14 DAY TRIAL // Medical imaging helps doctors establish precise diagnosis, but the frequent use of these methods has led to concerns about the effects of radiation exposure in adults.
University of Michigan researchers have carried out a new study showing that children receive these types of procedures too, during routine clinical care, and they highlight the importance of performing these tests only if necessary, and at the lowest radiation doses as possible.
Adam L. Dorfman, MD, clinical assistant professor of pediatrics and communicable diseases and of radiology at the U-M Medical School, says that these “findings indicate that more awareness about the frequent use of these tests may be needed among care providers, hospitals and parents.
“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.”
There are many discussions about the dangers of environmental exposures in children, however, maybe because of insufficient data, the effects of radiation exposure from the frequent use of imaging procedures have been left aside.
To fill in the blanks, this new study identified 355,088 children under 18, from five large US health care markets, and tried to establish how often these imaging procedures are used.
The data showed that in just three years, over 400,000 imaging procedures were performed, and 42.5% of the kids received at least one of these procedures, as well as many undergoing multiple tests.
The tests went from routine x-rays, using very low doses of radiation, to more advanced procedures, like CT scans, where the doses are much higher.
The conclusion was that an average child from the study population, will receive about 7 imaging procedures involving radiation, by the time he/she turns 18.
ALARA, or As Low As Reasonably Achievable, is the principle that the researchers recommend for each imaging procedure, insisting that health care providers should use the minimum possible radiation dose for obtaining the necessary clinical information.
Co-author Kimberly E. Applegate, MD, vice chair for Quality and Safety in the Department of Radiology at Emory University, and member of the international Image Gently Campaign, is working with a group of health care organizations to increase awareness of the necessity to adjust radiation doses when it comes to children.
Andrew J. Einstein, MD, PhD, a cardiologist at Columbia University and another coauthor, says this study should not discourage parents from imaging procedures that can be beneficial for their children.
“It should encourage discussions about the value of each imaging test that is ordered, recognizing that radiation exposure, even in small amounts, may not be risk free.”
Among the tests considered by the team, CT scans are the most important in terms of radiation exposure, so they underlined that during the 3-year study period, nearly 8% of the children in the study received a CT scan, and 3.5% of them even received more than one.
Children are more sensitive than adults when it comes to radiation exposure and possible future cancers risks, so it is very important to understand the patterns of utilization of these tests.
Co-author, Reza Fazel, MD, M.Sc., a cardiologist at the Emory School of Medicine, explained that “developing tissues in children are more sensitive to radiation and their longer expected life spans also allows additional time for the emergence of detrimental effects.”
On the other hand, the cardiologist reminds that undergoing a single test presents a typically low risk for a child, and Dr Applegate insists that the purpose of this study is not to discourage the use of medical imaging in children.
It's just that “we have to be smarter about how we use tests,” she adds.
“For example, children don’t always need the same radiation dose during a CT scan to get the same quality of image and information.”
Dr Dorfman explains: “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.
“One limitation of this type of analysis is that the clinical appropriateness of the tests could not be determined.
“The next step is to better understand when these tests really add value to the care of a child and when they do not,” he adds.
This study focused on the number of imaging procedures, so it did not calculate the specific amount of radiation that every child received, and since the data necessary for this kind of calculations is limited in children, the team already started working on gathering it.
The results of this study were published online in the Archives of Pediatrics and Adolescent Medicine.