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CT Use and Radiation Exposure in Children

Surging Numbers of Scans in Children

A study in the April issue of the journal Radiology [1] revealed that the number of CT scans performed on pediatric patients in the emergency department (ED) has increased fivefold over a 13-year period ending in 2008. This pattern essentially duplicates what has happened with CT scans for adult patients in the ED.

The findings raised questions about CT use and radiation exposure in radiosensitive children, issues that were debated extensively in the media. Scratch the surface, though, and you will find that multiple efforts are underway to ensure not only appropriate use of CT in pediatric patients but also that those scans are conducted at the lowest dose rates possible.

That CT scan rates have risen for pediatric populations should not be surprising. The modality has seen tremendous technological advancements over the past dozen years and offers decided advantages in scanning children.

"The main driver is, frankly, that CT is an amazing technology," said Marilyn Goske, MD, a pediatric radiologist at Cincinnati Children's Hospital Medical Center. "Thirty years ago, we couldn't see inside the brain. Now, we can do a child's body in half a second. We have technology that gives us exquisite imaging and we don't need to sedate the child. We can have a definitive answer."

That level of accuracy has improved the quality of pediatric care, making procedures such as exploratory surgery for tumors and staging laparotomies for lymphoma are no longer necessary, Dr. Goske added.

Donald Frush, MD, a pediatric radiologist at Duke University Health System, echoes this point. Twenty years ago, he noted, the accepted false-negative rate for laparotomies for appendicitis was 30%; with the availability of CT, the false-negative rate has dropped to the 5%-7% range.

Heightened concerns about pediatric radiation exposure from medical scans have led to increased awareness among patients and physicians. One of the most visible manifestations of this has been the Image Gently™ campaign,[2] a multiorganizational drive to change practice by increasing opportunities to lower radiation dose in the imaging of children. The Image Gently campaign, now 3 years old, counts among its supporters dozens of organizations throughout the world. According to Dr. Frush, preliminary data from an ongoing survey of non-pediatric-focused practices in the United States found that approximately 50%-70% of respondents said information from the Image Gently campaign prompted them to lower their dose rates for CT in children.

David Larson, MD, MBA, Assistant Professor of Radiology at Cincinnati Children's Hospital, and the lead investigator in the pediatric utilization growth study, said the Image Gently campaign is prompting more questions from patients and physicians. "Patients are checking to make sure we are adjusting dose, and other radiology practices are making inquiries about how to adjust dose," he said.

http://www.medscape.com/viewarticle/744484?src=mp&spon=17
 

Crohn's Mom

Moderator
thank for this Wendy...interesting read.

Gab's doctor's (all of them separately) have always agreed to try and keep the exposure to radiation from the CT scans to a minimum with her. They worry about the risk mostly to her ovaries at such a young age. Her docs at the Mayo clinic now prefer the MR enterography if such a test is warranted. This is supposed to be a much better test than the CT scan; however, the CT picked up the abscesses she had pre-surgery, but the MRE did not.
 
np ..

same here.. I had the MRE's (3) and 2 picked up abnormalities and the last did not pick up anything yet the same pain is still there. So, they give me a lot of narcotics to help with pain but they're not fixing or treating the underlying issue. I think this applies to adults as well... I heard a CT is the equilivent to 3 years of background radiation and something like 287 chest x-rays (something like that...). The 3 years is the correct number. It is sort of worrisome for children as they have the disease early and a potential of a lifetime of tests yet to be had.
I am going for a CT as there are risks with taking a whack load of narcotics as well.. scary though....
 

DustyKat

Super Moderator
Yikes! I freak every time I see something mentioned about CAT Scans and radiation!

So much so that you may as well call me Aussie the Ostrich!

Sarah has had one CT scan but Matt on the other hand...hell I have never sat down and counted how many he has had...arrrrrhhhh. Okay, here goes, deep breaths...

CT Enterogram when diagnosed. December

CT at local hospital when he presented to ER. December

CT at RPA when he presented to ER. January

CT five days later to try and find abcess. January

CT next day to assist in inserting drain. January

CT six days after as part of a sinogram. January

CT about a week after that because of acute pain. January

CT mid February because the GP could feel a mass again.

CT end of March for surgeon to use during surgery.

Holy hell 9! :yfaint:

Maybe the only saving grace is when he had the last one the guy at radiology said they only use phase one on patients Matt's age. He then asked me what hospital he had been in and when I said RPA he said he knew the head radiographer there and that would have been what they used as well. It still scares me S***less but then again if it's not that doing it it's the meds or some other thing with CD!

To be honest, at the time he was having all these done it was the last thing on my mind. I was freaking out about him and how to get him better! :lol:

Much love, :Karl:
Freakin' out Dusty. xxx
 

DustyKat

Super Moderator
Just saw your last post Wendy. took me a looooooong time to post mine!, and now I have my fingers in my ears and I'm saying la, la, la! :lol:

Dusty. xxx
 
well Dusty,

the good news is the radiologist already knew the risks and lowered the does - as recommended in the article.

I think it goes back to what would have happened to Matt had he not had the CT's?
Just tell him not to watch TV for a few years ;) Also, tell him he cant get sick anymore.

I have had a head CT already when they thought I was having a stroke. Turns out I had a bad reaction to my medication (whch seriously messed up my walking... I could not do simple tasks like the gross motor and fine motor skill tests they do in ER. (i.e: touching finger to nose, and I didn't have any reflexes in my left side either).

I am choosing to have another as the tests I have been having aren't working... there is something not being picked up... for whatever reason.

Just tell Matt he has to be extra healthy now... eating properly and exercise to make up for it. :)
 

DustyKat

Super Moderator
That's right Kathy, there is no radiation in an MRI/E's, they use magnets.

Ultrasonography is diagnostic in only 60% of cases of psoas abscess,[9] compared with 80% to 100% for CT.[10] Sensitivity and specificity of diagnosing psoas abscess is not improved by magnetic resonance imaging (MRI), and with its higher cost and greater patient discomfort, MRI has no role in the diagnosis of psoas abscess.
This is something I quoted a while back (January), I asked a couple of different radiographers their views and they agreed that CT was better at visualising abscesses...(((shrug))).

Dusty. xxx
 
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