April 5, 2011

Overuse Of CT Scans For Children Causes Concern

The number of children receiving computed tomography (CT) scans in emergency rooms is on the rise, according to a study published online and in the June print edition of Radiology. These extra tests may expose children to adult-sized radiation doses and potential risks for cancer down the road.

To study CT utilization trends in children, Dr. Larson and colleagues from the Cincinnati Children's Hospital Medical Center used data frm the National Hospital Ambulatory Medical Care Survey from 1995 to 2008, analyzing annual government surveys on ER visits at non-federal hospitals nationwide, focusing on visits in patients younger than age 18.

The nationwide number of ER visits in which children were exposed to CT scans surged from about 330,000 in 1995 to 1.65 million in 2008, the Associated Press (AP) reports. The percentage of visits involving CT scans climbed from about 1 percent to almost 6 percent despite no increase in total number of visits of children to emergency room services.

Although the study didn't include dose information, there are growing concerns that some children may be receiving adult-sized doses of radiation. General hospitals may be less likely than pediatric facilities to use special CT protocols with kids to limit their radiation exposure, the study authors said.

"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," said 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.

Children require special oversight with CT scans, including adjusting doses to their smaller size. Young people are more sensitive to radiation than adults, with longer life spans and more time for radiation-related cancers to develop, Reuters reported.

The study, "underscores the need for special attention to this vulnerable population to ensure that imaging is appropriately ordered, performed and interpreted," the researchers claim.

The increase in CT use may be due to improvements in the technology, with modern scanners creating clearer images and which are quicker than older models, producing results in just seconds, Larson explains.

Other factors likely contributed to the increases, and in some cases, overuse, include fear of lawsuits, results in some doctors ordering tests to avoid getting sued for a missed diagnosis. "If you send a kid home (without a CT scan) and it turns out you missed an abnormality, not many juries are going to be sympathetic," Larson said.

CT scans were most commonly used for children with head injuries, headaches or abdominal pain. Larson said it's impossible to tell from the data whether X-rays, which use less radiation, or other tests could have been done instead of CT scans.


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