CT Use and Radiation Exposure in Children

John C. Hayes

Disclosures

June 17, 2011

In This Article

Surging Numbers of Scans in Children

A study in the April issue of the journal Radiology[1] revealed that the number of CT scans performed on pediatric patients in the emergency department (ED) has increased fivefold over a 13-year period ending in 2008. This pattern essentially duplicates what has happened with CT scans for adult patients in the ED.

The findings raised questions about CT use and radiation exposure in radiosensitive children, issues that were debated extensively in the media. Scratch the surface, though, and you will find that multiple efforts are underway to ensure not only appropriate use of CT in pediatric patients but also that those scans are conducted at the lowest dose rates possible.

That CT scan rates have risen for pediatric populations should not be surprising. The modality has seen tremendous technological advancements over the past dozen years and offers decided advantages in scanning children.

"The main driver is, frankly, that CT is an amazing technology," said Marilyn Goske, MD, a pediatric radiologist at Cincinnati Children's Hospital Medical Center. "Thirty years ago, we couldn't see inside the brain. Now, we can do a child's body in half a second. We have technology that gives us exquisite imaging and we don't need to sedate the child. We can have a definitive answer."

That level of accuracy has improved the quality of pediatric care, making procedures such as exploratory surgery for tumors and staging laparotomies for lymphoma are no longer necessary, Dr. Goske added.

Donald Frush, MD, a pediatric radiologist at Duke University Health System, echoes this point. Twenty years ago, he noted, the accepted false-negative rate for laparotomies for appendicitis was 30%; with the availability of CT, the false-negative rate has dropped to the 5%-7% range.

Heightened concerns about pediatric radiation exposure from medical scans have led to increased awareness among patients and physicians. One of the most visible manifestations of this has been the Image Gently™ campaign,[2] a multiorganizational drive to change practice by increasing opportunities to lower radiation dose in the imaging of children. The Image Gently campaign, now 3 years old, counts among its supporters dozens of organizations throughout the world. According to Dr. Frush, preliminary data from an ongoing survey of non-pediatric-focused practices in the United States found that approximately 50%-70% of respondents said information from the Image Gently campaign prompted them to lower their dose rates for CT in children.

David Larson, MD, MBA, Assistant Professor of Radiology at Cincinnati Children's Hospital, and the lead investigator in the pediatric utilization growth study, said the Image Gently campaign is prompting more questions from patients and physicians. "Patients are checking to make sure we are adjusting dose, and other radiology practices are making inquiries about how to adjust dose," he said.

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