Home

  • Home
    • » e-Newsletters

Reduce risks of radiation in children's CT scans

Radiology Administrator's Compliance and Reimbursement Insider, April 1, 2008

In the past decade, patients’ exposure to medical radiation increased due to advancements in CT technology. Approximately 4 million pediatric CT scans were performed in 2006. Soon, medical imaging (with CT scans as the largest contributor) will approach or potentially exceed naturally occurring background radiation as the single largest source of radiation for humans.

There’s no doubt that CT scans save lives. But children are particularly susceptible to radiation received from imaging scans. Cumulative radiation exposure to their developing bodies could, over time, have adverse effects.

It’s important for your facility to adopt measures to ensure children’s safety, says Marilyn Goske, MD, chair of the Alliance for Radiation Safety in Pediatric Imaging at Cincinnati Children’s Hospital Medical Center.

There has been action to help children; earlier this year, prominent radiology groups launched the Image Gently campaign.

Associations included in the effort are the Society for Pediatric Radiology, the American College of Radiology (ACR), the American Society of Radiologic Technologists, and the American Association of Physicists in Medicine (AAPM), founding members of the Alliance for Radiation Safety in Pediatric Imaging.

The campaign Web site (www.imagegently.org) contains the most recent research and educational materials to help determine the appropriate radiation techniques for the imaging of children.

The campaign aspires to change the way children are imaged in the United States, using kid-size, rather than adult-sized, radiation doses.

“Children are not just smaller adults,” says -Goske. “Their bodies are different and require a different -approach to imaging.”

Children are more sensitive to radiation and have a lifetime to manifest biological changes.

The best available risk estimates suggest that pediatric CT will result in significantly increased lifetime radiation risk over adult CT because of the increased dose per milliampere-second and the increased lifetime risk per unit dose.

To help mitigate the potential hazards for children, implement the following at your facility:

Discuss current practices in reducing radiation. Increase awareness for the need to decrease radiation doses to children during CT scanning. Evaluate what measures you currently employ to protect children’s safety.

Awareness of risks and available information should empower you to improve patient safety, says -Goske.

Some hospitals have state-of-the art machines that -automatically adjust radiation dosages to child levels. If you don’t have these machines, you can still use your current machines and work with your medical physicist to adjust the dosage appropriately, she says.

Change your daily practices. Collaborate with your technologists, medical physicist, referring doctors, and parents. Consider creating a pledge to lower radiation doses in children. Ask medical physicists to monitor pediatric CT techniques and involve technologists to optimize scanning.

Significantly reduce, or child-size, the amount of radiation used. First, contact your medical physicist to review your adult CT protocols, says Keith Strauss, M.Sc., director of radiology physics and engineering at Children’s Hospital Boston. If you do not have a medical physicist, find one, says Strauss.

Visit the AAPM Web site at www.aapm.org to identify medical physicists in your geographical area. Ensure that your adult protocol delivers radiation doses within ACR recommendations.

Use the simple CT protocols on the Image Gently Web site to downsize the protocols for kids, says -Goske. Remember, more is not better. Adult size (kV) and mAs are not necessary for small bodies, she explains.

Possible adjustments in the tube current, the spacing of CT slices, and slice thickness could reduce the radiation exposure while maintaining diagnostic image quality, according to Image Gently reports. Because children are smaller, these adjustments are not likely to compromise image quality.

Don’t overscan.

Eliminate multiple scans when possible. Single phase scans are usually adequate, especially for children. Pre- and postcontrast and delayed CT scans rarely add additional information in children yet can double or triple the dose, says Goske. Consider removing multiphase scans from your daily protocols.

Scan only the indicated area. For example, if a patient has a possible dermoid on his or her ultrasound, there is rarely a need to scan the entire abdomen and pelvis. Child-size the scan and only scan the area required to obtain the necessary information, says Goske.

Scan only when necessary. In many cases, CT scans will be necessary to save lives. Work closely with referring physicians and parents to determine whether a CT scan is necessary. Radiologists should consider developing more well-defined approaches to selection of patients for CT. However, for situations in which the diagnostic yield of CT is expected to be low, alternative examinations should be considered.

Give parents notice about safe imaging. A simple patient/parent handout can improve understanding of potential risks so that parents can be partners in minimizing scans. In other words, parents will be less likely to insist on scans that physicians say aren’t mandatory if they know the risk.

Conversely, studies show that a handout won’t cause parents to refuse studies recommended by the referring physician. (Use our model handout below.)

Insider sources

Marilyn Goske, MD, chair of the Alliance for Radiation Safety in Pediatric Imaging, 3333 Burnet Avenue, Cincinnati, OH 45229, 513/636-4975; marilyn.goske@cchmc.org.

Keith Strauss, M.Sc., director of radiology physics and engineering, department of radiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, 617/908-7492; Keith.Strauss@childrens.harvard.edu.


Keep parents informed of the realities regarding CT scan risks

Use the following FAQs to help parents understand the risks associated with CT scans. Consider having these handouts available for parents.

Q: Is there an increased risk of cancer from medical radiation, especially CT scans?

A: Although no one can point to a single individual and say that their cancer was caused by medical radiation, there is evidence that exposures to radiation levels found during CT scans may slightly increase the risk of future cancer. The risk for developing cancer is debated and variable, and may be zero, but estimates also range from about one in 500 to one in 10,000 fatal cancers from a single CT scan.

This needs to be interpreted against the risk of developing cancer over one’s lifetime. The risk of developing cancer is about one in five during a lifetime, so the extra risk from CT is very small. 

Q: If my doctor orders a CT scan, should I let my child have it?

A: Like any medical test, the beneficial information gained from the test should outweigh the risk of having the test performed. 

CT is a very powerful and valuable imaging technique that can provide important and even life-saving information. However, sometimes, imaging tests such as ultrasound and MRI can provide the same information as CT but not expose your child to any radiation. You should ask your doctor and imaging provider whether these alternatives are appropriate for your child’s situation. 

If a CT is the best test, make sure that your imaging provider uses appropriate low-dose techniques to minimize radiation exposure during the test.

Q: How can I be sure that my imaging facility is using appropriate reduced radiation techniques?

A: Some facilities that perform CT scans on adults do not use radiation dose reduction techniques when scanning children. 

You won’t know unless you ask, and it is both reasonable and within your rights to do so.

Your imaging provider should be able to provide you with information about procedures to reduce radiation doses during CT (such as reducing CT tube output, performing single-phase scans, and reducing exposure to areas away from the clinical concern).

Parents should also ask whether:

  • The facility has American College of Radiology accreditation
  • The CT technologists are credentialed
  • The person interpreting the studies is a board-certified radiologist or pediatric radiologist

Source: The Alliance for Radiation Safety in Pediatric Imaging and the Image Gently campaign.

Most Popular