1.1 mGy (1–5 years) to 20.8 ± 1.2 mGy (11–15 years), with effective doses of 3.2 ± 0.3 to 6.7 ± 0.5 mSv. Organ doses demonstrated parallel trends: lung doses 4.8–8.9 mSv, thyroid doses 4.3–8.0 mSv. Cancer risk was highest in younger children (LAR: 0.16 ± 0.02 cancers/10,000 person-years/mSv), decreasing with age but remaining clinically significant.
Conclusions: This study demonstrates that as children age and body size increase, CT dose and cancer risk increase; therefore, dose optimization and the use of appropriate protocols are essential.
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25- Faris Abdul Kareem, AP Saeed Kamona, and Thamer Al Hilfi, "Age-Specific and Age-Standardized Incidence Trends of Iraq's Top Five Childhood Cancers (2002–2021)." Journal of Health Sustainable Development, (2025).
26- Khaled Alenazi et al., "Local diagnostic reference levels of pediatric chest and abdominopelvic CT examinations based on body weight in central region of Saudi Arabia." Journal of Radiation Research and Applied Sciences, Vol. 18 (No. 2), p. 101371 ,(2025).
27- Agapi Ploussi, Vasileios Syrgiamiotis, Triantafillia Makri, Christiana Hatzigiorgi, and Efstathios P Efstathopoulos, "Local diagnostic reference levels in pediatric CT examinations: a survey at the largest children’s hospital in Greece." The British journal of radiology, Vol. 93 (No. 1116), p. 20190358, (2020)
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29- Isabelle Thierry-Chef et al., "Dose estimation for the European epidemiological study on pediatric computed tomography (EPI-CT)." Radiation research, Vol. 196 (No. 1), pp. 74-99, (2021).
30- Walter Huda and Awais Vance, "Patient radiation doses from adult and pediatric CT." American Journal of Roentgenology, Vol. 188 (No. 2), pp. 540-46, (2007).
31- VC Monteiro, HR Schelin, A Legnani, D Filipov, MB Freitas, and ALMC Malthez, "A study of SSDE, CTDI, and DLP dose indexes for establishing diagnostic reference levels in pediatric CT exams." Radiation Physics and Chemistry, Vol. 235p. 112813, (2025).
32- Kalpana M Kanal et al., "US diagnostic reference levels and achievable doses for 10 pediatric CT examinations." Radiology, Vol. 302 (No. 1), pp. 164-74, (2022).
33- Khaled Alenazi, Essam Alkhybari, Ali Alhailiy, Sultan Alghamdi, Nada Fisal, and Salman Albeshan, "Pediatrics organ dose and lifetime attributable cancer risk estimates in routine computed tomography." Radiation Physics and Chemistry, Vol. 223p. 112021, (2024).
34- Michael Esser et al., "Radiation dose optimization in pediatric chest CT: major indicators of dose exposure in 1695 CT scans over seven years." in RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, (2018), Vol. 190 (No. 12): © Georg Thieme Verlag KG, pp. 1131-40.
35- Sebastian Tschauner, Robert Marterer, Eszter Nagy, Georg Singer, Michael Riccabona, and Erich Sorantin, "Experiences with image quality and radiation dose of cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) in pediatric extremity trauma." Skeletal Radiology, Vol. 49 (No. 12), pp. 1939-49, (2020).
36- Khalid M Aloufi, "Estimation of Radiation Equivalent Dose and Lifetime Attributable Risk from Pediatric CAP CT Examination." BioMed, Vol. 4 (No. 4), pp. 395-403 ,(2024).
37- Neige Journy et al., "Predicted cancer risks induced by computed tomography examinations during childhood, by a quantitative risk assessment approach." Radiation and environmental biophysics, Vol. 53 (No. 1), pp. 39-54, (2014).
38- Kushaljit S Sodhi, Satheesh Krishna, Akshay K Saxena, Anindita Sinha, Niranjan Khandelwal, and Edward Y Lee, "Clinical application of ‘Justification’and ‘Optimization’principle of ALARA in pediatric CT imaging:“How many children can be protected from unnecessary radiation?”." European journal of radiology, Vol. 84 (No. 9), pp. 1752-57, (2015).
