Abstract
Background
During the last decade, there has been a movement in the United States toward utilizing size-appropriate radiation doses for pediatric body CT, with smaller doses given to smaller patients.
Objective
This study assesses community adoption of size-appropriate pediatric CT techniques. Size-specific dose estimates (SSDE) in pediatric body scans are compared between community facilities and a university children’s hospital that tailors CT protocols to patient size as advocated by Image Gently.
Materials and methods
We compared 164 pediatric body scans done at community facilities (group X) with 466 children’s hospital scans. Children’s hospital scans were divided into two groups: A, 250 performed with established pediatric weight-based protocols and filtered back projection; B, 216 performed with addition of iterative reconstruction technique and a 60% reduction in volume CT dose index (CTDIvol). SSDE was calculated and differences among groups were compared by regression analysis.
Results
Mean SSDE was 1.6 and 3.9 times higher in group X than in groups A and B and 2.5 times higher for group A than group B. A model adjusting for confounders confirmed significant differences between group pairs.
Conclusions
Regional community hospitals and imaging centers have not universally adopted child-sized pediatric CT practices. More education and accountability may be necessary to achieve widespread implementation. Since even lower radiation doses are possible with iterative reconstruction technique than with filtered back projection alone, further exploration of the former is encouraged.
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References
Pierce DA, Preston DL (2000) Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 154:178–186
Brenner DJ, Elliston CD, Hall EJ et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296
Paterson A, Frush DP, Donnelly LF (2001) Helical CT of the body: are settings adjusted for pediatric patients? AJR Am J Roentgenol 176:297–301
Slovis TL (2011) Where we were, what has changed, what needs doing: a decade of progress. Pediatr Radiol 41:S456–S460
Mahesh M (2011) Advances in CT technology and application to pediatric imaging. Pediatr Radiol 41:S493–S497
The Alliance for Radiation Safety in Pediatric Imaging (2008) Image Gently®. http://www.imagegently.org Accessed 26 August 2012
Townsend BA, Callahan MJ, Zurakowski D et al (2010) Has pediatric CT at children’s hospitals reached its peak? AJR Am J Roentgenol 194:1194–1196
Arch ME, Frush DP (2008) Pediatric body MDCT: a 5-year follow-up survey of scanning parameters used by pediatric radiologists. AJR Am J Roentgenol 191:611–617
Singh S, Kalra MK, Moore MA et al (2009) Dose reduction and compliance with pediatric CT protocols adapted to patient size, clinical indication, and number of prior studies. Radiology 252:200–208
Larson DB, Johnson LW, Schnell BM et al (2011) Increasing use of CT in children visiting emergency departments, 1995–2007. Radiology 258:164–173
American College of Radiology (2012) CT accreditation program requirements. http://www.acr.org/Quality-Safety/Accreditation/CT Accessed 27 August 2012
Koninklijke Philips Electronics NV (2011) iDose4 iterative reconstruction technique: breakthrough in image quality and dose reduction with the 4th generation of reconstruction. http://www.healthcare.philips.com/pwc_hc/main/shared/Assets/Documents/ct/idose_white_paper_452296267841.pdf Accessed 3 January 2013
Strauss KJ, Goske MJ (2011) Estimated pediatric radiation dose during CT. Pediatr Radiol 41:S472–S482
American Association of Physicists in Medicine (2011) Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations (Report No. 204). American Association of Physicists in Medicine, College Park
McCollough C, Branham T, Herlihy V et al (2011) Diagnostic reference levels from the ACR Accreditation Program. Am J Cancer Res 8:795–803
Goske MJ, Phillips RR, Mandel K et al (2010) Image Gently: a web-based practice quality improvement program in CT safety for children. AJR Am J Roentgenol 194:1177–1182
Strauss KJ, Goske MJ, Kaste SC et al (2010) Image Gently: ten steps you can take to optimize image quality and lower CT does for pediatric patients. AJR Am J Roentgehol 194:868–873
U.S. Food and Drug Administration (2012) Draft guidance for industry and Food and Drug Administration staff—pediatric information for x-ray imaging device premarket notifications. Available via http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm300850.htm Accessed 10 May 2012
Acknowledgments
The authors thank David P. Hopkins, MD, MPH, for invaluable assistance with study design and manuscript review.
Conflict of interest
K.L.H. reports unrelated research funding from GE Medical Systems (1995) and Toshiba Medical Systems (1997), D.R.P. was a speaker from Philips Healthcare (2011), and D.M.E.B. is a consultant and member of the Speaker’s Bureau for Koninklijke Philips Electronics NV.
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Hopkins, K.L., Pettersson, D.R., Koudelka, C.W. et al. Size-appropriate radiation doses in pediatric body CT: a study of regional community adoption in the United States. Pediatr Radiol 43, 1128–1135 (2013). https://doi.org/10.1007/s00247-013-2680-7
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DOI: https://doi.org/10.1007/s00247-013-2680-7