Are kids getting too much radiation from CT scans?

WebMD has an eye-opening story about more children getting CT scans when they go to the ER, and some doctors are concerned they are being exposed to too much radiation.

From WebMD:

“We found that abdominal CT imaging went from almost never being used in 1995 to being used in 15% to 21% of visits in the last four years of [our] study,” Children’s Hospital of Cincinnati researcher David B. Larson, MD, MBA, says in a news release.

“From 1995 to 2008, Larson and colleagues found a fivefold increase in the percentage of emergency department visits in which children received a CT scan. Nearly 90% of these scans were done in ERs that did not specialize in pediatrics.”

” ‘The performance of CT in children requires special oversight,’ Larson and colleagues note in the June issue of Radiology. ‘It is possible that non-pediatric-focused radiology departments may be less likely to consistently tailor the CT technique to the body size of the pediatric patient.’

Children are far more vulnerable to radiation than adults. Here’s why according to the article:

  • “Children’s organs are more sensitive to radiation than adults’ organs.
  • Children have a longer life expectancy than adults, giving cancer a longer time to form.
  • Radiation settings often may not be set to match children’s body size.
  • Because CT use is increasing, children may eventually receive a higher lifetime dose of medical radiation.”

The most common CT scans for kids were head injury, headache and abdominal pain.

Has your child ever had a CT scan? Did they bring in anybody special to do it or use special equipment just for kids? How many have your kids had? Does this concern you about getting CT scans in the future?

Do you worry about the dental X-rays? None of my kids have had CT scans but they have had dental X-rays. I wonder if we should be concerned about those puppies? Hmmm.

16 comments Add your comment

some guy

April 7th, 2011
7:54 am

increasing CT use is of concern, but the doses from a single CT scan are still small. For most screening cases (head trauma, abdomen etc.) you’re talking about lifetime increased cancer risks on the order of <0.5%. The baseline cancer rate is somewhere around 33% in people. CT is helpful in emergency cases because it allows docs to get a large amount of info in a very short period of time. There is a risk/benefit analysis to everything in medicine, and most of the time the immediate benefit of knowing whether there is acute internal bleeding etc. outweighs the slight increased cancer risk. It doesnt matter if someone will develop cancer in 10-20 years (the latent period for most cancers), if they're going to die today without intervention.

if youre a parent be sure to ask questions and be informed, but refusing a scan ordered by a doc is probably a bad idea. ask whether the CT could perhaps be replaced with an ultrasound or MRI, both of which do not involve ionizing radiation. sometimes these can be used to diagnose the same things as a CT, but not always. Because of the way images are formed, MRI's take a lot longer than a CT, which can be problematic with children who might not be able to lie still on a table for 20+minutes (as opposed to <10 seconds for most CT scans). Anyone who's taken blurry pictures of their kids can understand this. This can require anesthesia for pediatric MRI scans sometimes, and the risks from that can far outweigh the minuscule risks from a single CT scan.

If possible take your children to a pediatric ER, where the docs are more likely to deal with pediatrics regularly and better understand their sensitvity to radiation. Ask if the facility participates in the image gently campaign, which aims to inform docs and parents on proper pediatric imaging protocols. more info for parents at http://spr.affiniscape.com/associations/5364/ig/index.cfm?page=591

library volunteer

April 7th, 2011
7:55 am

Took my teenage daughter to CHOA last fall with severe abdominal pain. They diagnosed viral illness with no diagnostic testing. We were back in the emergency room 6 hours later when they did a CT scan and found appendicitis. At the time, I was frustrated that it took two trips, but after reading this I think they acted responsibly.

some guy

April 7th, 2011
7:59 am

did my comment get blocked because of the attached link? this is what I do for a living and had a bunch of good info, but I don’t feel like retyping all that…

some guy

April 7th, 2011
8:33 am

also, the exposure from dental x-rays is orders of magnitude lower than from CT. As long as the machine is properly calibrated, and the dentist isnt going crazy with it, the risk from dental x-rays is very very very low.

shaggy

April 7th, 2011
8:42 am

Once again, like the car seat thing, i marvel that me and practically all of my childhood friends made it to adulthood.
I was a US Army Brat. Their doctors were renown in those days for having the bedside manner of sand paper and hands to match. For abdominable pains, it was customary to give you milk of magnesia. If you complained about headache, you got aspirin…plenty of aspirin. If you had a cold, some gooey cough medicine that tasted like transmission fluid. If you had a real infection, the heavy artillery was broken out, penicillin shots and penicillin-funny tasting pills that would be litrerally poked down your gurgling kid throat if necessary. If you continued complaining, for the sake of complaining and an extra day out of school, you received the last line of defense, a butt whuppin. The butt whuppin, miracuolusly cured you of many ailments, both physical and mental. I rermember many halleluyah cures taking place after I had seen the light.
Then, there were those trips to the dentist. I still can’t be around a dremel tool without shaking uncontrolably.

That MUST be my problem...

April 7th, 2011
8:58 am

…too much radiation exposure – I have had 10 knee surgeries (including 3 replacements)with xrays of my knees starting when I was 11 years old, numerous brain scans from playing football since I was 8 years old (with 3 concussions in HS and college), rotator cuff repair, tosillectomy (age 5), nephrectomy, ureterectomy, numerous broken bones and fingers (starting at age 10), boocoo dental xrays (starting when I was 4-5 – I am now 58 yers old), heart catheterization, multiple echograms of my heart, annual lung/chest xrays (since about age 25), colonoscopy, braces on my teeth, and mucho xray exposure as I have traveled through airports for the past 20+ years.

