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Keep X-Rays Low for Young Patients

Posted on: Sunday, 6 April 2003, 06:00 CDT

By Kathleen Doheny, HealthScoutNews Reporter

HealthScoutNews -- A child takes a tumble during a playground game and his parents rush him to the emergency room.

The doctor assures them everything is fine, yet the parents press him: Can you do a CT scan, just to be sure?

Dr. Tom Slovis, chief of pediatric imaging at Children's Hospital of Michigan in Detroit, hears the question on an almost daily basis. Often, he has to tell the worried parents that the CT scan, a special computer-enhanced X-ray, is a marvelous medical tool but that sometimes their child not only doesn't need it, he is better off without it.

Overuse of CT scans on children has become a major concern, sparked by a trio of reports published in 2001 in radiology medical journals that underscored the risk of cancers associated with pediatric exposure and pointed to the need to adjust the radiation dose for smaller patients.

Another study, which reviewed 1,000 CT scans on children, concluded that the scans are, indeed, used too liberally. The review found that only 7 percent of the scans detected an intercranial injury, such as a concussion. In many cases, the doctors requesting the scans did so for children with minor injuries, or to appease parents who pressured them, says Dr. Shireen Atabaki, assistant professor of pediatrics at Children's National Medical Center in Washington, D.C., who conducted the study.

Two million to 3 million CT scans are performed on children annually in the United States, and use of the technology has increased about seven-fold in the last decade, the National Cancer Institute estimates.

Since the studies brought the issue of overuse to light, radiologists and federal agencies have moved to address the problem, drafting policy statements and guidelines and offering perspective for both doctors and parents.

The consensus: Doses need to be adjusted lower for children, doctors need to carefully consider which patients might benefit from a CT scan, and parents should be aware that sometimes not ordering a CT scan is good medicine.

The risk of cancer associated with radiation must be carefully weighed. In one of the reports, researchers estimated that about 600,000 abdominal and head CT scans are done each year on children under age 15, and that 500 of the children will die later in life from cancer attributable to the radiation.

However, critics of that report, in the American Journal of Roentgenology, say the method of calculating the risk is controversial and may not be accurate.

Even so, U.S. radiology groups as well as the U.S. Food and Drug Administration are urging radiologists to adjust the dose of CT scans for children. In a public health notification issued in late 2001, the FDA recommends that CT scan doses be adjusted based on a person's weight and size. Manufacturers of scanning equipment are working to improve hardware and software to lower the doses, Slovis says.

Parents shouldn't be alarmed but should be informed, says Dr. Lane Donnelly, radiologist-in-chief at Cincinnati Children's Hospital Medical Center, and one of the co-authors of the medical journal reports.

"The first thing to stress is that CT is an incredibly valuable tool," says Donnelly, who is also a member of the pediatric radiology committee for the American College of Radiology. "It's not something for [parents or children] to be scared of when used appropriately."

Deciding whether a CT scan is needed can be difficult. But Atabaki found some factors in her study that indicated when such treatment would be beneficial. They included: being under 2 years of age; exhibiting some "deficit," such as not being able to see correctly; dizziness; and evidence of a fracture at the base of the skull.

Many more radiologists and physicians are now aware of the need to "child-size" the dose when using CT scans. But not all are, Donnelly says. Doctors at children's hospitals are probably more knowledgeable than other physicians.

Whatever the setting, it's appropriate for parents to ask about the dose if a CT scan is ordered, he says.

The question may be put something like this, he suggests: "Do you adjust your CT scan to minimize the radiation dose to children?"

And if you get a doctor who's not up-to-date on the latest research? "Go to a facility where they alter the CT scan for pediatric patients," Slovis advises.

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On the Net:

National Cancer Institute information

FDA Notification

More science, space, and technology from RedNova

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