More and more doctors turned to computed tomography (CT) in the last two decades. In 2011, doctors performed 85 million CT scans on patients across the United States. Five to eleven percent of these took place among pediatric patients.
CT scans are essential diagnostics tools. But because they also come with doses of radiation, a CT scan comes with risks.
Any professional medical body will tell you: there’s no safe exposure to a CT radiation dose no matter how small.
As we continue to follow the trend of increased use of CT in pediatric patients, we also need to keep asking important questions about safety and the risk of cancer.
CT Radiation Dose: How High Is It?
Today, humans find themselves exposed to radiation in all kinds of places including in the hospital. Why should exposure to a CT radiation dose matter?
The dosage from these tools is far higher than other procedures. The average hospital sees CT scans making up 12 percent of diagnostic radiological procedures. It also accounts for nearly 49 percent of the entire U.S. population’s collective radiation dose from any and all radiologic examinations.
Why is this the case?
The radiation associated with a CT scan is 100 to 500 times higher than the dose in conventional radiography. Indeed, the ionizing radiation doses that come with CTs are in ranges that come with an increased link to cancer.
At the same time, we now use CT scans in a greater number of pediatric cases. An estimate believes that CT use doubled for children under five between 1996 and 2005. In the same period, CTs tripled for kids between 5 and 14.
CTs then began to decline around 2007, but they continue to remain in use.
As a result, there’s a huge difference between conventional radiography and CT scans. If we’re going to continue to use them among children, then we need to talk about the risks of cancer.
What Is the Cancer Risk?
Several studies on the subject associated higher doses with cancers among children. The need for distinguishing children from adults is three-pronged.
First, children are most sensitive to radiation than adults. Second, children have a longer life expectancy, which gives them more time to experience and express radiation damage. Third, their smaller body size means they do not need a large radiation dosage.
In a study from the United Kingdom, researchers found that when children received a 30 mGy or higher active bone marrow dose, their risk of leukemia was 3.2 times higher than children with no exposure to radiation.
The same study also examined the effect of a brain dose. Children with 50 mGy or higher presented a risk of brain cancer 2.8 times higher.
Among children, the projected lifetime risks for cancer are higher for children under five. Prevalence was also noted to be higher for girls as well as patients who received scans of their abdomen, pelvis, and spine.
One study suggests that given the four million pediatric CT scans performed every year, it could cause 4,870 cancer cases in the future.
What Do We Do?
There’s no doubt that CT is an invaluable diagnostic tool. But how do we mitigate the risks for all children and more vulnerable children in particular?
The answer appears to be radiation dose reduction across the board.
As previously mentioned, the radiation dose varies wildly, often between 100 and 500 times the dosage of conventional radiography. Studies suggest that reducing the highest 25 percent of doses down to the median could play a role in preventing 43 percent of cancers induced by radiation exposure.
Over the last ten years, medical device evolution improved to allow us to generate better images with lower radiation dosages. We also use more appropriate settings to reduce doses for pediatric patients.
While issues with high doses once abounded, these are now known to be unnecessary, and the proper settings are both available and widely used.
However, we must also account for multiple scans. The use of more than one scan over time or in one examination increases pediatric patients’ exposure.
Ways to Minimize Exposure Among Pediatric Patients
Everyone in the medical field from physicians to radiologic technologists to government organizations has a shared responsibility: we must minimize radiation doses in children’s CTs.
There are three immediate ways to achieve this goal.
First, physicians and pediatric healthcare providers should only perform CT exams when necessary. Standard indications for pediatric patients exist, and they should be used. Radiologists should also participate in this decision making and should recommend other technologies like ultrasound or MRI when possible.
Second, we need to follow the exposure parameters that best suit children. We should administer doses based on size and weight, region scanned, and the organ systems scanned. We should limit the area to the smallest necessary and be particularly careful in head, abdomen, pelvis and spine imaging.
Third, we may have to settle for lower quality images. High-quality images demand higher radiation doses. But top images aren’t necessary for all diagnostics. Given the improvements in technology, lower-resolution scans are suitable tools for generating a diagnosis.
Finally, we should continue to look out for ways to improve pediatric CT protocols for both safety and accuracy. One of these methods is through continuing education to encourage standardization across disciplines and healthcare organizations.
Protecting Children Through Continuing Education
CT radiation makes up most of the radiation Americans face. The doses are higher here than in any other radiologic application and radiation wasn’t adequately controlled in pediatric imaging until recently.
There is no safe CT radiation dose. But we do need to be careful of the doses we give children, particularly young children and those receiving scans of their head or abdomen.
Young children are more susceptible to radiation. Because they’re young, they also have more time to see the damage high radiation doses can do.
Today’s machines offer better quality images with lower doses. It’s also important to remember that clear, sharp images are not the standard for diagnoses. Education is the way to protect children while still providing excellent healthcare.
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