Clinical application of ‘Justification’ and ‘Optimization’ principle of ALARA in pediatric CT imaging: “How many children can be protected from unnecessary radiation?”

Sodhi, Kushaljit Singh; Krishna, Satheesh; Saxena, Akshay Kumar; Sinha, Anindita; Khandelwal, Niranjan; Lee, Edward Y.

doi:10.1016/j.ejrad.2015.05.030

Cited by 82 publications

(69 citation statements)

References 12 publications

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“…The latest technologic advances (such as scanners with a high volume of coverage) have enabled sub-mSv doses with acquisitions lasting less than 1 s. These devices can scan the entire thorax without the need for sedation and can obtain volumetric high-resolution images, even in small children who are unable to follow breathing instructions. [6][7][8][9][10][11][12][13] The effective radiation doses are similar to those for previously reported acquisitions by scanners with high volumes of coverage. In the study performed by Bonelli-Sica and colleagues 6 using 256-slice MDCT (whether with ECG-gated or non-ECG-gated protocol) in pediatric patients with anomalous PV drainage, the overall effective radiation dose was 1.01 mSv (range, 0.13-6.43 mSv), and it was 0.78 mSv (range, 0.13-4.16) in patients younger than 1 year of age.…”

Section: B a Csupporting

confidence: 70%

“…In an average of all age groups, the estimated additional lifetime risk for developing cancer after 10 mSv radiation exposure is approximately 1 in 2,000. 13 Children have a higher risk of damage from radiation exposure than do adults, because of longer life expectancy and higher radiation sensitivity. Therefore, pediatric scanning protocols with safeguards designed specifically for children are necessary.…”

Section: B a Cmentioning

confidence: 99%

“…Compared with first-generation computed tomographic (CT) scanners, multidetector CT scanners-with their high volume of coverage (≥128 slices/gantry rotation)-enable faster and more accurate evaluation of the cardiac and vascular anatomy, with lower radiation exposure. [6][7][8][9][10][11][12][13] In this study, we used high-pitch, dual-source 256-slice MDCTA to evaluate the anatomic features of TAPVC and associated cardiovascular anomalies in a pediatric population, and we report the radiation doses associated with these examinations.…”

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confidence: 99%

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Total Anomalous Pulmonary Venous Connection in Children: Preoperative Evaluation with Low-Dose Multidetector Computed Tomographic Angiography

Türkvatan¹,

Tola²,

Ayyıldız³

et al. 2017

Texas Heart Institute Journal

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We report the results of our retrospective evaluation, from February 2011 through August 2014, of the anatomic features of total anomalous pulmonary venous connection (TAPVC) and its associated cardiovascular anomalies in a pediatric population. In all 43 patients under study (23 female; average age, 9 mo [range, 4 d-7 T otal anomalous pulmonary venous connection (TAPVC) constitutes approximately 1% to 3% of all cardiovascular abnormalities in which the pulmonary veins (PVs) have no connection with the left atrium and connect directly to the right atrium or to one or more systemic veins. 1 Embryologically, TAPVC results from early atresia or failure of the common PV to develop, with persistence of at least one connection to the cardinal or the umbilical vitelline venous system. 2 Total anomalous pulmonary venous connection is a cause of neonatal cyanosis and can result in rapid death when blood is not shunted from the right side of the heart to the left side. Isolated TAPVC is diagnosed if the patient has atrial septal defect (ASD), patent ductus arteriosus (PDA), or both; complex TAPVC is diagnosed if the patient has other intracardiac lesions in addition to ASD or PDA. Although TAPVC is usually isolated, it can be a component of a complex cardiovascular disease such as heterotaxy syndrome. 3 Accurate delineation of TAPVC and the cardiovascular anomalies that accompany it are important to the guidance of surgical planning in these patients.Although TAPVCs have usually been evaluated with use of echocardiography and catheter angiography, magnetic resonance imaging (MRI) and multidetector computed tomographic angiography (MDCTA) are now playing larger roles in the diagnosis of these anomalies. 4 These imaging methods help overcome the shortcomings of transthoracic echocardiography (TTE), which gives a suboptimal acoustic window and a poor depiction of extracardiac vascular structures. They are also an improvement over catheter angiography, which produces overlapping views of adjacent vascular structures, causes difficulty in the simultaneous depiction of the systemic and pulmonary vascular systems, leads to undesirable catheter-related sequelae, and delivers relatively high doses of ionizing radiation. 5 Even though MRI is eminently

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Section: B a Csupporting

confidence: 70%

Section: B a Cmentioning

confidence: 99%

mentioning

confidence: 99%

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Total Anomalous Pulmonary Venous Connection in Children: Preoperative Evaluation with Low-Dose Multidetector Computed Tomographic Angiography

