Increasing Concern Regarding Computed Tomography Irradiation in Craniofacial Surgery

Abstract

The safety of medical radiation, particularly computed tomography, has recently received much attention in both the medical literature and the popular press. As knowledge regarding side effects of radiation exposure has increased, so have attempts to limit doses to patients through more selective use of scans and transitions to lower-dose protocols to conform to the As Low As Reasonably Achievable (ALARA) principle. This trend has been apparent across many fields within medicine, including craniofacial surgery. Craniofacial surgeons should be familiar with these issues to participate in the determination of practice standards and to address patient concerns. A number of authors have questioned the value and necessity of obtaining computed tomography scans for the management of single-suture craniosynostosis in light of known radiation risks. Although unnecessary exposure to radiation from computed tomography scans should be avoided, imaging provides useful--often vital--information to the treatment of craniosynostosis. Use of low-dose protocols, which have been shown to provide images of satisfactory quality for the evaluation of both suture patency and associated intracranial abnormalities, may be a favorable alternative. The authors discuss the issue of medical radiation and its risks. In the context of risks and benefits, the authors reviewed the current practice of imaging in craniofacial surgery with the intent to encourage dialogue between surgeons and radiologists to develop thoughtful practice standards.

Avoiding CT scans in children with single-suture craniosynostosis

“…Too often the discussion focused on the quality of images rather than on radiation protection. It is beyond question that a thin-layer CT scan optimally depicts cranial sutures [10]. But this is of little importance in clinical practice as our results demonstrate (Fig.…”

“…3). Remarkably enough, Domeshek et al [10] recently demonstrated that the existing low dose protocols might even be further ) and plain Xray with a left-sided anterior plagiocephaly (c, d) due to premature closure of the coronal suture. Note the typical characteristics of the lesser sphenoid wing on the affected side.…”

Computed Tomography–Based Morphometric Analysis of Extended Strip Craniectomy for Sagittal Synostosis

“…Over the last 5 years, there have been emerging international concerns regarding ionizing radiation and its potential for tumor induction and developmental delays. 25,26 Third, morphometric evaluation in this study was limited to 12 months following extended strip craniectomy, which precluded long-term assessment of surgical correction. Serial CT scans for the purpose of short-and long-term morphometric appraisal, however, would not have been medically ethical in the context of radiation safety.…”

A new quantitative image-based method for evaluation of bony temporal hollowing in metopic synostosis

“…Some author's have presented calculations of estimations of increased cancer incidence due to radiation from CT investigations [15]. However, with modern CT equipment the dose from a CT of the head, in a child, is equal to that of the background radiation during 1-2 months and, thus, adds very little risk [16].…”