39- Ali Aamry, Mohammed Alsufayan, Hassan Aldossari, Batil Alonazi, and Abdelmoneim Sulieman, "Assessment of imaging protocol and patient radiation exposure in pediatric computed tomography angiography." Radiation Physics and Chemistry, Vol. 172p. 108807, (2020).
40- Beverley Newman, Arundhuti Ganguly, Jee-eun Kim, and Terry Robinson, "Comparison of different methods of calculating CT radiation effective dose in children." American Journal of Roentgenology, Vol. 199 (No. 2), pp. W232-W39 ,(2012).
41- Lenitza M Nieves Lopez, "Exploring Novel Materials To Be Used As Dual-Energy Mammography Contrast Agents For Breast Cancer Detection." University of Pennsylvania, (2022).
42- Rebecca Smith-Bindman et al., "Projected lifetime cancer risks from current computed tomography imaging." JAMA internal medicine, Vol. 185 (No. 6), pp. 710-19, (2025).
43- Anja Almén, Jónína Guðjónsdóttir, Nils Heimland, Britta Højgaard, Hanne Waltenburg, and Anders Widmark, "Paediatric diagnostic reference levels for common radiological examinations using the European guidelines." The British Journal of Radiology, Vol. 95 (No. 1130), p. 202107, (2022).
2- Shunsuke Shibata, Yuta Shibamoto, Megumi Maehara, Ayano Hobo, Naohide Hotta, and Yoshiyuki Ozawa, "Reasons for undergoing CT during childhood: can CT-exposed and CT-naive populations be compared?" Dose-Response, Vol. 18 (No. 1), p. 1559325820907011, (2020).
3- Jeffrey M Albert, "Radiation risk from CT: implications for cancer screening." American Journal of Roentgenology, Vol. 201 (No. 1), pp. W81-W87, (2013).
4- Parinaz Mehnati, Reza Malekzadeh, and Sooteh Mohammad Yousefi, "New Bismuth composite shield for radiation protection of breast during coronary CT angiography."(2019).
5- Parinaz Mehnati, Reza Malekzadeh, Mohammad Yousefi Sooteh, and Soheila Refahi, "Assessment of the efficiency of new bismuth composite shields in radiation dose decline to breast during chest CT." The Egyptian Journal of Radiology and Nuclear Medicine, Vol. 49 (No. 4), pp. 1187-89, (2018).
6- Parinaz Mehnati, Sooteh Mohammad Yousefi, Reza Malekzadeh, Baharak Divband, and Soheila Refahi, "Breast conservation from radiation damage by using nano bismuth shields in chest computed tomography scan," (2019).
7- Mayar M Aziz et al., "Reducing radiation exposure in pediatric CT imaging: strategies and alternatives in emergency medicine—a narrative review." Journal of Emergency and Critical Care Medicine, Vol. 9, (2025).
8- Amy Berrington De Gonzalez et al., "Relationship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions." British journal of cancer, Vol. 114 (No. 4), pp. 388-94, (2016).
9- Muzahem MY Al-Hashimi, "Incidence of childhood leukemia in Iraq, 2000-2019." Asian Pacific Journal of Cancer Prevention: APJCP, Vol. 22 (No. 11), p. 3663, (2021).
10- GI Ogbole, "Radiation dose in paediatric computed tomography: risks and benefits." Annals of Ibadan postgraduate medicine, Vol. 8 (No. 2), pp. 118-26, (2010).
11- Carly Stewart et al., "Quantifying and contextualizing radiation doses in common pediatric medical imaging examinations." The Journal of Pediatrics: Clinical Practice, p. 200166, (2025).
12- John D Mathews et al., "Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians." Bmj, Vol. 346, (2013).
13- Mohammed Alsabri et al., "Diagnostic value of CT scans in pediatric patients with acute non-traumatic altered mental status: a systematic review and meta-analysis." European journal of pediatrics, Vol. 184 (No. 2), p. 136, (2025).
