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Pediatric CT radiation exposure: where we were, and where we are now

  • Minisymposium: Quality and safety
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Abstract

Since the turn of the last millennium, the pediatric radiology community has blazed a patient-quality and safety trail in helping to effectively address the public and the news media’s concerns about the implications of ionizing radiation from CT scanners in children. As such, this article (1) reviews the potential deleterious effects of ionizing radiation, (2) discusses why limiting radiation exposure in children is so important, (3) tells the history of pediatric CT radiation exposure concerns, (4) explains the interventions that took place to address these concerns and (5) touches on the current school of thought on pediatric CT dose reduction.

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References

  1. National Research Council (1998) Health risks from exposure to low levels of ionizing radiation: BEIR VII, phase I, letter report. The National Academies Press, Washington, DC. https://doi.org/10.17226/9526

    Book  Google Scholar 

  2. United States Environmental Protection Agency, Office of Radiation and Indoor Air (2012) Radiation facts, risks and realities https://www.epa.gov/sites/production/files/2015-05/documents/402-k-10-008.pdf. Accessed 11 Sept 2018

  3. Dendy PP, Heaton B (2012) Physics for diagnostic radiology Series in medical physics and biomedical engineering, vol 17, 3rd edn. CRC Press, Boca Raton

    Google Scholar 

  4. Williams R (2010) Stroke scans and radiation risk. Lancet Neurol 9:1150–1151

    Article  PubMed  Google Scholar 

  5. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2008) IARC monographs on the evaluation of carcinogenic risks to humans. Volume 97. 1,3-butadiene, ethylene oxide and vinyl halides (vinyl fluoride, vinyl chloride and vinyl bromide). IARC Monogr Eval Carcinog Risks Hum 97:3–471

    PubMed Central  Google Scholar 

  6. Pierce DA, Shimizu Y, Preston DL et al (1996) Studies of the mortality of atomic bomb survivors. Report 12, Part I. Cancer: 1950-1990. Radiat Res 146:1–27

    Article  CAS  PubMed  Google Scholar 

  7. Ichimaru M, Ishimaru T, Belsky JL (1978) Incidence of leukemia in atomic bomb survivors belonging to a fixed cohort in Hiroshima and Nagasaki, 1950-71. Radiation dose, years after exposure, age at exposure, and type of leukemia. J Radiat Res 19:262–282

    Article  CAS  PubMed  Google Scholar 

  8. Tomonaga M (1966) Statistical investigation of leukemia in Japan. N Z Med J 65S:863–869

    Google Scholar 

  9. Bizzozero OJ Jr, Johnson KG, Ciocco A et al (1967) Radiation-related leukemia in Hiroshima and Nagasaki 1946-1964. II. Ann Intern Med 66:522–530

    Article  PubMed  Google Scholar 

  10. Bushberg JT (2012) The essential physics of medical imaging, 3rd edn. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  11. 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. National Academies Press, Washington, DC

    Google Scholar 

  12. Court-Brown WM, Doll R (1957) Leukaemia and aplastic anaemia in patients irradiated for ankylosing spondylitis. Medical Research Council

  13. Linet MS, Slovis TL, Miller DL et al (2012) Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin 62:75–100

    Article  PubMed  PubMed Central  Google Scholar 

  14. Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–221

    Article  PubMed  Google Scholar 

  15. United Nations Scientific Committee on the Effects of Atomic Radiation (2012) Sources, effects and risks of ionizing radiation: 2012 report to the general assembly, with annexes. United Nations, New York

    Google Scholar 

  16. Land CE (1980) Estimating cancer risks from low doses of ionizing radiation. Science 209:1197–1203

    Article  CAS  PubMed  Google Scholar 

  17. Siegel JA, McCollough CH, Orton CG (2017) Advocating for use of the ALARA principle in the context of medical imaging fails to recognize that the risk is hypothetical and so serves to reinforce patients' fears of radiation. Med Phys 44:3–6

    Article  PubMed  Google Scholar 

  18. Doss M (2015) Counterpoint: should radiation dose from CT scans be a factor in patient care? No Chest 147:874–877

    Article  PubMed  Google Scholar 

  19. Brenner DJ, Hall EJ (2007) Computed tomography — an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  CAS  PubMed  Google Scholar 

