OBJECTIVE: To perform a systematic review to evaluate the risk of malignancy 
associated with computed tomography (CT) of the head and/or neck in infants, 
children, and adolescents.
DATA SOURCES: Pubmed, EMBASE, and the Cochrane Library were assessed from the 
date of their inception to January 2014. Additionally, manual searches of 
bibliographies were performed and topic experts were contacted.
REVIEW METHODS: Data were obtained from studies measuring or estimating the 
risks of malignancy associated with radiation from head and/or neck CT in 
pediatric populations according to an a priori protocol. Two independent 
evaluators corroborated the extracted data.
RESULTS: There were 16 criterion-meeting studies that included data from n = 
858,815 patients. The radiation-related risk of malignancy was estimated using 
primary patient data for both the exposure and outcome in a minority of studies, 
with most analyses utilizing mathematical modeling techniques. The data 
regarding otolaryngology-specific studies were limited and suggested a 
borderline significant increase in the risk of all combined cancers after facial 
CT (incidence rate ratio [IRR] = 1.14; 95% CI, 1.01-1.28) and neck/spine CT (IRR 
= 1.13; 95% CI, 1.00-1.28). Cohort data suggest that 1 excess brain malignancy 
occurred after 4000 brain CTs (40 mSv per scan) and that the estimated risk in 
the 10 years following CT exposure was 1 brain tumor per 10,000 patients exposed 
to a 10 mGy scan at less than 10 years of age.
CONCLUSION: Detailed understanding of any potential malignancy risk associated 
with pediatric imaging of the head and neck furthers our ability to engage in 
rational, shared, informed decision making with families considering CT scan.