14- David J Brenner, Carl D Elliston, Eric J Hall, and Walter E Berdon, "Estimated risks of radiation-induced fatal cancer from pediatric CT." American Journal of Roentgenology, Vol. 176 (No. 2), pp. 289-96, (2001).
15- Kristy R Kutanzi, Annie Lumen, Igor Koturbash, and Isabelle R Miousse, "Pediatric exposures to ionizing radiation: carcinogenic considerations." International journal of environmental research and public health, Vol. 13 (No. 11), p. 1057, (2016).
16- M Kiani and A Chaparian, "Evaluation of image quality, organ doses, effective dose, and cancer risk from pediatric brain CT scans." European journal of radiology, Vol. 158p. 110657, (2023).
17- Giovanni Bibbo, Scott Brown, and Rebecca Linke, "Diagnostic reference levels of paediatric computed tomography examinations performed at a dedicated Australian paediatric hospital." Journal of medical imaging and radiation oncology, Vol. 60 (No. 4), pp. 475-84, (2016).
18- Zakariya Vawda, Richard Pitcher, John Akudugu, and Willem Groenewald, "Diagnostic reference levels for paediatric computed tomography." SA Journal of Radiology, Vol. 19 (No. 2), (2015).
19- Rebecca Smith-Bindman et al., "International variation in radiation dose for computed tomography examinations." BMJ: British Medical Journal, Vol. 364, (2018).
20- Sangsoo Han et al., "Pediatric computed tomography scan and subsequent risk of malignancy: a nationwide population-based cohort study in Korea using National Cancer Institute dosimetry system for computed tomography (NCICT)." BMC medicine, Vol. 23 (No. 1), p. 355 ,(2025).
21- Alan S Brody, Donald P Frush, Walter Huda, Robert L Brent, and Section on Radiology, "Radiation risk to children from computed tomography." Pediatrics, Vol. 120 (No. 3), pp. 677-82, (2007).
22- Keith J Strauss, Elanchezhian Somasundaram, Debapriya Sengupta, Jennifer R Marin, and Samuel L Brady, "Radiation dose for pediatric CT: comparison of pediatric versus adult imaging facilities." Radiology, Vol. 291 (No. 1), pp. 158-67, (2019).
23- Christoph Suess and Xiaoyan Chen, "Dose optimization in pediatric CT: current technology and future innovations." Pediatric Radiology, Vol. 32 (No. 10), (2002).
24- SL Brady, BS Yee, and RA Kaufman, "Characterization of adaptive statistical iterative reconstruction algorithm for dose reduction in CT: a pediatric oncology perspective." Medical physics, Vol. 39 (No. 9), pp. 5520-31,(2012).
25- Faris Abdul Kareem, AP Saeed Kamona, and Thamer Al Hilfi, "Age-Specific and Age-Standardized Incidence Trends of Iraq's Top Five Childhood Cancers (2002–2021)." Journal of Health Sustainable Development, (2025).
26- Khaled Alenazi et al., "Local diagnostic reference levels of pediatric chest and abdominopelvic CT examinations based on body weight in central region of Saudi Arabia." Journal of Radiation Research and Applied Sciences, Vol. 18 (No. 2), p. 101371 ,(2025).
27- Agapi Ploussi, Vasileios Syrgiamiotis, Triantafillia Makri, Christiana Hatzigiorgi, and Efstathios P Efstathopoulos, "Local diagnostic reference levels in pediatric CT examinations: a survey at the largest children’s hospital in Greece." The British journal of radiology, Vol. 93 (No. 1116), p. 20190358, (2020)
28- Jenia Vassileva et al., "IAEA survey of pediatric CT practice in 40 countries in Asia, Europe, Latin America, and Africa: Part 1, frequency and appropriateness." American Journal of Roentgenology, Vol. 198 (No. 5), pp. 1021-31, (2012).
29- Isabelle Thierry-Chef et al., "Dose estimation for the European epidemiological study on pediatric computed tomography (EPI-CT)." Radiation research, Vol. 196 (No. 1), pp. 74-99, (2021).
