A nationwide push is underway to lower radiation exposure from CT scans, amid growing concern about the risks of cancer linked to the high-powered imaging technology, as I write in the Informed Patient column today.
While much of the focus is on adult CT scanning, between 5% and 10% of the approximately 70 million CT scans performed each year are administered to children, who are at higher risk because of their smaller size and the longer life expectancy. The Society for Pediatric Radiology is sponsoring an “Image Gently” campaign to promote use of the smallest amount of radiation possible during an imaging study. The group also is urging radiologists to take other precautions, including covering areas of the such as reproductive organs, and to consider alternative tests such as ultrasound.
Take head injuries. The CDC estimates that 435,000 children under 14 visit emergency rooms every year to be evaluated for traumatic brain injury, but not all head trauma results in a TBI –- the severity of a brain injury may range from mild, causing brief change in mental status or consciousness, to severe, causing permanent symptoms and irreversible damage.
Emergency department physicians at the University of California Davis Children’s Hospital recently developed guidelines for doctors, based on a study that found a substantial percentage of children who get CT scans after apparently minor head trauma don’t need them, and as a result are put at increased risk of cancer due to radiation exposure.
The study, published last fall in the Lancet, evaluated records of more than 42,000 children from 25 medical centers using data from the Pediatric Emergency Care Applied Research Network and found that one in five over the age of 2 and nearly one quarter of those under 2 who received CT scans following head trauma didn’t need them because they were at very low risk of developing serious brain injury compared with the cancer risks of the radiation dose.
Study lead author Nathan Kupperman, chairman of emergency medicine and a professor of pediatrics at UC Davis, tells the Health Blog that guidelines can help identify children who wouldn’t need a CT Scan, including kids who show normal mental status, with no palpable scalp swelling or skull fracture, and are showing normal behavior according to a parent. To validate the rules, the researchers applied them to data from a second group of 8,600 children; in more than 99.9% of cases they accurately predicted kids who weren’t diagnosed with serious brain injuries.
Dr. Kupperman says that for children whose risks are determined to be low or intermediate, he would engage parents in the decision-making process and explain the risks of radiation. The hard part, he says, is getting doctors to use evidence-based prediction rules in making the call on a CT scan.