Medical diagnostic radiation promotes murine Apc/Kras-driven colon carcinogenesis

Computed tomography (CT) is one of the most widely used diagnostic imaging modalities worldwide, yet the biological risks associated with such exposures remain incompletely understood. Here, we investigated the effects of clinically relevant low (25 mGy) and moderate (250 mGy) dose radiation exposures on colon carcinogenesis using in vivo KPC:APC transgenic mice and an ex vivo organoid system carrying inducible Apc and Kras driver mutations. While medical diagnostic radiation did not initiate carcinogenesis in wild-type and did not alter carcinogenesis in Apc -mutant tissues, it significantly promoted the progression of precancerous lesions in the presence of both mutations, especially when exposure occurred during early tumor initiation. Organoids derived from mice harboring both Apc and Kras mutations mirrored this susceptibility, exhibiting radiation-induced enlargement and activation of transcriptomic and proteomic programs associated with colorectal cancer, including cell-cycle dysregulation and mTORC1 pathway activation. These findings show that radiation doses within the range delivered by routine abdominal CT imaging can potentiate the carcinogenic processes in genetically predisposed cells, underscoring the need to consider individual susceptibility when evaluating the benefit–risk balance of medical diagnostic exposures.