New CT Scan Standards Proposed for Kids with Minor Head Injury

Last week, we wrote that the U.S. Food and Drug Administration (FDA) unveiled an initiative to reduce <"">unnecessary radiation exposure from medical imaging, specifically procedures with high radiation doses: Computed tomography (CT), nuclear medicine studies, and fluoroscopy. Considered among the greatest contributors to total radiation exposure within the U.S. population, these procedures use much higher radiation doses than other radiographic procedures, such as standard and dental X-rays and mammography. Now, an emerging tool will likely standardize protocols for CT scans when conducted on children, said Science Daily.

According to a new study in the Canadian Medical Association Journal (CMAJ), the tool is targeted to children with minor head injuries and will also help to reduce the number of CT scans performed, said Science Daily. Figures indicate that over 650,000 children with such injuries resulting in a loss of consciousness, amnesia, disorientation, and /or vomiting, are seen in hospitals nationwide every year, wrote Science Daily. Although critical as a diagnostic tool, especially for serious brain injuries, the procedures can expose children to the potentially adverse effects of ionizing radiation, ultimately increasing health care costs, explained Science Daily.

Yet, use of CT scanning in pediatric patients is on the rise. For instance, in Canada’s pediatric emergency departments, an increase to 53 percent from 15 percent was seen in a recent ten-year period (1995-2005). There are no evidence-based guidelines on pediatric CT scanning protocols for minor head injuries, noted Science Daily.

A team of researchers from pediatric institutions in Canada developed the CATCH—Canadian Assessment of Tomography for Childhood Injury—Rule, meant to assist doctors in deciding if a pediatric patient presenting with a minor head injury should undergo a CT scan, said Science Daily. The team looked at 3,866 children up to 16 years of age from 10 of Canada’s pediatric teaching institutions, added Science Daily.

The CATCH Rule is comprised of seven “simple” findings from the child’s medical history and the physical exam, said Science Daily.

“We believe an accurate clinical decision rule, like the CATCH Rule, can stabilize or reduce the number of children receiving a CT scan, thereby minimizing both health care costs and exposure to the potentially harmful effects of ionizing radiation,” wrote Dr. Osmond, Department of Pediatrics, Children’s Hospital of Eastern Ontario and coauthors, quoted Science Daily. “There is growing concern that early exposure to ionizing radiation may result in a significant rise in lifetime fatal cancer risk…. Without the support of widely accepted, evidence-based guidelines, physicians are likely to follow the conservative approach of ordering CT scans for most children seen in emergency departments with minor head injury,” the authors added.

Although all medical procedures pose risks, the ionizing radiation used in some scans can increase a person’s lifetime cancer risk. Accidental exposure to very high amounts of radiation can cause injuries, such as skin burns, hair loss, and cataracts. While there is some disagreement over the extent of the cancer risk associated with exposure to radiation from medical imaging, there is broad agreement that steps can and should be taken to reduce unnecessary radiation exposure.

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