Türkvatan¹,

Tola²,

Ayyıldız³

et al. 2017

Texas Heart Institute Journal

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“…Appreciation of this link has, over the past decade, led to a decrease in the use of computerized tomography (CT) testing in children in part due to the dissemination of education and guidelines for reducing pediatric imaging radiation exposure 2,3 . Therapy related myeloid neoplasm, the development of either Myelodysplastic Syndrome (MDS) or Acute Myeloid Leukemia (AML), following exposure to therapeutic radiotherapy treatment, is well described and has a poor prognosis 4 .…”

mentioning

confidence: 99%

“…As the authors state; this work re-enforces rather than challenges existing radiation protection guidelines. It may however stimulate reflection and allow conversations to ensure local radiology facilities are practicing according to best principles 2,3 to consistently limit radiation doses used for essential tests to the lowest possible level while also reducing variation by benchmarking to reference standards 5 . Our feeling is that minimizing radiation exposure, particularly in children, is prudent while also recognizing that the benefit for CT imaging for a strong medical indication outweighs risk 10 .…”

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confidence: 99%

Leukaemia risk associated with low-dose radiation

Hourigan

Savani

2018

The Lancet Haematology

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Comparison of chest radiography and chest CT for evaluation of pediatric COVID‐19 pneumonia: Does CT add diagnostic value?

Das

Alkoteesh

Kaabi

et al. 2021

Pediatric Pulmonology

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Purpose First, to investigate the added diagnostic value of chest computed tomography (CT) for evaluating COVID‐19 in symptomatic children by comparing chest CT findings with chest radiographic findings, and second, to identify the imaging signs and patterns on CT associated with COVID‐19 pneumonia in children. Materials and Methods From March 2020 to December 2020, 56 consecutive children (33 males and 23 girls; mean age ± SD , 14.8 ± 5.0 years; range, 9 months–18 years) with mild to moderate symptom and laboratory confirmed COVID‐19 (based on Centers for Disease Control criteria) underwent both chest radiography and chest CT on the same day within the first 2 days of initial presentation to the hospital. Two experienced radiologists independently evaluated chest radiographs and chest CT studies for thoracic abnormalities. The findings from chest radiography and chest CT were compared to evaluate the added diagnostic value of chest CT for affecting patient management. Interobserver agreement was measured with Cohen's κ statistics. Results Eleven (19.6%) of 56 patients had abnormal chest radiographic findings, including ground‐glass opacity (GGO) in 5/11 (45.4%) and combined GGO and consolidation in 6/11 (54.5%). On chest CT, 26 (46.4%) of 56 patients had abnormal CT findings, including combined GGO and consolidation in 19/26 (73.1%), GGO in 6/26 (23.1%), and consolidation in 1/26 (3.8%). Chest CT detected all thoracic abnormalities seen on chest radiography in 11/26 (42.3%) cases. In 15/26 (57.7%), chest CT detected lung abnormalities that were not observed on chest radiography, which included GGO and consolidation in 9/15 (60%), GGO in 5/15 (33.3%), and consolidation in 1/15 (6.6%) cases. These additional CT findings did not affect patient management. In addition, chest CT detected radiological signs and patterns, including the halo sign, reversed halo sign, crazy paving pattern, and tree‐in‐bud pattern. There was almost perfect interobserver agreement between the two reviewers for detecting findings on both chest radiographs ( κ , 0.89, p = .001) and chest CT ( κ , 0.96, p = .001) studies. Conclusion Chest CT detected lung abnormalities, including GGO and/or consolidation, that were not observed on chest radiography in more than half of symptomatic pediatric patients with COVID‐19 pneumonia. However, these additional CT findings did not affect patient management. Therefore, CT is not clinically indicated for the initial evaluation of mild to moderately symptomatic pediatric patients with COVID‐19 pneumonia.

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Clinical application of ‘Justification’ and ‘Optimization’ principle of ALARA in pediatric CT imaging: “How many children can be protected from unnecessary radiation?”

Cited by 82 publications

References 12 publications

Total Anomalous Pulmonary Venous Connection in Children: Preoperative Evaluation with Low-Dose Multidetector Computed Tomographic Angiography

Total Anomalous Pulmonary Venous Connection in Children: Preoperative Evaluation with Low-Dose Multidetector Computed Tomographic Angiography

Leukaemia risk associated with low-dose radiation

Comparison of chest radiography and chest CT for evaluation of pediatric COVID‐19 pneumonia: Does CT add diagnostic value?

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