Review of radiation risks from computed tomography: essentials for the pediatric surgeon

doi:10.1016/j.jpedsurg.2006.12.009

Journal of Pediatric Surgery

Volume 42, Issue 4, April 2007, Pages 603-607

https://doi.org/10.1016/j.jpedsurg.2006.12.009 Get rights and content

Abstract

Background/Purpose

Over the past several years, increasing attention has been focused on the potential for radiation exposure from computed tomography (CT) for inducing the development of cancers. An understanding of these issues is important for the practice of pediatric surgery.

Methods

Medline based clinical review of current medical literature of the risks for the induction of cancers by CT. Data includes estimates of cancer risk from computer models, epidemiologic data from survivors of atomic bomb radiation exposure, and consensus opinions from expert panels.

Results

Review of scientific evidence demonstrates varied opinions, but consensus suggests there may be a potential for an increased risk of cancer from low level radiation exposure such as from CT. These calculations suggest that there may be as high as 1 fatal cancer for every 1000 CT scans performed in a young child.

Conclusions

Pediatric surgeons should be aware of the potential risks of CT. Minimizing the radiation risks of CT is a complex endeavor, and will require investments from pediatric surgeons as well as pediatric radiologists.

Section snippets

Measures of radiation

It is important to understand the basic terms pertinent to radiation, especially absorbed dose and effective dose equivalent. The absorbed dose is the actual radiation dose to a specific tissue or organ, and is measured in the SI units of gray (Gy). The previous unit was rad, which stands for the radiation absorbed dose, and 1 Gy is equal to 100 rad. However, the measurement of absorbed dose is not practical and only represents the dose to the exposed tissue. A more useful measure of radiation

Is there a risk of developing cancer from CT radiation?

Ongoing debate exists as to whether there is an increased risk of cancer from low-dose radiation exposure, such as from a CT examination. After a series of articles in 2001 in the American Journal of Roentgenology[1], [2], [3], recent attention has been focused on potential cancer risks of low-dose radiation exposure from CT [4], [11]. Most of these studies conclude that there may be a small increased risk of cancer from exposure to radiation from CT, based on estimates of cancer risk from

Strategies to manage radiation dose

One important role for the pediatric surgeon is to communicate with the radiologist to decide whether a CT is the best study to perform for a given clinical indication. It should be the goal of both parties to facilitate discussions on imaging strategies. Some authors have suggested that up to 40% of all CT examinations in children have questionable indications [18]. Alternative imaging strategies may include substituting a CT examination with either ultrasound or magnetic resonance imaging

Role of pediatric surgeon

Pediatric surgeons have an important role in the proper use of CT in children, and the underlying fiduciary responsibility of the surgeon is for the overall care for the child with surgical needs [5]. With this responsibility often comes a decision as to whether a CT examination is necessary for clinical care. The surgeon has a responsibility to recognize the value of CT as well as its risks. Risk/benefit analysis has a role in virtually all aspects of clinical care, and it ranges from

Conclusions

Computed tomography is a powerful adjunct to the practice of pediatric surgery. When used correctly, the benefits of CT generally far outweigh the risks. However, available scientific evidence suggests that there may be a potential for an increased risk of cancer from low-level radiation exposure. The fiduciary role of the pediatric surgeon is to care for acute surgical needs of a child while minimizing potential long-term complications of their treatment. When presented with a clinical

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Citation Excerpt :
Although argued extensively, current research suggests CT scans may predispose children to certain types of cancers [20,21]. One study found that children who receive a cumulative dose of 50–60 mGy of radiation may have a three times greater risk of developing leukemias or brain cancer at some point in their lifetime [22]. Additionally, it has been estimated that almost 5000 future cancers per year could potentially be attributed to CT scans in the pediatric population [23].
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A single institution retrospective review was conducted for all pediatric patients under the age of 18 who presented to the emergency department with suspected PTA over a ten-year period. Patients were divided into two groups; those that presented during the years prior to policy implementation and those that presented during the years following. Main outcome measures were the frequency of patients who underwent CT scanning as a part of their workup, the specialty of the ordering physician, and the treatment for suspected PTA.
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An institution-wide policy to decrease unnecessary imaging studies in pediatric patients resulted in a significant reduction in the use of CT imaging in the work-up for suspected PTA. Additionally, there was increase in the frequency of patients who underwent surgical intervention for their PTA after CT imaging, suggesting a more scrutinized approach to CT usage since policy implementation.
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Review articleReview of radiation risks from computed tomography: essentials for the pediatric surgeon

Abstract

Background/Purpose

Methods

Results

Conclusions

Section snippets

Measures of radiation

Is there a risk of developing cancer from CT radiation?

Strategies to manage radiation dose

Role of pediatric surgeon

Conclusions

Semin Ultrasound CT MRI

Clin Radiol

Estimated risks of radiation-induced fatal cancer from pediatric CT

Am J Roentgenol

Minimizing radiation dose for pediatric body applications of single-detector helical CT

Am J Roentgenol

Helical CT of the body: are settings adjusted for pediatric patients?

AJR Am J Roentgenol

Strategies of dose reduction

Pediatr Radiol

Computed tomography and radiation risks: what pediatric health care providers should know

Pediatrics

Lessons we have learned from our children: cancer risks from diagnostic radiology

Pediatr Radiol

An approach for the estimation of effective radiation dose at CT in pediatric patients

Radiology

Review article
Review of radiation risks from computed tomography: essentials for the pediatric surgeon