30- Walter Huda and Awais Vance, "Patient radiation doses from adult and pediatric CT." American Journal of Roentgenology, Vol. 188 (No. 2), pp. 540-46, (2007).
31- VC Monteiro, HR Schelin, A Legnani, D Filipov, MB Freitas, and ALMC Malthez, "A study of SSDE, CTDI, and DLP dose indexes for establishing diagnostic reference levels in pediatric CT exams." Radiation Physics and Chemistry, Vol. 235p. 112813, (2025).
32- Kalpana M Kanal et al., "US diagnostic reference levels and achievable doses for 10 pediatric CT examinations." Radiology, Vol. 302 (No. 1), pp. 164-74, (2022).
33- Khaled Alenazi, Essam Alkhybari, Ali Alhailiy, Sultan Alghamdi, Nada Fisal, and Salman Albeshan, "Pediatrics organ dose and lifetime attributable cancer risk estimates in routine computed tomography." Radiation Physics and Chemistry, Vol. 223p. 112021, (2024).
34- Michael Esser et al., "Radiation dose optimization in pediatric chest CT: major indicators of dose exposure in 1695 CT scans over seven years." in RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, (2018), Vol. 190 (No. 12): © Georg Thieme Verlag KG, pp. 1131-40.
35- Sebastian Tschauner, Robert Marterer, Eszter Nagy, Georg Singer, Michael Riccabona, and Erich Sorantin, "Experiences with image quality and radiation dose of cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) in pediatric extremity trauma." Skeletal Radiology, Vol. 49 (No. 12), pp. 1939-49, (2020).
36- Khalid M Aloufi, "Estimation of Radiation Equivalent Dose and Lifetime Attributable Risk from Pediatric CAP CT Examination." BioMed, Vol. 4 (No. 4), pp. 395-403 ,(2024).
37- Neige Journy et al., "Predicted cancer risks induced by computed tomography examinations during childhood, by a quantitative risk assessment approach." Radiation and environmental biophysics, Vol. 53 (No. 1), pp. 39-54, (2014).
38- Kushaljit S Sodhi, Satheesh Krishna, Akshay K Saxena, Anindita Sinha, Niranjan Khandelwal, and Edward Y Lee, "Clinical application of ‘Justification’and ‘Optimization’principle of ALARA in pediatric CT imaging:“How many children can be protected from unnecessary radiation?”." European journal of radiology, Vol. 84 (No. 9), pp. 1752-57, (2015).
39- Ali Aamry, Mohammed Alsufayan, Hassan Aldossari, Batil Alonazi, and Abdelmoneim Sulieman, "Assessment of imaging protocol and patient radiation exposure in pediatric computed tomography angiography." Radiation Physics and Chemistry, Vol. 172p. 108807, (2020).
40- Beverley Newman, Arundhuti Ganguly, Jee-eun Kim, and Terry Robinson, "Comparison of different methods of calculating CT radiation effective dose in children." American Journal of Roentgenology, Vol. 199 (No. 2), pp. W232-W39 ,(2012).
41- Lenitza M Nieves Lopez, "Exploring Novel Materials To Be Used As Dual-Energy Mammography Contrast Agents For Breast Cancer Detection." University of Pennsylvania, (2022).
42- Rebecca Smith-Bindman et al., "Projected lifetime cancer risks from current computed tomography imaging." JAMA internal medicine, Vol. 185 (No. 6), pp. 710-19, (2025).
43- Anja Almén, Jónína Guðjónsdóttir, Nils Heimland, Britta Højgaard, Hanne Waltenburg, and Anders Widmark, "Paediatric diagnostic reference levels for common radiological examinations using the European guidelines." The British Journal of Radiology, Vol. 95 (No. 1130), p. 202107, (2022).
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How to Cite
1.
Zeinali A, Bakr Al jawali Z, Awny R, Muayad Sultan O, Rasouli N. Evaluating Organ Doses and Cancer Risk Estimation in Pediatric Abdominal and Chest CT Imaging: A Multicenter Study in Iraq. Frontiers Biomed Technol. 2026;.