  20. Pierce DA, Preston DL (2000) Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 154:178–186

    Article  CAS  PubMed  Google Scholar 

  21. Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296

    Article  CAS  PubMed  Google Scholar 

  22. Mettler FA Jr, Wiest PW, Locken JA, Kelsey CA (2000) CT scanning: patterns of use and dose. J Radiol Prot 20:353–359

    Article  PubMed  Google Scholar 

  23. 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

    Article  CAS  PubMed  Google Scholar 

  24. Frush DP (2003) Responsible use of CT. Radiology 229:289–291

    Article  PubMed  Google Scholar 

  25. (2002) The ALARA (as low as reasonably achievable) concept in pediatric CT intelligent dose reduction. Multidisciplinary conference organized by the Society of [sic] Pediatric Radiology. August 18-19, 2001. Pediatr Radiol 32:217–313

  26. Linton OW, Mettler FA Jr, National Council on Radiation Protection Measurements (2003) National conference on dose reduction in CT, with an emphasis on pediatric patients. AJR Am J Roentgenol 181:321–329

    Article  PubMed  Google Scholar 

  27. Strauss KJ (2014) Developing patient-specific dose protocols for a CT scanner and exam using diagnostic reference levels. Pediatr Radiol 44:479–488

    Article  PubMed  Google Scholar 

  28. Siegel MJ, Schmidt B, Bradley D et al (2004) Radiation dose and image quality in pediatric CT: effect of technical factors and phantom size and shape. Radiology 233:515–522

    Article  PubMed  Google Scholar 

  29. McCollough CH, Bruesewitz MR, Kofler JM Jr (2006) CT dose reduction and dose management tools: overview of available options. Radiographics 26:503–512

    Article  PubMed  Google Scholar 

  30. Costello JE, Cecava ND, Tucker JE, Bau JL (2013) CT radiation dose: current controversies and dose reduction strategies. AJR Am J Roentgenol 201:1283–1290

    Article  PubMed  Google Scholar 

  31. Jacob K, Vivian G, Steel JR (2004) X-ray dose training: are we exposed to enough? Clin Radiol 59:928–934

    Article  CAS  PubMed  Google Scholar 

  32. Lee CI, Haims AH, Monico EP et al (2004) Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 231:393–398

    Article  PubMed  Google Scholar 

  33. Goske MJ, Applegate KE, Boylan J et al (2008) The Image Gently campaign: working together to change practice. AJR Am J Roentgenol 190:273–274

    Article  PubMed  Google Scholar 

  34. Image Gently Alliance (2014) Image Gently development of pediatric CT protocols 2014. https://radiologiadetrinchera.files.wordpress.com/2018/01/ig-ct-protocols-111714.pdf. Accessed 01 June 2018

  35. Brody AS, Frush DP, Huda W et al (2007) Radiation risk to children from computed tomography. Pediatrics 120:677–682

    Article  PubMed  Google Scholar 

  36. Greenwood TJ, Lopez-Costa RI, Rhoades PD et al (2015) CT dose optimization in pediatric radiology: a multiyear effort to preserve the benefits of imaging while reducing the risks. Radiographics 35:1539–1554

    Article  PubMed  Google Scholar 

  37. Huda W, Vance A (2007) Patient radiation doses from adult and pediatric CT. AJR Am J Roentgenol 188:540–546

    Article  PubMed  Google Scholar 

  38. Larson DB, Rader SB, Forman HP, Fenton LZ (2007) Informing parents about CT radiation exposure in children: it's OK to tell them. AJR Am J Roentgenol 189:271–275

    Article  PubMed  Google Scholar 

  39. Shah NB, Platt SL (2008) ALARA: is there a cause for alarm? Reducing radiation risks from computed tomography scanning in children. Curr Opin Pediatr 20:243–247

    Article  PubMed  Google Scholar 

  40. Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505

    Article  PubMed  PubMed Central  Google Scholar 

  41. International Commission on Radiological Protection (2007) The 2007 recommendations of the international commission on radiological protection. ICRP publication 103. Ann ICRP 37:1–332

