Fewer CTs, More MRI and Ultrasounds for Kids

Marcia Frellick

August 24, 2015

A study of 33 children's hospitals has found that use of computed tomography (CT) for the 10 most common diagnostic groups in children decreased from 2004 to 2012.

Meanwhile, rates for magnetic resonance imaging (MRI) and ultrasound have increased in 8 of the 10 groups. The findings were published online August 24 in Pediatrics.

"Decreases in CT utilization have public health implications by decreasing exposure to hazardous ionizing radiation," Michelle W. Parker, MD, from the Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Ohio, and colleagues write.

"Pediatric exposure to ionizing radiation in doses frequently administered by CT has been linked with [one] additional cancer per 10,000 exposed children," they explain. Substituting an imaging modality that does not use ionizing radiation may therefore affect lifetime cancer risk in children who receive diagnostic imaging.

Studies of CT frequency during the last 20 years have shown a large increase from the mid-1990s, with some showing a plateau or decrease in recent years, the authors report. However, most of these studies were based on a single condition or institution, unlike the current research.

The diagnostic groups in the study included categories such as seizures, appendicitis, concussions, upper respiratory infections, and abdominal pain. For all of the All Patient Refined Diagnosis-Related Groups (APR-DRGs) except ventricular shunt procedures and nonbacterial gastroenteritis, the number of children imaged with any modality increased. However, CT use fell for all APR-DRGs (P values < .001).

Many Explanations for Shift

Dr Parker and colleagues say the shift could be attributed to concerns about ionizing radiation and cancer risk, as well changes in confidence in using alternate imaging methods. Support for the shift may also come from advances in diagnostic imaging quality for nonradiation imaging and more staffing to perform the studies, such as sedation teams, which may be needed for MRI.

The authors also point to the 2006 push by the Alliance for Radiation Safety in Pediatric Imaging to raise awareness of radiation exposure and opportunities to lower doses when imaging children.

This study also shows that the evidence to support choosing nonradiation modalities may have played a role in the increase in alternate imaging. The authors point to the dramatic shifts to ultrasound for appendectomy, gastroenteritis, and abdominal pain. For gastroenteritis, although CT use marginally increased, there was an almost 300% increase in ultrasounds during the study period.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 24, 2015.

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