Child's Nervous System

, Volume 28, Issue 5, pp 681–689 | Cite as

Reducing radiation exposure from computed tomography of the brain in children — report of a practical approach

  • Sui-To Wong
  • Gwendolin Yiu
  • Yiu-Man Poon
  • Ming-Keung Yuen
  • Dawson Fong
Original Paper

Abstract

Purpose

To reduce radiation exposure to paediatric neurosurgical patients from computed tomography (CT), a CT scanning protocol — lower radiation dose and selective scan segment (LDSS) protocol was used for CT brain at the authors’ hospital. To evaluate the amount of reduction in radiation exposure by using this LDSS protocol compared to their usual protocol, the authors prospectively documented their findings.

Methods

From May 2010 to June 2011, paediatric neurosurgical patients requiring CT brain, and when it was not a clinical emergency and there was baseline CT or MRI brain available, were evaluated for the LDSS protocol. The LDSS protocol used a lower tube current–time product and a shorter scan length to attain a lower total radiation dose. The CT scanning parameters of the patients’ usual CT brain and LDSS CT were recorded and compared. Adverse events were also recorded.

Results

A total of 24 paediatric patients were included. Using the LDSS protocol, the effective doses were between 9% and 80% of the usual protocol and, in 20 patients, ≤50% of the usual protocol. The tube voltage was 120 kV. For patients below 10 years old, 100 mA s was adequate for the purposes of their CTs; in some patient categories, it was lower than 100 mA s. For patients aged 10 or above, 150 mA s was used. The scan length varied.

Conclusions

Radiation exposure from CT brain in paediatric neurosurgical patients could be reduced by adopting a CT scanning protocol, which aimed dynamically at a lower tube current–time product and a shorter scan length than the usual settings at a hospital.

Keywords

Computed tomography Low radiation dose Paediatric 

Notes

Acknowledgement

The authors thank all radiographers at the Department of Diagnostic Radiology at Tuen Mun Hospital for their contribution in carrying out the protocol.

