Cumulative Effective Dose Associated With Radiography and CT of Adolescents With Spinal Injuries

Lemburg, Stefan P.; Peters, Sören; Roggenland, D.; Nicolas, Volkmar; Heyer, C. M.

doi:10.2214/ajr.10.4616

Cited by 16 publications

(20 citation statements)

References 29 publications

(43 reference statements)

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“…These body regions mainly represent areas with the most-radiation-sensitive organs. In addition, the resulting effective doses of imaging procedures of the trunk—regardless of the chosen ionising imaging modality—are highest compared with all other body regions [20]. …”

Section: Discussionmentioning

confidence: 99%

Interventional radiology at the meetings of the German Radiological Society from 1998 to 2008: evaluation of structural changes and radiation issues

et al. 2011

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ObjectivesEvaluation of structural changes and the weight given to radiation exposure of interventional radiology (IR) contributions at the Congress of the German Radiological Association from 1998 to 2008.MethodsAll IR abstracts were evaluated for type of contribution, design, imaging modality, and anatomic region. Weight given to radiation exposure was recorded as general statement, main topic and/or dose reduction. Statistical analysis included calculation of absolute/relative proportions of subgroups and ANOVA regression analyses.ResultsOut of 9,436 abstracts, 1,728 (18%) were IR-related. IR abstracts significantly rose to a maximum of 200 (20%) in 2005 (P = 0.048). While absolute numbers of scientific contributions declined, educational contributions significantly increased (P = 0.003). Computed tomography (CT) and magnetic resonance imaging (MRI) were the main IR imaging modalities, with growing use of CT (P = 0.021). The main body regions were vessels (45%) and abdomen (31%). Radiation exposure was addressed as a general statement in 3% of abstracts, as a main topic in 2%, and for dose reduction in 1%, respectively. During the study interval a significant growth of dose reduction abstracts was observed (P = 0.016).ConclusionsIR emerged as a growing specialty of radiology, with a significant increase in educational contributions. Radiation exposure was rarely in the focus of interest but contributions relating to dose reduction demonstrated a significant growth during the study period.Main Messages• Interventional radiology emerged as a growing specialty at the German radiological congress.• Significant increments of educational and prospective research contributions could be observed.• Despite a significant trend towards computed tomography, radiation exposure of IR was rarely in the focus of interest.• Contributions related to dose reduction demonstrated a significant growth during the study period.

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Section: Discussionmentioning

confidence: 99%

Interventional radiology at the meetings of the German Radiological Society from 1998 to 2008: evaluation of structural changes and radiation issues

et al. 2011

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“…[25][26][27] Therefore, regarding evaluation of bone fractures, we believe that further studies are needed to assess the use of ultra-low-dose CT, which so far has only been analyzed by Konda et al 28 Ultra-low-dose CT uses a radiation dose similar to that of radiography and, consequently, further reduces the incidence of malignant neoplasms caused by standard-dose CT. Today, standard-dose CT is the cause of 1.5-2% of cases of malignant neoplasms. 1,6 This proportion is higher among children under 15 years old, 1,12,28 and even more so among children younger than 5 years. 6 Moreover, use of ultra-low-dose CT implies lower spending on medications and CT tubes.…”

Section: Detection Rate In Relation To Number Of Patientsmentioning

confidence: 98%

“…12 Thus, there is a growing awareness of the need to use the lowest possible radiation dose level that is capable of providing appropriate diagnostic information, also known as the ALARA principle (As Low As Reasonably Achievable). 9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] CT is the gold standard for diagnosing fractures, 10,[25][26][27] characterizing them in greater detail, identifying hidden fractures and showing incomplete union. 27,28 In musculoskeletal radiology, lowdose CT has shown good results in studies with pre and postoperative scoliosis evaluations, as well as in diagnosing lytic injuries and fractures in patients with multiple myeloma.…”

mentioning

confidence: 99%

Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis

Duarte¹,

Santos

Oliveira

et al. 2021

Sao Paulo Med. J.

