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How Much Radiation Is Too Much For Kids?

January 12, 2011
Written by: , Filed in: Medical Ethics, Pediatric Radiology, Practice Management
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How many imaging procedures using ionizing radiation do you think the average child receives by age 18? Two? Three? More?

Seven.

That, at least, is the finding of a new study led by University of Michigan researchers and published online last week in the Archives of Pediatrics & Adolescent Medicine. Said Adam L. Dorfman, MD:

Our findings indicate that more awareness about the frequent use of these tests may be needed among care providers, hospitals, and parents.

Dr. Dorfman is clinical assistant professor of pediatrics and communicable diseases and of radiology at the University of Michigan Medical School. He was quoted in a university news release. “Imaging tests are a critical component of good medical care,” he said, “but the high number of tests raises questions about whether we are being judicious in our use of the technology.”

The study looked at 355,088 children under age 18 in five large U.S. health-care markets, all enrolled in UnitedHealthcare from 2005 through 2007. During that three-year period, 436,711 imaging procedures involving ionizing radiation were performed, with 42.5 percent of the children receiving at least one procedure. Many received multiple scans.

Based on that data, the average child in the study population would be expected to receive approximately seven imaging procedures that involved radiation by age 18. Of course, this population—insured and in large health-care markets—is not necessarily typical. The study did not calculate radiation doses. Nor did it attempt to assess the clinical appropriateness of each test.

“What we’ve tried to do is raise awareness of the issue and start a national dialogue by identifying the overall scope of the problem,” Dr. Dorfman said. “The next step is to better understand when these tests really add value to the care of a child and when they do not.”

Nearly 8 percent of the children in the study received a CT scan, the type of procedure that would subject them to the most radiation, and 3.5 percent received more than one.

“Developing tissues in children are more sensitive to radiation,” said study coauthor Reza Fazel, MD, a cardiologist at the Emory School of Medicine, “and their longer expected life spans also allow additional time for the emergence of detrimental effects.”

Another coauthor, Kimberly E. Applegate, MD, is vice chair for quality and safety in the radiology department at Emory and a member of the Image Gently campaign, which seeks to lower radiation exposure in children.

“Of course, there is immense lifesaving value in medical imaging, so our study doesn’t suggest at all that these tests shouldn’t be used in children,” Dr. Applegate said. “We have to be smarter about how we use tests. For example, children don’t always need the same radiation dose during a CT scan to get the same quality of image and information.”

Related seminar: Pediatric Radiology—Clinical and Radiology Perspectives

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