References

  1. 1.
    Berdon WE, Slovis TL (2002) Where we are since ALARA and the series of articles on CT dose in children and risk of long-term cancers: what has changed? Pediatr Radiol 32:699PubMedCrossRefGoogle Scholar
  2. 2.
    Bongartz G, Golding SJ, Jurik AG, Leonardi M, van Persijn van Meerten E, Rodríguez R, Schneider K, Calzado A, Geleijns J, Jessen KA, Panzer W, Shrimpton PC, Tosi G (2004) European guidelines for multislice computed tomography. Funded by the European Commission, Contract number FIGM-CT2000-20078-CT-TIPGoogle Scholar
  3. 3.
    Boone JM, Geraghty EM, Selbert JA, Wootton-Gorges SL (2003) Dose reduction in pediatric CT: a rational approach. Radiology 228:352–360PubMedCrossRefGoogle Scholar
  4. 4.
    Brenner DJ, Hall EJ (2007) Computed tomography — an increasing source of radiation exposure current concepts. New Engl J Med 357:2277–2284PubMedCrossRefGoogle Scholar
  5. 5.
    Chan CY, Wong YC, Chau LF, Yu SK, Lau PC (1999) Radiation dose reduction in paediatric cranial CT. Pediatr Radiol 29:770–775PubMedCrossRefGoogle Scholar
  6. 6.
    Chodick G, Ronckers CM, Shalev V, Ron E (2007) Excess lifetime cancer mortality risk attributable to radiation exposure from computed tomography examinations in children. Isr Med Assoc J 9:584–587PubMedGoogle Scholar
  7. 7.
    Diekmann S, Siebert E, Juran R, Roll M, Deeg W, Bauknecht HC, Diekmann F, Klingebiel R, Bohner G (2010) Dose exposure of patients undergoing comprehensive stroke imaging by multidetector-row CT: comparison of 320-detector row and 64-detector row CT scanners. AJNR Am J Neuroradiol 31:1003–1009PubMedCrossRefGoogle Scholar
  8. 8.
    European Commission (1999) European Guidelines on Quality Criteria for Computed Tomography, Report EUR 16262. EC, BrusselsGoogle Scholar
  9. 9.
    Frush DP (2002) Pediatric CT: practical approach to diminish the radiation dose. Pediatr Radiol 32:714–717PubMedCrossRefGoogle Scholar
  10. 10.
    Galanski M, Nagel HD, Stamm G (2007) Paediatric CT exposure practice in the federal republic of Germany: results of a nationwide survey in 2005–2006. Medizinische Hochschule, HannoverGoogle Scholar
  11. 11.
    Goldman LW (2007) Principles of CT: radiation dose and image quality. J Nucl Med Technol 35:213–25PubMedCrossRefGoogle Scholar
  12. 12.
    Hall P, Adami HO, Trichopoulos D, Pedersen NL, Lagiou P, Ekbom A, Ingvar M, Lundell M, Granath F (2004) Effect of low doses of ionising radiation in infancy on cognitive function in adulthood: Swedish population based cohort study. BMJ 328:19PubMedCrossRefGoogle Scholar
  13. 13.
    Jaffurs D, Denny A (2009) Diagnostic pediatric computed tomographic scans of the head: actual dosage versus estimated risk. Plast Reconstr Surg 124:1254–1260PubMedCrossRefGoogle Scholar
  14. 14.
    Ledenius K, Stålhammar F, Wiklund LM, Fredriksson C, Forsberg A, Thilander-Klang A (2010) Evaluation of image-enhanced paediatric computed tomography brain examinations. Radiat Prot Dosimetry 139:287–292PubMedCrossRefGoogle Scholar
  15. 15.
    Little MP, Wakeford R, Tawn EJ, Bouffler SD, Berrington de Gonzalez A (2009) Risks associated with low doses and low dose rates of ionizing radiation: why linearity may be (almost) the best we can do. Radiology 251:6–12PubMedCrossRefGoogle Scholar
  16. 16.
    McCollough CH, Leng S, Yu L, Cody DD, Boone JM, McNitt-Gray MF (2011) CT dose index and patient dose: they are not the same thing. Radiology 259:311–316PubMedCrossRefGoogle Scholar
  17. 17.
    Ngaile JE, Uiso CB, Msaki P, Kazema R (2008) Use of lead shields for radiation protection of superficial organs in patients undergoing head CT examinations. Radiat Prot Dosimetry 130:490–498PubMedCrossRefGoogle Scholar
  18. 18.
    Nievelstein RAJ, van Dam IM, van der Molen AJ (2010) Multidetector CT in children: current concepts and dose reduction strategies. Pediatr Radiol 40:1324–1344PubMedCrossRefGoogle Scholar
  19. 19.
    Pang D, Altschuler E (1994) Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery 35:643–655PubMedCrossRefGoogle Scholar
  20. 20.
    Shah R, Gupta AK, Rehani MM, Pandey AK, Mukhopadhyay (2005) Effect of reduction in tube current on reader confidence in paediatric computed tomography. Clin Radiol 60:224–231PubMedCrossRefGoogle Scholar
  21. 21.
    Shope TB, Gagne RM, Johnson GC (1981) A method for describing the doses delivered by transmission x-ray computed tomography. Med Phys 8:488–495PubMedCrossRefGoogle Scholar
  22. 22.
    Shrimpton PC, Hillier MC, Lewis MA, Dunn M (2006) National survey of doses from CT in the UK 2003. Br J Radiol 79:968–980PubMedCrossRefGoogle Scholar
  23. 23.
    Shrimpton PC, Wall BF (2000) Reference doses for paediatric computed tomography. Radiat Prot Dosimetry 90:249–252Google Scholar
  24. 24.
    Stein SC, Hurst RW, Sonnad SS (2008) Meta-analysis of cranial CT scans in children. A mathematical model to predict radiation-induced tumors. Pediatr Neurosurg 44:448–457PubMedCrossRefGoogle Scholar
  25. 25.
    Tubiana M, Feinendegen LE, Yang C, Kaminski JM (2009) The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology 251:13–22PubMedCrossRefGoogle Scholar
  26. 26.
    U.S. National Academy of Sciences, National Research Council, Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation (2006) Health risks from exposure to low levels of ionizing radiation. BEIR VII Phase 2. Chapter 1. NationalAcademies Press, WashingtonGoogle Scholar
  27. 27.
    U.S. National Academy of Sciences, National Research Council, Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation (2006) Health risks from exposure to low levels of ionizing radiation. BEIR VII Phase 2. Chapter 2. NationalAcademies Press, WashingtonGoogle Scholar
  28. 28.
    Verdun FR, Gutierrez D, Vader JP, Aroua A, Alamo-Maestre LT, Bochud F, Gudinchet F (2008) CT radiation dose in children: a survey to establish age-based diagnostic reference levels in Switzerland. Eur Radiol 18:1980–1986PubMedCrossRefGoogle Scholar
  29. 29.
    Wong ETH, Yu SK, Lai M, Wong YC, Lau PC (2001) MAPD—an objective way to select mAs for paediatric brain CT. Br J Radiol 74:932–937PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Sui-To Wong
    • 1
  • Gwendolin Yiu
    • 2
  • Yiu-Man Poon
    • 2
  • Ming-Keung Yuen
    • 2
  • Dawson Fong
    • 1
  1. 1.Department of NeurosurgeryTuen Mun HospitalHong Kong SARChina
  2. 2.Department of Diagnostic RadiologyTuen Mun HospitalHong Kong SARChina

Personalised recommendations