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Ionizing radiation such as X-rays is a singular form of energy that surmounts the binding energy of electrons that orbit atoms and molecules. 1 In biological material exposed to X-rays, the most common consequential scenario is that this creates hydroxyl radicals from interactions between X-rays and water molecules. These radicals, in turn, interact with deoxyribonucleic acid (DNA) to cause breakage of bonds or damage to the base. 1 Thus, mutations, chromosomal translocations and fusions between genes can occur, which in some cases may lead to cancer. 1 All X-ray-based imaging methods have the characteristic in common of a trade-off between image quality and radiation dose, since all forms of ionizing radiation can damage tissues. 2 In patients undergoing radiographic and/or tomographic monitoring, the patient's exposure to radiation needs to be considered, and this poses a challenge to radiologists regarding dose reduction. 3,4 The main concern in diagnostic imaging is that a stochastic lesion of radiation-induced cancer could develop, which can occur with any radiation dose. [5][6][7] Conversely, deterministic effects occur only when the threshold has been exceeded and, above that, the incidence and severity of the injury increase with the radiation dose. 6,7 It also needs to be taken into account that the pediatric population is 10 times more sensitive to radiation than adults. 8 To date, no safe dose of ionizing radiation, below which there is no risk of cell damage and subsequent risk of cancer, has been established. 9,10 However, it has been estimated in the United States that about 1.5%-2.0% of all malignancies can be attributed to radiation from computed tomography (CT) scans. 1,6 Taking all imaging examinations into account, this proportion ranges

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“…Children who are victims of high‐risk trauma should, therefore, be evaluated for spinal injuries . Although radiography is easy to perform and readily available, its diagnostic value is inferior to that of computed tomography (CT) for the evaluation of spinal injuries . The use of CT for pediatric trauma patients is, therefore, increasing.…”

mentioning

confidence: 99%

Is spinal computed tomography necessary in pediatric trauma patients?

Eren¹,

Güzey²

2020

Pediatrics International

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Background: To investigate the prevalence of findings of spinal injury on computed tomography (CT) images of pediatric trauma patients and to define indicators for the possible presence of spinal injuries. Methods: Spinal CT for pediatric trauma patients (age ≤ 12 years) over a 2-year period was retrospectively evaluated for the presence of findings suggestive of spinal injury. Results: Of the 773 patients reviewed, 19 (2.4%) showed traumatic spinal lesions on their spinal CT images. These patients were significantly older than those without spinal lesions (mean age 7.9 AE 3.3 years vs 6.1 AE 3.3 years; P = 0.02). The prevalence of spinal trauma was significantly lower in patients aged 0-8 years than in those aged 9-12 years (P = 0.025). Spinal injury was significantly higher in female patients (P = 0.014). Most of the spinal injuries were located at the lumbar and sacral vertebral levels, and most did not cause neurological complications or require surgical treatment. Important indicators of the possible presence of spinal injuries were pain, tenderness, or ecchymosis over the spine, a low Glasgow Coma Scale score (≤12), head injury (for cervical injuries), or intrathoracic injuries and pelvic fractures (for lumbar and sacral injuries). Conclusions: Most spinal CT examinations for the diagnosis of spinal injuries in children did not show positive findings. Thus, many children were exposed to an unnecessary high dose of radiation. New clinical evaluation criteria and indicators should be defined to diagnose spinal injuries and avoid unnecessary radiological examinations.

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Cumulative Effective Dose Associated With Radiography and CT of Adolescents With Spinal Injuries

Cited by 16 publications

References 29 publications

Interventional radiology at the meetings of the German Radiological Society from 1998 to 2008: evaluation of structural changes and radiation issues

Interventional radiology at the meetings of the German Radiological Society from 1998 to 2008: evaluation of structural changes and radiation issues

Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis

Is spinal computed tomography necessary in pediatric trauma patients?

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