    Google Scholar 

  42. Huda W, Atherton JV, Ware DE, Cumming WA (1997) An approach for the estimation of effective radiation dose at CT in pediatric patients. Radiology 203:417–422

    Article  CAS  PubMed  Google Scholar 

  43. Huda W, Ogden KM, Khorasani MR (2008) Converting dose-length product to effective dose at CT. Radiology 248:995–1003

    Article  PubMed  PubMed Central  Google Scholar 

  44. Huda W, Ogden KM (2008) Computing effective doses to pediatric patients undergoing body CT examinations. Pediatr Radiol 38:415–423

    Article  PubMed  Google Scholar 

  45. Hendee WR, O'Connor MK (2012) Radiation risks of medical imaging: separating fact from fantasy. Radiology 264:312–321

    Article  PubMed  Google Scholar 

  46. Parakh A, Kortesniemi M, Schindera ST (2016) CT radiation dose management: a comprehensive optimization process for improving patient safety. Radiology 280:663–673

    Article  PubMed  Google Scholar 

  47. Hendee WR (1992) Estimation of radiation risks. BEIR V and its significance for medicine. JAMA 268:620–624

    Article  CAS  PubMed  Google Scholar 

  48. Huda W, Chamberlain CC, Rosenbaum AE, Garrisi W (2001) Radiation doses to infants and adults undergoing head CT examinations. Med Phys 28:393–399

    Article  CAS  PubMed  Google Scholar 

  49. Hollingsworth C, Frush DP, Cross M, Lucaya J (2003) Helical CT of the body: a survey of techniques used for pediatric patients. AJR Am J Roentgenol 180:401–406

    Article  PubMed  Google Scholar 

  50. 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

    Article  PubMed  Google Scholar 

  51. Bernier MO, Rehel JL, Brisse HJ et al (2012) Radiation exposure from CT in early childhood: a French large-scale multicentre study. Br J Radiol 85:53–60

    Article  PubMed  PubMed Central  Google Scholar 

  52. American Association of Physicists in Medicine (2017) Routine pediatric chest CT. https://aapm.org/pubs/CTProtocols/documents/PediatricRoutineChestCT.pdf. Accessed 01 June 2018

  53. Lauing B (2013) Radiation dose legislation: is your state next? Advisory Board. https://www.advisory.com/research/imaging-performance-partnership/the-reading-room/2013/06/radiation-dose-legislation-is-your-state-next. Accessed 11 Aug 2018

  54. Domino D (2010) Court transcripts don't resolve questions in Mad River CT case. https://www.auntminnie.com/index.aspx?sec=sup&sub=imc&pag=dis&ItemID=91193. Accessed 01 June 2018

  55. Mezrich JL, Siegel EL (2013) Dose reporting legislation in California: are we placing the idea of patient safety ahead of reality? J Am Coll Radiol 10:814–816

    Article  PubMed  Google Scholar 

  56. Shore R, Beck H, Boice JD Jr et al (2018) Implications of recent epidemiologic studies for the linear nonthreshold model and radiation protection. J Radiol Prot 38:1217–1233

    Article  CAS  PubMed  Google Scholar 

  57. Siegel JA, Sacks B, Pennington CW, Welsh JS (2017) Dose optimization to minimize radiation risk for children undergoing CT and nuclear medicine imaging is misguided and detrimental. J Nucl Med 58:865–868

    Article  PubMed  Google Scholar 

  58. Siegel JA, Pennington CW, Sacks B (2017) Subjecting radiologic imaging to the linear no-threshold hypothesis: a non sequitur of non-trivial proportion. J Nucl Med 58:1–6

    Article  PubMed  Google Scholar 

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Correspondence to Thomas R. Goodman.

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Goodman, T.R., Mustafa, A. & Rowe, E. Pediatric CT radiation exposure: where we were, and where we are now. Pediatr Radiol 49, 469–478 (2019). https://doi.org/10.1007/s00247-018-4281-y

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  • DOI: https://doi.org/10.1007/s00247-018-4281-y

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