Lower radiation exposure from body CT imaging for trauma at a dedicated pediatric hospital

Sharp, Nicole E.; Svetanoff, Wendy Jo; Alemayehu, Hanna; Desai, Arti D.; Raghavan, Maneesha U.; Sharp, Susan W.; Brown, James R.; Rivard, Douglas C.; Peter, Shawn D. St.; Holcomb, George

doi:10.1016/j.jpedsurg.2014.09.035

Cited by 12 publications

(5 citation statements)

References 18 publications

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“…These results are supported by data obtained by the American College of Radiology from reported CT dose indices 12 . In addition, there have been studies from several institutions around the country demonstrating that dedicated children’s hospitals have been more successful in implementing lower CT radiation dosing in pediatric patients when compared with AGHs for a broad range of clinical indications, including trauma 26–31 . This remains true even if the referring institution is a trauma center 32 .…”

Section: Discussionmentioning

confidence: 62%

“…12 In addition, there have been studies from several institutions around the country demonstrating that dedicated children's hospitals have been more successful in implementing lower CT radiation dosing in pediatric patients when compared with AGHs for a broad range of clinical indications, including trauma. [26][27][28][29][30][31] This remains true even if the referring institution is a trauma center. 32 Indeed, when we split our AGHs into trauma centers and non-trauma centers, we found a similarly significant dose reduction for both.…”

Section: Discussionmentioning

confidence: 99%

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Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan

LaQuaglia

Anderson

Goodhue

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:When head injured children undergo head computed tomography (CT), radiation dosing can vary considerably between institutions, potentially exposing children to excess radiation, increasing risk for malignancies later in life. We compared radiation delivery from head CTs at a level 1 pediatric trauma center (PTC) versus scans performed at referring adult general hospitals (AGHs).We hypothesized that children at our PTC receive a significantly lower radiation dose than children who underwent CTat AGHs for similar injury profiles. METHODS:We retrospectively reviewed the charts of all patients younger than 18 years who underwent CT for head injury at our PTC or at an AGH before transfer between January 1 and December 31, 2019. We analyzed demographic and clinical data. Our primary outcome was head CT radiation dose, as calculated by volumetric CT dose index (CTDI vol ) and dose-length product (DLP; the product of CTDI vol and scan length). We used unadjusted bivariate and multivariable linear regression (adjusting for age, weight, sex) to compare doses between Children's Hospital Los Angeles and AGHs. RESULTS:Of 429 scans reviewed, 193 were performed at our PTC, while 236 were performed at AGHs. Mean radiation dose administered was significantly lower at our PTC compared with AGHs (CTDI vol 20.3/DLP 408.7 vs. CTDI vol 30.6/DLP 533, p < 0.0001). This was true whether the AGH was a trauma center or not. After adjusting for covariates, findings were similar for both CTDI vol and DLP. Patients who underwent initial CT at an AGH and then underwent a second CT at our PTC received less radiation for the second CT (CTDI vol 25.6 vs. 36.5, p < 0.0001). CONCLUSIONS:Head-injured children consistently receive a lower radiation dose when undergoing initial head CT at a PTC compared with AGHs. This provides a basis for programs aimed at establishing protocols to deliver only as much radiation as necessary to children undergoing head CT.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan

LaQuaglia

Anderson

Goodhue

et al. 2021

J Trauma Acute Care Surg

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“…In their review of 75 patients with known cervical spine trauma, 78% of whom had clinically significant injuries, plain radiographs were negative in 24 (32%) clinically significant injuries compared with CT. MRI has been shown to be very sensitive in identifying spinal injuries in both the cervical53 and thoracolumbar spine,54 but it still has not replaced CT in the initial evaluation of pediatric trauma patients because of the longer scan times and potential need for sedation. It has been shown that at high-volume pediatric trauma centers there is a lower rate of CT scan use55 and fewer diagnostic errors than nonpediatric trauma centers 56. Educational efforts and clinical practice guidelines appear to be stabilizing or decreasing the rate of CT scan use in pediatric trauma patients 57,58.…”

Section: Discussionmentioning

confidence: 99%

Radiation Reduction Strategies in Pediatric Orthopaedics

Sawyer

2021

Journal of Pediatric Orthopaedics

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Introduction:Pediatric orthopaedic patients have the potential for significant radiation exposure from the use of imaging studies, such as computed tomography and bone scintigraphy. With the potential for long-term treatment, such as is required for scoliosis or osteogenesis imperfecta, patients are at even greater risk of radiation-induced carcinogenesis. Discussion: Although an association between radiation and cancer risk is evident, causation is difficult to prove because comorbidities or genetic predispositions may play a role in the higher baseline rates of malignancy later in life. Efforts have been made over the years to reduce exposure using more modern imaging techniques and simple radiation reduction strategies. Educational efforts and clinical practice guidelines are decreasing the rate of computed tomography scan use in pediatrics. Although considerable work is being done on the development of radiation-free imaging modalities, imaging that uses ionizing radiation will, in the near term, be necessary in specific circumstances to provide optimal care to pediatric orthopaedic patients. Conclusion: Knowledge of the ionizing radiation exposure associated with commonly used tests as well as radiation-reduction strategies is essential for the optimal and safe care of pediatric orthopaedic patients.

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“…Es konnte gezeigt werden, dass in kindertraumatologischen Zentren mit angepassten Richtlinien hinsichtlich der bildgebenden Verfahren weniger strahlenintensiv gearbeitet wird, ohne dabei mehr Verletzungen zu übersehen [14].…”

Section: Einteilung In Stabile Und Instabile Beckenfrakturenunclassified