Minimizing Radiation Dose for Pediatric Body Applications of Single-Detector Helical CT

Donnelly, Lane F.; Emery, Kathleen H.; Brody, Alan S.; Laor, Tal; Gylys-Morin, Victoria M.; Anton, Christopher; Thomas, Stephen R.; Frush, Donald P.

doi:10.2214/ajr.176.2.1760303

Cited by 443 publications

(204 citation statements)

References 15 publications

Supporting

Mentioning

187

Contrasting

Unclassified

Order By: Relevance

“…Recent reports in the literature concerning an increased cancer risk in children undergoing CT scans recommend radiation dose reduction for children [8,9]. Approximately one half of pediatric surgeons who completed an anonymous survey recognized this increased cancer risk [10].…”

Section: Discussionmentioning

confidence: 99%

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Keckler

Tsao

Sharp

et al. 2008

Journal of Pediatric Surgery

View full text Add to dashboard Cite

Objective-Given the perceived technical demands of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess, initial percutaneous drainage has become an attractive option in this patient population. This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon. However, the medical burden on the patient and on the quality of patient outcomes has not been described in the literature. Therefore, we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospective trial.Methods-After institutional review board approval, a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006. Continuous variables are listed with standard deviation.Results-There were 52 patients with a mean age of 9.0 ± 3.9 years and weight of 34.4 ± 18.8 kg. The mean duration of symptoms at presentation was 8.4 ± 7.6 days. Percutaneous aspiration only was performed in 2 patients. The mean volume of fluid on initial aspiration/drain placement was 76.3 ± 81.1 mL. The mean time to appendectomy was 61.9 ± 25.2 days. The laparoscopic approach was used in 49 patients (94.2%), of which one was converted to an open operation. The mean length of hospitalization after interval appendectomy was 1.4 ± 1.4 days. A recurrent abscess developed in 17.3% of the patients. Six patients (11.5%) required another drainage procedure. The mean total charge to the patients was $40,414.02. There were 4 significant drain complications (ileal perforation, colon perforation, bladder perforation, and buttock/thigh necrotizing abscess).The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy.Conclusions-The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach. However, this management poses complication risks and uses considerable resources. Therefore, this strategy should be compared with early operation in a prospective trial.

show abstract

Section: Discussionmentioning

confidence: 99%

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Keckler

Tsao

Sharp

et al. 2008

Journal of Pediatric Surgery

View full text Add to dashboard Cite

show abstract

“…This method ensures that thicker regions of the body are imaged using higher tube currents than thinner, less attenuating areas. Within each imaged section, user-specified noise indices are chosen, which predict an acceptable level of image noise, thereby preserving diagnostic quality while minimising radiation exposure [24,25]. The higher the noise index chosen by the radiologist, the greater the noise in the CT image and the lower the radiation dose required to acquire the image.…”

Section: Low-dose Ct Technologymentioning

confidence: 99%

Minimization of radiation exposure due to computed tomography in inflammatory bowel disease

O’Neill

O’Connor

McWilliams

et al. 2011

Clinics and Research in Hepatology and Gastroenterology

View full text Add to dashboard Cite

“…Recent studies in pediatric CT have shown that it is unacceptable to use a tube current setting that is appropriate for an adult on a child (85,95,96). Reductions in tube current or gantry speed have recently been introduced that decrease the radiation dose in pediatric CT (97)(98)(99). It is a welcome sign that most major manufacturers have recently added dose-reduction features specifically geared toward pediatric patients, and initiated user education programs for CT dose control (43).…”

Section: Patient Sizementioning

confidence: 99%

Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI

Semelka

Armao

Elias

et al. 2007

Magnetic Resonance Imaging

195

106

View full text Add to dashboard Cite

“When one admits that nothing is certain one must, I think, also admit that some things are much more nearly certain than others.” Bertrand Russell (1872–1970) Computed tomography (CT) is one of the largest contributors to man‐made radiation doses in medical populations. CT currently accounts for over 60 million examinations in the United States, and its use continues to grow rapidly. The principal concern regarding radiation exposure is that the subject may develop malignancies. For this systematic review we searched journal publications in MEDLINE (1966–2006) using the terms “CT,” “ionizing radiation,” “cancer risks,” “MRI,” and “patient safety.” We also searched major reports issued from governmental U.S. and world health‐related agencies. Many studies have shown that organ doses associated with routine diagnostic CT scans are similar to the low‐dose range of radiation received by atomic‐bomb survivors. The FDA estimates that a CT examination with an effective dose of 10 mSv may be associated with an increased chance of developing fatal cancer for approximately one patient in 2000, whereas the BEIR VII lifetime risk model predicts that with the same low‐dose radiation, approximately one individual in 1000 will develop cancer. There are uncertainties in the current radiation risk estimates, especially at the lower dose levels encountered in CT. To address what should be done to ensure patient safety, in this review we discuss the “as low as reasonably achievable” (ALARA) principle, and the use of MRI as an alternative to CT. J. Magn. Reson. Imaging 2007;25:900–909. © 2007 Wiley‐Liss, Inc.

show abstract

Minimizing Radiation Dose for Pediatric Body Applications of Single-Detector Helical CT

Cited by 443 publications

References 15 publications

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Minimization of radiation exposure due to computed tomography in inflammatory bowel disease

Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI

Contact Info

Product

Resources

About