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Exposure is cumulative, and children are likely to need numerous CT
exams over the course of their lives that will add up.
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CT
SCANS — computer-enhanced X-rays that can provide a better view of
all parts of the body, not just the brain — have revolutionized
medicine. But the scans, more popularly known as CAT scans, do emit
significantly more radiation than a standard X-ray, and children are
more sensitive to radiation than adults.
Yet with the number CT scans increasing sevenfold in the last
decade, up to 3 million a year now are being performed on U.S.
children. There’s little guidance on when they’re truly necessary or
when other exams will do.
So specialists have begun a nationwide effort to curb
unnecessary child CT scans — and ensure that when one is needed,
hospitals use a child-appropriate radiation dose instead of the
higher adult dose too often used. |
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“We don’t want to scare
anybody,” says Dr. Tom Slovis, chief of pediatric imaging at
Children’s Hospital of Michigan, who co-wrote an advisory explaining
child-sized doses that the National Cancer Institute and Society for
Pediatric Radiology mailed to 160,000 doctors in late summer.
CT is “a wonderful test, it saves lives,” he stresses. “But
we’ve got to do it the right way.”
“Just because a procedure’s available doesn’t mean it’s
necessary for your child,” adds Dr. Shireen Atabaki of Children’s
National Medical Center in Washington, who led the new head-injury
research.
RADIATION RISKS
Radiation from a single CT scan still is relatively low — and
certainly not high enough to warrant skipping a scan if a child may
be seriously ill or injured, such as after a car crash, specialists
warn. But recent research suggests lower radiation doses than once
thought — as low as 10 to 20 REMs — may somewhat increase people’s
risk of getting cancer decades later. Exposure is cumulative, and
children are likely to need numerous exams over the course of their
lives that will add up. |
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Advertisement
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Simply
adjusting the dose can lower children’s radiation absorption. For
example, a child given a typical adult-dose brain CT scan will
absorb 6 REMs of radiation, and 2 to 3 REMS for abdominal CT. Adjust
the scanner to a pediatric setting, and that child will absorb 3
REMS from a brain CT and 0.6 REMS to the abdomen. (A standard chest
X-ray, in contrast, provides about 0.01 REM.)
PRESSURE FROM PARENTS
When not to give a CT scan at all, however, is trickier.
About 2 percent of all children’s ER visits are for head
injuries. Major trauma definitely requires a CT scan, but Atabaki
noticed that doctors gave widely varied reasons for scanning kids
with minor injuries — some merely cited pressure from worried
parents.
Together with three other hospitals — Strong Memorial
Hospital in Rochester, N.Y., Hasbro Children’s Hospital in
Providence, R.I., New York’s Mt. Sinai Hospital and Inova Fairfax
Hospital in suburban Washington — she studied 1,000 patients.
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CT scans found an intercranial injury in less than 7 percent
— just 65 children.
Then Atabaki examined characteristics that predicted an
injury, and concluded CT scans are needed if children have any of
the following risk factors: is age 2 or younger; has a skull
fracture or deformity; has a bicycle-related injury; is dizzy, has a
behavior change or problems with vision or other senses; or scores
less than 15 on a standard neurological exam called the Glasgow Coma
Score.
More than two dozen other supposed risk factors didn’t
predict who needed a CT scan, Atabaki told a recent meeting of the
American Academy of Pediatrics — not even the very commonly cited
vomiting. Why? Vomiting is a symptom of concussion, but CT scans
can’t diagnose concussion.
Several universities are planning a larger study to confirm
Atabaki’s guidelines. Doctors also are studying for other illnesses,
such as when ultrasound, which doesn’t emit radiation, can be
substituted to diagnose appendicitis.
While that research continues, parents should ask doctors if
a CT scan is the best exam for their child — and if the answer is
yes, then ask if the scanner will be adjusted to a child dose,
Slovis advises.
“If they do it the way they do adults, that’s probably not
the place you should be,” he says.
© 2002 Associated Press. All rights reserved. This
material may not be published, broadcast, rewritten or
redistributed.
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