An Analysis of Computed Tomography-Related Radiation Exposure in Pediatric Trauma Patients

Abstract

Objective: To compare radiation doses used for pediatric computed tomography (CT) scans at community-based referring facilities (RF) to those at a designated pediatric trauma center (PTC) to assess the consistency of radiation exposure. Methods:In this retrospective study, patients 0 to 18 years of age with CT imaging performed either at a RF or at a PTC from January 1, 2015, to January 5, 2016, were identified. Data about patients, CT radiation dose, and characteristics of the RFs were compared. Results:We identified 502 patients (156 RF, 346 PTC) with 281 head CTs (79 RF, 202 PTC) and 86 abdominal/pelvis CTs (28 RF, 58 PTC). The radiation dose (measured in mean dose-length product [DLP] ± 1 standard deviation) was significantly higher for RF scans compared with PTC scans (head, RF DLP = 545 ± 334 vs PTC DLP = 438 ± 186 (P < 0.001); abdomen/pelvis, RF DLP = 279 ± 160 vs PTC DLP = 181 ± 201 [P = 0.027]). There was a nonsignificant trend toward lower head CT radiation dosages at RFs with a dedicated pediatric emergency department compared with RFs without a pediatric emergency department.Conclusions: Our data suggest that CT scans performed at RFs expose pediatric patients to significantly higher doses of radiation when compared with a PTC. These data support further study to identify factors associated with increased radiation and educational outreach to RFs.

Optimising whole body computed tomography doses for paediatric trauma patients: a Swiss retrospective analysis

“…A review by Goodman et al provides an overview of EDs for CT scans reported in the literature, including experimental studies reporting doses as low as 1 mSv for CCTs and less than 1 mSv for abdominal CT [30]. The impact of the low-dose protocol was more pronounced in our hospital than reported in a recent publication comparing CT doses of PTCs with referral facilities in the United States [18]. The mean DLPs for the PTCs included were 444 for CT head and 181 for abdomen-pelvis scans; the corresponding medians for our sample were 266 for CT head and 86 for thorax-abdomen-pelvis scans in our sample (table 2 and figure 3).…”

“…This could translate into a higher probability in the use of CT at non-level-1 PTCs and adult trauma centres [13,[36][37][38]. In addition to higher EDs at adult facilities [18,39,40], this combination may increase the risk of exposing children to unnecessary radiation. Our standard protocol group had a lower mean ISS, which could be due to injury mechanisms leading clinicians to opt for WBCT.…”

“…Various studies report reduction of radiation while maintaining adequate image quality in adult patients undergoing CT examinations [15][16][17]. Following the ALARA concept, continuous efforts to achieve the lowest radiation exposure possible is essential for any paediatric centre [18,19].…”