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Predictably, an uproar has followed Monday’s online publication of a JAMA Pediatrics article suggesting that reducing radiation doses for CT scans of children and eliminating unnecessary pediatric CT scans could each year prevent more than 3,000 future U.S. cancers.

Diana Miglioretti, PhD, the study’s lead author, was particularly troubled by the wide variation in dosages. “Most studies just use average dose that’s reported in the literature,” she told DOTmed News, “but we estimated the actual radiation exposure from hundreds of randomly selected exams of each type. We found it very surprising and worrisome that there was so much variability for exams of the same type.”

Dr. Miglioretti, dean’s professor of biostatistics at UC Davis Health System, said of the variations:

It can be radiologist’s preference, the variation across the technologists and how much they adjust the parameters, or the manufacturer. So there are many factors, and we really need to standardize and optimize the dose, especially for children.

An editorial published along with the article seconded the idea of using the minimum necessary dose and eliminating unnecessary scans. However, it added, “This will require a shift in our culture to become more tolerant of clinical diagnoses without confirmatory imaging, more accepting of ‘watch and wait’ approaches and less accepting of the ‘another test can’t hurt’ mentality.”

The American College of Radiology released a statement Monday urging parents not to delay or forgo medical imaging for their children based on the study. “Parents should, however, discuss the risks and benefits of any procedure, including CT scans, with their child’s physician and factor this important information into their joint decision-making,” the statement said.

The statement said parents should keep records of their children’s X-ray history—a good idea for everyone, not just kids, although parents/patients are unlikely to have access to dosage information. It also suggested government action to, among other things, encourage both participation in the ACR Dose Index Registry and integration of medical imaging into electronic health records.

The study covered 4,857,736 child-years of observation. It combed through seven integrated health-care systems’ CT scan records for children younger than 15 from 1996 through 2010. It found that the use of CT doubled for children younger than 5 and tripled for children 5 to 14 from 1996 through 2005, stabilized in 2006 and 2007, then began to decline.

The study concluded that the 4 million annual U.S. pediatric CT scans of the most commonly imaged organs could result in approximately 4,870 future cancers. Reducing the highest 25 percent of dosages to the median dosage, it determined, might prevent 2.090 of those cancers—43 percent. Eliminating unnecessary scans could prevent another 930 cancers, bringing the total prevented to 3,020, or 62 percent.

A UC Davis Health System news release about the study quoted Dr. Miglioretti as saying, “A smaller person needs a lower dose to come out of the machine to create an image of adequate quality for making a clinical diagnosis.”

Related CME seminar: Pediatric Musculoskeletal Imaging: Beyond the Basics


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