{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:34:46Z","timestamp":1789238086488,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T00:00:00Z","timestamp":1692576000000},"content-version":"vor","delay-in-days":51,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["CDCD\u20101304\u20107043\u20101304\u20107043 and DI\u20102018C1\u201011375)"],"award-info":[{"award-number":["CDCD\u20101304\u20107043\u20101304\u20107043 and DI\u20102018C1\u201011375)"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pulm. circ."],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Pediatric patients with pulmonary hypertension (PH) receive imaging studies that use ionizing radiation (radiation) such as computed tomography (CT) and cardiac catheterization to guide clinical care. Radiation exposure is associated with increased cancer risk. It is unknown how much radiation pediatric PH patients receive. The objective of this study is to quantify radiation received from imaging and compute associated lifetime cancer risks for pediatric patients with PH. Electronic health records between 2012 and 2022 were reviewed and radiation dose data were extracted. Organ doses were estimated using Monte Carlo modeling. Cancer risks for each patient were calculated from accumulated exposures using National Cancer Institute tools. Two hundred and forty\u2010nine\u00a0patients with PH comprised the study cohort; 97% of patients had pulmonary arterial hypertension, PH due to left heart disease, or PH due to chronic lung disease. Mean age at the time of the first imaging study was 2.5 years (standard deviation [SD]\u2009=\u20094.9 years). Patients underwent a mean of 12 studies per patient per year, SD\u2009=\u200932. Most (90%) exams were done in children &lt;5 years of age. Radiation from CT and cardiac catheterization accounted for 88% of the total radiation dose received. Cumulative mean effective dose was 19\u2009mSv per patient (SD\u2009=\u200930). Radiation dose exposure resulted in a mean increased estimated lifetime cancer risk of 7.6% (90% uncertainty interval 3.0%\u221214.2%) in females and 2.8% (1.2%\u22125.3%) in males. Careful consideration for the need of radiation\u2010based imaging studies is warranted, especially in the youngest of children.<\/jats:p>","DOI":"10.1002\/pul2.12282","type":"journal-article","created":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T08:11:30Z","timestamp":1692691890000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Associated radiation exposure from medical imaging and excess lifetime risk of developing cancer in pediatric patients with pulmonary hypertension"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8082-7977","authenticated-orcid":false,"given":"Malini","family":"Mahendra","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Critical Care, UCSF Benioff Children's Hospital University of California at San Francisco  San Francisco California USA"},{"name":"Philip R. Lee Institute for Health Policy Studies University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9160-1957","authenticated-orcid":false,"given":"Philip","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena K.","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, UCSF Benioff Children's Hospital University of California at San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hythem","family":"Nawaytou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, UCSF Benioff Children's Hospital University of California at San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R.","family":"Duncan","sequence":"additional","affiliation":[{"name":"Interventional Radiology Section, Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9740-405X","authenticated-orcid":false,"given":"Jeffrey R.","family":"Fineman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Critical Care, UCSF Benioff Children's Hospital University of California at San Francisco  San Francisco California USA"},{"name":"Cardiovascular Research Institute University of California San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Smith\u2010Bindman","sequence":"additional","affiliation":[{"name":"Philip R. Lee Institute for Health Policy Studies University of California  San Francisco California USA"},{"name":"Department of Epidemiology and Biostatistics University of California San Francisco San Francisco California USA"},{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences University of California San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.026591"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.03.575"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000329"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.021686"},{"key":"e_1_2_10_6_1","volume-title":"Leveraging Advances in Modern Science to Revitalize Low\u2010Dose Radiation Research in the United States","author":"National Academies of Sciences, Engineering, and Medicine, Division on Earth and Life Studies, Nuclear and Radiation Studies Board, Committee on Developing a Long\u2010Term Strategy for Low\u2010Dose Radiation Research in the United States","year":"2022"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2013.311"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.10.4907"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(22)00655-6"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60815-0"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.10.029"},{"key":"e_1_2_10_12_1","volume-title":"Radiation Reporting\u2010SB 1237","author":"Alex Padilla EA","year":"2010"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2021.03.004"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/59\/18\/5225"},{"key":"e_1_2_10_15_1","unstructured":"NCIRF: National Cancer Institute dosimetry system for radiography and fluoroscopy. NCI;\u00a02021."},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-022-01556-z"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/ab1bad"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.427"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1088\/0952-4746\/32\/3\/205"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra072149"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1086\/685102"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ppedcard.2009.09.003"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-022-01659-8"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13244-012-0176-x"},{"key":"e_1_2_10_25_1","unstructured":"United States EPA.Radiation sources and doses.2022.https:\/\/www.epa.gov\/radiation\/radiation-sources-and-doses"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-1162"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1667\/RADE-20-00231.1"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/RTI.0000000000000404"},{"key":"e_1_2_10_29_1","unstructured":"Center for Disease Control and Prevention. Radiation from space (cosmic radiation) [Internet]. [cited\u00a0May 22 \u00a02023].https:\/\/www.cdc.gov\/nceh\/radiation\/terrestrial.html."},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.019137"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.6762"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029138"},{"issue":"8","key":"e_1_2_10_33_1","first-page":"245","article-title":"Congenital heart disease and the risk of cancer: an update on the genetic etiology, radiation exposure damage, and future research strategies","volume":"9","author":"Campolo J","year":"2022","journal-title":"J Cardiovasc\u00a0Development\u00a0Dis"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.118.006765"}],"container-title":["Pulmonary Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pul2.12282","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T12:12:53Z","timestamp":1709813573000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pul2.12282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1002\/pul2.12282"],"URL":"https:\/\/doi.org\/10.1002\/pul2.12282","archive":["Portico"],"relation":{},"ISSN":["2045-8940","2045-8940"],"issn-type":[{"value":"2045-8940","type":"print"},{"value":"2045-8940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7]]},"assertion":[{"value":"2023-02-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e12282"}}