Nationwide survey of radiation exposure during pediatric computed tomography examinations and proposal of age-based diagnostic reference levels for Japan

Takei, Yasutaka; Miyazaki, Osamu; Matsubara, Kosuke; Shimada, Yoshiya; Muramatsu, Yoshihisa; Akahane, Keiichi; Fujii, Keisuke; Suzuki, Shigehiko; Koshida, Kichiro

doi:10.1007/s00247-015-3474-x

Cited by 39 publications

(33 citation statements)

References 15 publications

(23 reference statements)

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“…This incidence of future cancers related to ionizing radiation is further complicated by the multiply interacting variables, including the cumulative radiation dose from all radiographic studies, the age of the child at the time of the study and their sex (14). While radiation dose can vary by the exact protocol, the imaging center and the patient’s body size, the mean dose-length product (DLP) for a non-contrasted CT scan of the head was recently found to be 543 mGy-cm (15). In the US validation study, a CTA neck in pediatric trauma patients was found to have a mean DLP of 649 mGy-cm, approximately twice the radiation exposure of pediatric trauma patients who did not undergo a CTA neck (18).…”

Section: Discussionmentioning

confidence: 99%

“…The Eastern Association for the Surgery of Trauma (EAST) has made a Level III recommendation that pediatric patients should be screened according to the same guidelines as adults, acknowledging a paucity of pediatric-specific data (13). While a liberal pediatric screening strategy would likely improve BCVI detection rates, concerns regarding the oncogenic effects of ionizing radiation may limit widespread applicability of this strategy, in comparison to adults (14, 15). In an attempt to optimize pediatric BCVI screening, several groups have attempted to either apply adult screening guidelines to pediatric patients or derive pediatric specific scoring systems to help predict patients at increased risk for BCVI (2, 7, 16-18).…”

Section: Introductionmentioning

confidence: 99%

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A cohort study of blunt cerebrovascular injury screening in children: Are they just little adults?

Cook

Witt

Bonow

et al. 2018

J Trauma Acute Care Surg

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A cohort study of blunt cerebrovascular injury screening in children: Are they just little adults?

Cook

Witt

Bonow

et al. 2018

J Trauma Acute Care Surg

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show abstract

“…However, Takei et al 25 summarized the mean DLP for noncontrast head CT in children across 6 countries. By combining the age groups from the study, the mean radiation exposure DLP for noncontrast head CT was 543 mGy-cm.…”

Section: Discussionmentioning

confidence: 99%

Predicting Blunt Cerebrovascular Injury in Pediatric Trauma: Validation of the “Utah Score”

Ravindra

Bollo

Sivakumar

et al. 2017

Journal of Neurotrauma

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Risk factors for blunt cerebrovascular injury (BCVI) may differ between children and adults, suggesting that children at low risk for BCVI after trauma receive unnecessary computed tomography angiography (CTA) and high-dose radiation. We previously developed a score for predicting pediatric BCVI based on retrospective cohort analysis. Our objective is to externally validate this prediction score with a retrospective multi-institutional cohort. We included patients who underwent CTA for traumatic cranial injury at four pediatric Level I trauma centers. Each patient in the validation cohort was scored using the "Utah Score" and classified as high or low risk. Before analysis, we defined a misclassification rate <25% as validating the Utah Score. Six hundred forty-five patients (mean age 8.6 ± 5.4 years; 63.4% males) underwent screening for BCVI via CTA. The validation cohort was 411 patients from three sites compared with the training cohort of 234 patients. Twenty-two BCVIs (5.4%) were identified in the validation cohort. The Utah Score was significantly associated with BCVIs in the validation cohort (odds ratio 8.1 [3.3, 19.8], p < 0.001) and discriminated well in the validation cohort (area under the curve 72%). When the Utah Score was applied to the validation cohort, the sensitivity was 59%, specificity was 85%, positive predictive value was 18%, and negative predictive value was 97%. The Utah Score misclassified 16.6% of patients in the validation cohort. The Utah Score for predicting BCVI in pediatric trauma patients was validated with a low misclassification rate using a large, independent, multicenter cohort. Its implementation in the clinical setting may reduce the use of CTA in low-risk patients.

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“…Also, the International Commission on Radiological Protection (ICRP) recommended the use of diagnostic reference levels (DRLs) in1996 [ 35 ]. However, DRLs were not set in Japan until 2015, when Takei et al conducted a nationwide survey on radiation exposure during pediatric CT examinations and established the DRLs in Japan [ 36 ]. They found that the DLP (dose–length product) values for pediatric CT in Japan were higher in comparison with those of other countries [ 37 – 40 ].…”

Section: Future Prospectsmentioning

confidence: 99%

The present state of radiation exposure from pediatric CT examinations in Japan—what do we have to do?

Ideguchi

Yoshida

Ohtsuru

et al. 2018

Journal of Radiation Research

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The use of computed tomography (CT) has increased dramatically over the past several decades and has resulted in a concurrent increase in medical exposure to ionizing radiation. Several recent studies have examined the link between medical radiation and the risk of cancer, especially in children. The cancer risk associated medical exposure has not been definitively confirmed. However, we have to reduce unwarranted medical radiation exposure in pediatric patients. Justification and optimization are of great importance in order to minimize these risks, and the standardization of CT usage is essential. However, in Japan no clinical guidelines for the use of CT have been commonly agreed upon, especially in children. Furthermore, the CT-associated radiation exposure in Japan varies widely among the different facilities. Further studies based on a nationwide survey in Japan will be required in order to establish simple and useful clinical guidelines.

show abstract

Nationwide survey of radiation exposure during pediatric computed tomography examinations and proposal of age-based diagnostic reference levels for Japan

Cited by 39 publications

References 15 publications

A cohort study of blunt cerebrovascular injury screening in children: Are they just little adults?

A cohort study of blunt cerebrovascular injury screening in children: Are they just little adults?

Predicting Blunt Cerebrovascular Injury in Pediatric Trauma: Validation of the “Utah Score”

The present state of radiation exposure from pediatric CT examinations in Japan—what do we have to do?

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