New Study Hopes To Raise Awareness About Kids and Radiation

The rapid growth in use of medical diagnostic imaging, such as CT scans, has led to widespread concern about radiation exposure in adults and the potential for future cancer risk in patients undergoing these tests.

Additionally, a new study led by University of Michigan researchers now shows kids also frequently receive these types of imaging procedures during their routine clinical care -- highlighting the importance of ensuring any tests being performed are necessary and use the lowest possible doses of radiation.

 

Raising awareness

“Our findings indicate that more awareness about the frequent use of these tests may be needed among care providers, hospitals and parents,” said Adam L. Dorfman, M.D., clinical assistant professor of pediatrics and communicable diseases and of radiology at the U-M Medical School.  

According to Dorfman, imaging tests are “a critical component of good medical care,” but a high number of these tests raises questions about whether health care professionals are being judicious in their use of technology.

Despite widespread discussions about the health hazards of environmental exposures in children, radiation exposure from the frequent use of imaging procedures has received less attention, possibly due to limited contemporary data in younger patients.

How much is too much?

As such, this study identified 355,088 children under the age of 18 in five large U.S. health care markets to track how often imaging procedures are used.

The researchers found over 400,000 imaging procedures were performed in just three years, with 42.5% of the children receiving at least one of these procedures and many undergoing multiple tests.

The types of tests the investigators considered included everything from routine x-rays that use very low doses of radiation to more advanced tests, like CT scans, that require doses that are greater.

Based on these data, the average child in this study population would be expected to receive approximately seven imaging procedures utilizing radiation by age 18.

By necessity, the study focused on the numbers and types of procedures that were performed, and did not calculate specific doses of radiation that were 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,” said Dorfman.

 

Appropriateness of tests

Because the clinical appropriateness of the tests performed on children in the study could not be determined, Dorfman said the next step is to better understand when these tests really add value to the care of a child and when they do not.

Among the tests that the investigators considered, CT scans are the most important from the standpoint of radiation exposure.

Nearly eight percent of the children in this study received a CT scan in the three-year study period, with 3.5% of the children receiving more than one.

Understanding patterns of utilization of these tests in children is important because children and infants are more susceptible than adults to the risks of radiation exposure, such as future cancers.

Caution urged

“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,” says study co-author, Reza Fazel, M.D., M.Sc., a cardiologist at the Emory School of Medicine.

Fazel cautions that for any individual child undergoing a single test the risk for later health problems is typically low. Also, the researchers point out this study is not advocating doing away with imaging tests.

“Of course, 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,” adds co-author Kimberly E. Applegate, M.D., vice chair for Quality and Safety in the Department of Radiology at Emory University.

Applegate said some doctors simply need to be smarter about how they use 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,” she said.

 Investigators note that each imaging procedure should be guided by the principle of ALARA, or As Low As Reasonably Achievable, which advocates for minimizing radiation doses while still obtaining sufficient clinical information.

Applegate, a member of the international Image Gently Campaign, is working with a coalition of health care organizations to raise awareness of the need  to adjust radiation doses when imaging children. The Image Gently campaign promotes optimal scanning strategies to lower radiation exposure in children.

Andrew J. Einstein, M.D., Ph.D., a cardiologist at Columbia University and another study coauthor, says this study should not deter parents from imaging procedures that may provide clear benefit for their children, but rather, “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.”

The results of this study are published online in the Archives of Pediatrics and Adolescent Medicine.