The use of CT scans in children is rising. Although the improved technology makes scanning pediatric patients easier, many in the industry worry scans contain doses are too large for children’s body weight and size.
A study in the April Radiology revealed many reasons for the five-fold spike in pediatric CT scans from 1995 to 2008 in emergency departments nationwide. Eighty-five percent occurred in hospitals without a pediatric focus, and industry leaders say this presents an opportunity to educate providers and technologists who work mostly with adults.
“The data confirms the technology has improved, and we can handle motion in young patients with little to no sedation,” says study author David Larson, M.D., a Cincinnati Children’s Hospital Medical Center radiologist. “It also shows it’s important for community hospitals to partner with children’s hospitals or vendors to set protocols appropriate for kids.”
According to an April Diagnostic Imaging poll, 85 percent of you feel pediatric CT scans occur too often. Overall, Larson says, increased use of CT scan is a positive development, because it indicates the imaging study is more readily available in most health care settings. But, he adds, addressing concerns about radiation risk and dosage amounts is important.
Larson also recommends swaddling small children and acclimating older children to the scan to reduce anxiety.
To reduce radiation risks for children, the Image Gently campaign has promoted the methods and benefits of lowering pediatric radiation doses since 2007. For non-pediatric hospitals, the program recommends you reduce your tube output to accommodate smaller patient sizes, perform single-phase studies, scan only necessary areas, and use breast shields for girls.
These guidelines give providers at non-pediatric hospitals and parents confidence CT scans are conducted as safely as possible, says Donald Frush, M.D., American College Radiology pediatric imaging commission chair and pediatric radiology chief at Duke University Medical Center.
“It’s a great way to ensure all hospitals use CT correctly – that there are appropriate strategies and providers in the same setting order scans similarly,” Frush says. “Radiologists everywhere are dedicated to providing excellent care to children, so it’s unfair to say community providers don’t offer equal quality care as what you get in children’s hospitals.”
Seattle Children’s Hospital radiologist Jonathan Swanson, M.D., agrees community hospitals should follow the Image Gently recommendations, but he stresses children’s hospitals remain the best option for pediatric CT scans. In addition, these specialists can decide whether an ultrasound or a CT is the correct study.
Having providers familiar with pediatric patients is important, Swanson says, because radiation concentrates more in smaller organs and children have more years to develop cancer due to radiation exposure. The biggest concern is safety, he says.
“It is important for radiologists to keep the question of radiation safety in the forefront of their minds so they can help the technologists dial down protocols appropriately,” Swanson says. “But until the technology exists and is widespread to have pediatric CT scan protocols hardwired, children’s hospitals are the best option.”