Yep, too much radiation can be a bad thing…

shaggy

April 7th, 2011
9:05 am

That MUST be my problem…

Sometimes I read things that make me damn glad to be me.

MomOf2Girls

April 7th, 2011
9:11 am

Shaggy – thanks for the laugh this morning!! Too funny :-)

Older girl has had more CT scans and X-rays than I can remember off the the top of my head, but since without them she’d be dead many times over, I can live with that. Since they were all done at Egleston, I have to assume that they were done with the appropriate equipment and calibration necessary for a child.

I doubt this is what the report is trying to address though – I assume it’s saying that they are being done more often than necessary. Not something I can make a call on – who’s to say what’s necessary and what was superfluous? After the fact, it’s easy to make that call (usually), but during diagnostic stage, don’t know.

Jeff

April 7th, 2011
10:11 am

We have made our bed on this one. We give them every piece of protective gear imaginable that we never had, but yet we still take them to the ER at a higher rate than when we were kids “just in case”.

I’ll throw another thought out there that’ll get me crucified but here goes: dads tend to say brush it off you’ll be OK. Moms tend to be more protective. Fewer dads in the home on a day to day basis and guess what? More ER visits in the big picture. I don’t want to hear reasons why you think dads aren’t in the home, that’s a separate issue. But if you look back to when we were growing up and more families were intact, can you honestly say I’m wrong?

Jeff (Radiology Technologist)

April 7th, 2011
10:27 am

As a parent of 3 kids I can understand the concern over our young ‘uns health care. I do work in pediatrics. One thing you need to know is that the digital xray machines deliver radiation only as much as needed to penetrate the body part and reach the cassette/film receptor. Once it senses the part has been appropriately penetrated then it stops. Also another point, the machines put out high energy xray beams. Thats good because the beams go right through the body cleanly.. no harm. no bumping atoms out of whack to cause damage. The harm from radiation comes from when it bounces around and comes back much slower. Slow xrays or weak xrays are bad because they dont penetrate the body all the way and they get stuck in the body. So the one who is most at risk from over exposure to xrays are the ones who are standing near the patient when the exam is going.
So parents, make sure you gown up with lead aprons. The other thing from a physics standpoint is that the xray beam is only strong up to about 8 feet from the tube source of the beam. After about 6 feet the beam loses energy by a factor of 4. ( in the industry we call this the “Inverse Square Law”).. so you can google it if you wish. Best wishes to all the kids out there.We will take good care of ya. :)

Photius

April 7th, 2011
12:10 pm

Time for a new topic to post as this one is not burning up the charts…

fred

April 7th, 2011
12:35 pm

I agree with Jeff. Whenever my girls get a minor cut scrape fall, I tell them to shake it off and rub dirt on it (got that one from a baseball coach) no harm has been done yet. Now I am an EMT and I think I can spot a true emergency better than average, but When needed I will not hesitate to take my daughters to the er (But it will be the ER of my choosing and not the closest one)

motherjanegoose

April 7th, 2011
1:15 pm

One trip each to the emergency room with mine…stitches both times.

@ shaggy…I just read( USA TODAY) that cold sores can be linked to Alzheimer’s.
SOOO, just in case anyone here thinks I am a KUKOO case, I have had my share of cold sores and thankfully they have Abreva to nip them in the bud now. I suffered mercilessly ( sp?) as a child.

shaggy

April 7th, 2011
2:48 pm

MJG,

Nope, no herpes here. Did something in my post make you think otherwise?

Ann

April 9th, 2011
10:08 am

The answer is “yes” for both children and adults. CT scans are similar to a lot of new medical advances and treatments. They are first seen as a “great tool” and an amazing invention; but, after a few years, the downside becomes clear, and the risks must be weighed with the benefits in your specific situation. Cancers are often slow developing, over several decades. In a couple of decades, we will know more about the impact of the increased use of CT scans. In the meantime, when you are at an emergency room or doctor’s office, and a CT scan is offered, you can ask if there are alternative diagnostic methods. And, you can discuss how many CT scans you or your child have already had, as the effects are cumulative.

Childrens DNA is more vulnerable to radiation because their cells divide more rapidly. Physicians and hospitals often order CT scans to avoid lawsuits. The amount of radiation can be as much as 500 times more than an x-ray. This article points out some unique concerns regarding children (and adults) and CT scans: http://www.time.com/time/health/article/0,8599,1818520,00.html
Research shows that machines are not typically “re-calibrated” for children in facilities that serve both children and adults.

Of course, there are times when a CT scan is needed for life saving reasons. I have personal knowledge that they are used too often in routine matters that are not life threatening. A few years ago, the HMO plan that I had did several CT scans of my sinuses over a couple of years because of recurring sinus infections, which is rarely life threatening. I currently have a kidney stone that is being monitored the past few years. Instead of a standard x-ray, I asked for an annual ultrasound. It doesn’t quite show the full organ picture, but gives them a good enough photo to compare size year to year, and to evaluate. There are often safer diagnostic/evaluation options, if you just ask your physician.

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