Emergency Rooms Performing more CT Scans on Children

A new study has found that children are undergoing five times more CT scans in the emergency room than they were in the recent past. The study, published online in the journal Radiology, is raising new questions about the amount of medical radiation children are being exposed to. According to the study authors, the current prevalence of CT makes it more likely that children will receive a higher cumulative lifetime dose of medical radiation than those who are currently adults.

According to the study, the number of CT scans performed on children during emergency room visits increased from 330,000 in 1995 to 1.65 million in 2008. The leading complaints among those receiving CT scans included head injury, abdominal pain and headache. Abdominal CT scans, rare in 1995, were performed in 15 percent to 21 percent of emergency visits. Such scans deliver seven times as much radiation as head CT scan.

Non-pediatric focused emergency departments made up 89.4 percent of emergency department visits associated with CT scans in children and increased from 316,133 examinations to 1,438,413 over the study period. The authors noted that most of the radiologists who oversaw and interpreted these studies likely were not subspecialty-trained in pediatric radiology.

The authors of the study attribute the increase in pediatric CT scans to advancements in scanning technology. While CT scans can be a vital tool for rapid diagnostic evaluation of children in the emergency department, the relatively higher radiation doses associated with CT, compared to most other imaging exams, have raised concerns over an increase in risks associated with ionizing radiation. A child’s organs are more sensitive to the effects of radiation than those of an adult, and they have a longer remaining life expectancy in which cancer may potentially form, they write.

“We need to think creatively about how to partner with each other, with ordering clinicians and with CT manufacturers to ensure that all children are scanned only when it is appropriate and with appropriate techniques,” the study’s lead author, David B. Larson, M.D., M.B.A., director of quality improvement in the Department of Radiology at Cincinnati Children’s Hospital Medical Center in Ohio, said in a statement.

“The performance of CT in children requires special oversight, especially in regards to the selection of size-based CT scan parameters and sedation techniques,” he said. “It is important to consistently tailor CT technique to the body size of the pediatric patient.”

According to a report in the Los Angeles Times, there are some precautions parents can take to make sure their child is not being subjected to an unnecessary CT scan. These include asking if there are alternative diagnostic means available; ensuring that the scan is not a duplicate of one performed earlier or at a different facility; asking technicians to ensure that vulnerable areas such as eyes, thyroid, breasts and reproductive organs are protected from radiation to the greatest extent possible; and checking to make sure the radiology department is accredited by the American College of Radiology.

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