Children frequently exposed to medical imaging procedures that utilize radiation

Research from the University of Michigan Health System has found that children are frequently exposed to medical imaging procedures that utilize radiation, suggesting parents and physicians should educate themselves and be more cautious about the use of these diagnostic tests on younger individuals.

The research was published in the Archives of Pediatrics and Adolescent Medicine.

“Our findings indicate that more awareness about the frequent use of these tests may be needed among care providers, hospitals and parents,” Adam L. Dorfman, MD, lead author of the study, stated in a release. “Imaging tests are a critical component of good medical care, but the high number of tests raises questions about whether we are being judicious in our use of the technology.”

Rates of use

The study identified 355,088 children in five large U.S. health care markets and tracked how often specific imaging procedures were used. The study found that more than 400,000 imaging procedures were performed in 3 years, with 42.5% of the children receiving at least one of these procedures – and many undergoing multiple tests.

The highest rates of use, according to the study, were in children older than 10 years, with frequent use being found in infants younger than 2 years. Plain radiography accounted for 84.7% of the imaging procedures formed.

CT scans – associated with “substantially higher doses of radiation” – were also commonly used, accounting for 11.9% of all procedures performed during the study period. Overall, the investigators found, 7.9% of children received at least one CT scan and 3.5% received two or more.

Based on these data, the authors wrote that the average child in the study population would be expected to receive approximately seven imaging procedures utilizing radiation by the age of 18 years. Understanding these utilization patterns, the study authors noted, is important because children and infants are more susceptible than adults to the risks of radiation exposure.

Individual risks “typically low”

The study focused on the numbers and types of procedures that were performed, rather than calculating specific doses of radiation received by each child. Data to perform such calculations are limited in children and are part of ongoing work by the team.

“What we’ve tried to do is raise awareness of the issue and start a national dialogue by identifying the overall scope of the problem,” Dorfman stated in the release. “The next step is to better understand when these tests really add value to the care of a child and when they do not.”

The authors did caution that the risks for any child undergoing one test are “typically low.”

“There is immense life-saving value in medical imaging, so our study doesn’t suggest at all that these tests shouldn’t be used in children,” Kimberly E. Applegate, MD, a co-author of the study, stated in the release. “We have to be smarter about how we use these tests. For example, children don’t always need the same radiation dose during a CT scan to get the same quality of image and information.”

Reference:
Dorfman AL, et al. Use of medical imaging procedures with ionizing radiation in children: A population-based study. Arch Pediatr Adolesc Med. Published online January 3, 2011. doi:10.1001/archpediatrics.2010.270
Disclosures: Dorfman has reported no relevant disclosures. Applegate has a textbook contract for evidence-based imaging in pediatrics with Springer.

This is a timely article illustrating the insurance industry’s interest in an issue paramount to the management of musculoskeletal conditions in children, i.e. usage patterns for medical imaging in children. Most visits to an orthopaedic practitioner will result in some type of imaging. While knowledge of the exact hazards of radiation exposure on children is limited, infants and children are at higher risk for future malignant neoplasms as compared with adults because their developing tissues are more sensitive to radiation, and their longer expected life spans allow additional time for the emergence of detrimental effects. While there are recognized flaws in the investigative, process, the identification of the number and types of ionizing radiation in children is of tremendous importance.

While medical imaging studies as shown in their paper are frequent, particularly the lower dose studies of plain radiography (84.7%), the authors are clear in the limitations of the study. They acknowledge that their study does not address the critical issues of appropriateness. If a child has a displaced fracture of the forearm requiring surgery, the series of films needed to ensure adequate reduction may certainly justify several radiographs, even on the same day. Scoliosis patients are at further risk for increased exposure, and it may be reflected in the higher number of procedures in females in the 15 to 17 year group.

Further, they did not attempt to estimate radiation dose from effective dose and, therefore, did not attempt to quantify risk in this paper. It will be important for future studies for providers and parents to understand the limitations of assessing risk from diagnostic imaging for an individual patient. Parents and providers want to know the risk estimates for an individual patient, not a population of patients, which is difficult to quantify with certainty with current knowledge. Orthopedic surgeons are and should be aware of the increased radiosensitivity of a child as requiring special attention when medical imaging from intraoperative fluoroscopy or other studies is performed.

Simple dose-saving strategies such as careful use of fluoroscopy time, proper collimating and shielding when able, evaluating only the indicated area and “child-sizing” the radiation dose are straight-forward methods that can be used on a daily basis in care of children.

Additional information regarding this topic for providers and parents can be obtained at www.imagegently.org.

– Marilyn J. Goske, MD
Chair, Alliance for Radiation Safety in Pediatric Imaging (the “Image Gently” campaign)
Silverman Chair for Radiology Education
Staff Radiologist
Cincinnati Children’s Hospital Medical Center
Cincinnati

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