ew reasons prior to every pediatric scan and be available for consultation when indications are uncertain. When appropriate, other modalities such as ultrasound or magnetic resonance imaging (MRI), which do not use ionizing radiation, should be considered.
- Adjust exposure parameters for pediatric CT based on
- Child size: guidelines based on individual size / weight parameters should be used.
- Region scanned: the region of the body scanned should be limited to the smallest necessary area.
- Organ systems scanned: lower mA and/or kVp settings should be considered for skeletal, lung imaging, and some CT angiographic and follow up examinations.
- Scan resolution: the highest quality images (i.e., those that require the most radiation) are not always required to make diagnoses. In many cases, lower-resolution scans are diagnostic. Providers should be familiar with the dose descriptors available on CT scanners and minimize the use of CT examinations that use multiple scans obtained during different phases of contrast enhancement (multiphase examinations). These multiphase examinations result in a considerable increase in dose and are rarely necessary, especially in body (chest and abdomen) imaging.
Long-Term Strategies to Minimize CT Radiation
In addition to the immediate measures to reduce CT radiation exposure in children, long-term strategies are also needed.
- Encourage the development and adoption of pediatric CT protocols.
- Encourage the use of selective strategies for pediatric imaging, such as for the pre-surgical evaluation of appendicitis.
- Educate through journal publications and conferences within and outside radiology specialties to optimize exposure settings and assess the need for CT in an individual patient. Disseminate information through associations, organizations, or societies involved in health care of children, including the American Academy of Pediatrics, the American Academy of Family Physicians, , and the American College of Emergency Physicians. Provide readily available information sources, such as the Alliance for Radiation Safety in Pediatric Imaging.
- Conduct further research to determine the relationship between CT quality and dose, to customize CT scanning for individual children, and to further clarify the relationship between CT radiation and cancer risk.
Although CT remains a crucial tool for pediatric diagnosis, it is important for the health care community to work together to minimize the radiation dose to children. Radiologists should continually think about reducing exposure as low as reasonably achievable by using exposure settings customized for children. All physicians who prescribe pediatric CT should continually assess its use on a case-by-case basis. Used prudently and optimally, CT is one of the most valuable imaging modalities for both children and adults.
Society for Pediatric Radiology
1891 Preston White Drive
Reston, Virginia 20191
Amis ES, Jr., Butler PF, Applegate KE, et al. American College of Radiology white paper on radiation dose in medicine. Journal of the American College of Radiology 2007; 4:272-284.
Arch ME, Frush DP. Pediatric body MDCT: A 5-year follow-up survey of scanning parameters used by pediatric radiologists. American Journal of Roentgenology 2008:191;611-617
Berrington de Gonzále. A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, Land C. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Archives of Internal Medicine 2009; 169: 2071-7.
Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation: Assessing what we really know. Proceedings of the National Academy of Sciences of the United States of America 2003; 100:13761-13766.
Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimated risks of radiation-induced fatal cancer from pediatric CT. American Journal of Roentgenology 2001; 176:289-296.
Brenner DJ, Hall EJ. Current concepts - Computed tomography - An increasing source of radiation exposure. New England Journal of Medicine 2007; 357:2277-2284.
Brody AS, Frush D