Estimating the risk of cancer incidence and radiation-induced cancer death of children patients undergoing digital radiology X-ray examinations

Background: It is generally accepted that children are more sensitive to radiation than adults and have a higher relative risk of cancer. The longer life expectancy after exposure increases the risk of developing radiationassociated malignancies. Purpose: This study aims to estimate the risk of cancer incidence and radiation-induced cancer death of children patients undergoing digital radiology X-ray examinations. Material and methods: In this study, data were collected retrospectively from 15 radiography rooms in the major radiology centers in Mazandaran province (Iran). The information of 12 common digital radiography examinations including pelvis (in the anteroposterior projection (AP)), skull (in the two lateral projection (LAT) and posteroanterior projection (PA)), abdomen (AP), cervical vertebra (AP and LAT), chest (PA and LAT), lumbar vertebra (AP and LAT), thoracic vertebra (AP and LAT) examinations which was recorded from 10 to 15 years old patients. The Entrance Surface Air Kerma (ESAK), Entrance Skin Dose (ESD), and Organ Effective Dose (ED) were measured. Finally, the risk of cancer incidence and Risk of Exposure-Induced cancer Death (REID) values were estimated for these patients. Results: In total, 1800 (983 females and 817 males) patients (10-15 years old) were included in this study. Across all procedures, the lowest ED belonged to the skull (PA) examination (10.40 mu Sv), and the highest ED belonged to the AP abdominal imaging technique (378.46 mu Sv). The highest ESD was related to the lumbar spine (LAT) projection (3.62 +/- 1.38 mGy) and the least to the cervical vertebra (AP) view (0.97 +/- 0.21). It was also shown that the differences in cancer incidence and radiation-induced cancer death values in male and female patients were not statistically significant. Conclusion: The result showed that ESDs are influenced by various factors that affect patients' dose distributions, so through the optimization of imaging parameters, image quality can be increased and the patient dose reduced. These actions will necessarily decrease the risk of cancer incidence and radiation-induced mortality risk. Further studies are recommended to assess the workplace environment and practical training in radiology institutions, along with the quality control tests of radiology devices.