Abstract
We would like to share our experience of reducing pediatric radiation exposure. Much of the recent literature regarding successes of reducing radiation exposure has come from dedicated children’s hospitals. Nonetheless, over the past two decades, there has been a considerable increase in CT imaging of children in the USA, predominantly in non-pediatric-focused facilities where the majority of children are treated. In our institution, two general hospitals with limited pediatric services, a dedicated initiative intended to reduce children’s exposure to CT radiation was started by pediatric radiologists in 2005. The initiative addressed multiple issues including eliminating multiphase studies, decreasing inappropriate scans, educating referring providers, training residents and technologists, replacing CT with ultrasound or MRI, and ensuring availability of pediatric radiologists for consultation. During the study period, the total number of CT scans decreased by 24 %. When accounting for the number of scans per visit to the emergency department (ED), the numbers of abdominal and head CT scans decreased by 37.2 and 35.2 %, respectively. For abdominal scans, the average number of phases per scan decreased from 1.70 to 1.04. Upon surveying the pediatric ED staff, it was revealed that the most influential factors on ordering of scans were daily communication with pediatric radiologists, followed by journal articles and lectures by pediatric radiologists. We concluded that a non-pediatric-focused facility can achieve dramatic reduction in CT radiation exposure to children; however, this is most effectively achieved through a dedicated, multidisciplinary process led by pediatric radiologists.
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References
Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284
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
United Nations Scientific Committee on the Effects of Atomic Radiation (2013) Sources, effects, and risks of ionizing radiation UNSCEAR 2013 Report. (United Nations Publication) Vienna: Austria
Matthews JD, Forsythe AV, Brady Z et al (2013) Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. Br Med J 346:f2360
Boice J (2013) The Boice Report #14. Health Physics News July 2013. National Council on Radiation Protection and Measurements. Vienna, Austria
Walsh L, Shore R, Auvinen A, Jung T et al (2013) Re: cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. Br Med J 346:f2360
Brenner DJ (2010) Should we be concerned about the rapid increase in CT usage? Rev Environ Health 25(1):63–68
Broder J, Fordham LA, Warshauer DM et al (2007) Increasing utilization of computed tomography in the pediatric emergency department, 2000–2006. Emerg Radiol 14(4):227–232
Fahimi J, Herring A, Harries A et al (2012) Computed tomography use among children presenting to emergency departments with abdominal pain. Pediatrics 130(5):1069–1075
Larson DB, Johnson LW, Schnell BM et al (2011) Rising use of CT in child visits to the emergency department in the United States, 1995–2008. Radiology 259(793–801)
Kocher KE, Muerer WJ, Fazel R et al (2011) National trends in use of computed tomography in the emergency department. Ann Emerg Med 58(5):452–462
Shahi V, Brinjikji W, Cloft HJ et al (2015) Trends in CT utilization for pediatric fall patients in US emergency departments. Acad Radiol 22:898–903
Hoshiko S, Smith D, Fan C et al (2014) Trends in CT scan rates in children and pregnant women: teaching, private, public and nonprofit facilities. Pediatr Radiol 44:522–528
Miglioretti DL, Johnson E, Williams A et al (2013) Pediatric computed tomography and associated radiation exposure and estimated cancer risk. JAMA Pediatr 167(8):700–707
Townsend BA, Callahan MJ, Zurakowski D et al (2010) Has pediatric CT at children’s hospitals reached its peak? Am J Roentgenol 194(5):1194–1196
Menoch MJ, Hirsh DA, Khan NS et al (2012) Trends in computed tomography utilization in the pediatric emergency department. Pediatrics 129(3):690–697
Neff LP, Ladd MR, Becher RD et al (2011) Computerized tomography utilization in children with appendicitis—differences in referring and children’s hospitals. Am Surg 77(8):1061–1065
Strauss KJ, Kaste SC (2006) The ALARA (As Low As Reasonably Achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients—a white paper executive summary. Pediatr Radiol 36(Suppl 2):110–112
Athey J, Dean JM, Ball J et al (2001) Ability of hospitals to care for pediatric emergency patients. Pediatr Emerg Care 17(3):170–174
Goske MJ, Applegate KE, Boylan J et al (2008) The image gently campaign: working together to change practice. Am J Roentgenol 190(2):273–274
Boone JM, Geraghty EM, Seibert JA et al (2003) Dose reduction in pediatric CT: a rational approach. Radiology 228(2):352–360
Morgan HT (2002) Dose reduction for CT pediatric imaging. Pediatr Radiol 32(10):724–728
Puylaert JB (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158:355–360
Amis ES (2011) CT radiation dose: trending in the right direction. Radiology 261:5–8
Gunn MLD, Kohr JR (2010) State of the art: technologies for computed tomography dose reduction. Emerg Radiol 17:209–218
Borjesson J, Latifi A, Friman O et al (2011) Accuracy of low-dose chest CT in intensive care patients. Emerg Radiol 18(1):17–21
Shenoy Bhangle A, Nimkin K, Gee MS (2010) Pediatric imaging: current and emerging techniques. J Postgrad Med 56(2):98–102
Hricak H, Brenner DJ, Adelstein SJ et al (2011) Managing radiation use in medical imaging: a multifaceted challenge. Radiology 258(3):889–905
Burr A, Renaud EJ, Manno M et al (2011) Glowing in the dark: time of day as a determinant of radiographic imaging in the evaluation of abdominal pain in children. J Pediatr Surg 46:188–191
Katz SI, Saluja S, Brink JA et al (2006) Radiation dose associated with unenhanced CT for suspected renal colic: impact of repetitive studies. Am J Roentgenol 186:1120–1124
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Appendix 1. Survey
Appendix 1. Survey
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Blumfield, E., Zember, J., Guelfguat, M. et al. Evaluation of an initiative to reduce radiation exposure from CT to children in a non-pediatric-focused facility. Emerg Radiol 22, 631–641 (2015). https://doi.org/10.1007/s10140-015-1335-4
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DOI: https://doi.org/10.1007/s10140-015-1335-4