Volume 28, Issue 4, Pages 263-271 (April 2016) Childhood and Adolescent Thyroid Cancer in Fukushima after the Fukushima Daiichi Nuclear Power Plant Accident: 5 Years On  S. Suzuki  Clinical Oncology  Volume 28, Issue 4, Pages 263-271 (April 2016) DOI: 10.1016/j.clon.2015.12.027 Copyright © 2016 The Royal College of Radiologists Terms and Conditions

Fig 1 (a) Schedule of the preliminary baseline survey (PBLS). ① First survey, financial year 2011, from October 2011 to March 2012; ② second survey, financial year 2012, from April 2012 to March 2013; ③ third survey, financial year 2013, from April 2013 to March 2014. PBLS subjects were 367 685 residents of Fukushima Prefecture, including visitors, who were born between 2 April 1992 and 1 April 2011. NPP, nuclear power plant. (b) Schedule of the full-scale survey (FSS). ① First survey, financial year 2014, from April 2014 to March 2015; ② second survey, financial year 2015, from April 2015 to March 2016. In total, there were 385 685 FSS subjects. FSS subjects were PBLS subjects and newly added subjects who were born between 2 April 2011 and 1 April 2012. (c) Readings of the Airborne Monitoring Survey by MEXT in the western part of Fukushima Prefecture (air dose rates at a height of 1 m above the ground surface in Fukushima Prefecture). Thyroid ultrasound examinations were carried out first on those who were living in high-exposure areas at the time of the accident. (http://radioactivity.nsr.go.jp/en/contents/4000/3168/24/1270_0912_2.pdf). Clinical Oncology 2016 28, 263-271DOI: (10.1016/j.clon.2015.12.027) Copyright © 2016 The Royal College of Radiologists Terms and Conditions

Fig 2 Ultrasound diagnostic criteria for thyroid nodules. A sonological flow chart for thyroid solid tumour evaluation by the Japan Association of Breast and Thyroid Sonology (JABTS). (1) For multiple nodules, each nodule should be evaluated using the criteria for solid nodular lesions. Observational follow-up is indicated for hyperplastic nodules, such as adenomatous thyroid nodules showing spongiform or honeycomb patterns. (2) Fine needle aspiration cytology (FNAC) is necessary when there are neck lymph node metastases or distant metastases, or high values of serum carcinoembryonic antigen or calcitonin. (3) When malignancy is strongly suspected according to the ultrasound diagnostic criteria for thyroid nodules by the Japan Society of Ultrasonics in Medicine (JSUM) (Table 1). (4) When there are one or more findings of malignancy according to the ultrasound diagnostic criteria for thyroid nodules by JSUM (Table 1) or positive blood flow (penetrating vessel) into a nodule by colour Doppler echogram. Clinical Oncology 2016 28, 263-271DOI: (10.1016/j.clon.2015.12.027) Copyright © 2016 The Royal College of Radiologists Terms and Conditions

Fig 3 Age and gender distribution of subjects with malignancy and suspected malignancy diagnosed by fine needle aspiration cytology (FNAC) in the preliminary baseline survey (PBLS) and the full-scale survey (FSS). (a) Age as of 11 March 2011 in PBLS, (b) age as of confirmatory examination in PBLS, (c) age as of 11 March 2011 in FSS, (d) age as of confirmatory examination in FSS. Clinical Oncology 2016 28, 263-271DOI: (10.1016/j.clon.2015.12.027) Copyright © 2016 The Royal College of Radiologists Terms and Conditions

Fig 4 Thyroid ultrasonic findings characteristic for children. (A) Ectopic intrathyroidal thymus (arrow) in the right lobe of thyroid (transverse view) [21]. (B) Ectopic intrathyroidal thymus (arrow) in the right lobe of thyroid (sagittal view) [21]. (C) Multiple colloid cysts showing comet tail sign in the thyroid lobe (sagittal view) [12]. (D) Colloid cyst with comet tail sign or cat's eye sign. Clinical Oncology 2016 28, 263-271DOI: (10.1016/j.clon.2015.12.027) Copyright © 2016 The Royal College of Radiologists Terms and Conditions