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

Abstract

Objective: We aimed to evaluate the impact of a low-dose whole-body computed tomography (WBCT) protocol on radiation doses in pediatric major trauma patients. Methods: Retrospective cohort study of pediatric trauma patients (<16 years) at a national level 1 pediatric trauma center (PTC) over a 6-year period prior and post introduction of a low-dose WBCT protocol (2014–2019). Demographic data, patient characteristics, CT device, and exposure information including scan range, dose-length product (DLP), and volume computed tomography dose index (CTDIvol) were collected. Effective dose (ED) and exposure parameters were compared before and after protocol introduction. Results: Forty-eight patients underwent WBCT during the study period. Prior to introduction of the low-dose protocol (n =18), the ED was 20.6 mSv (median 20.1 ± 5.3 mSv [range 12.5-30.7]). After introduction of the low-dose WBCT protocol (n = 30), mean ED was 4.8 mSv (median 2.6 ± 5.0 [range: 0.8–19.1]). This resulted in a reduction of 77% in mean ED (p value <0.001). Conclusions: Significant radiation dose reduction of 77% can be achieved with low-dose WBCT protocols in pediatric trauma centers

Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study

“…Other studies have reported a low adherence to imaging guidelines [ 36 , 37 ], raised concerns about the use of CT in hemodynamically stable patients [ 38 ], and shown high variability in imaging practice among trauma centers [ 39 , 40 ]. For patients in our cohort, a low-dose WBCT protocol was in place, limiting radiation exposure below the annual background radiation dose [ 41 ]. Thus, imaging should take place at a pediatric trauma center whenever possible [ 37 , 39 , 40 ].…”

Abstracts from the 14th International Conference on Osteogenesis Imperfecta, Sheffield, UK, 30 August – 2 September 2022

“…They were listed according to Sillence classification into type III (17) and type IV (5). The indications for the surgery were as follow: fracture (12), correction of deformity (20) or treatment of non-union (4). In all cases, allografting was added to compensate areas of fragility and in 28 cases they were used as a means of fixation to provide structural support and to avoid the need for plate fixation.…”

“…In certain fractures, follow-up radiographs may be necessary to accommodate this low diagnostic accuracy, especially in the context of suspected abuse, thus necessitating additional exposure to a relatively high radiation dose. Whole-body radiography imparts a mean radiation dose of approximately 0.20 mSv, 17 roughly the equivalent of 1 month of typical background radiation in the UK; 18 mean effective doses experienced during wholebody imaging using the other modalities discussed range from 0 mSv for methods that do not employ ionizing radiation (MRI and ultrasound), up to 0.001 mSv for dual X-ray absorptiometry (DXA), 19 2.3 mSv for nuclear medicine imaging 17 and 4.8 mSv for a low-dose CT. 20 CT provides cross-sectional imaging generated from multiple X-ray measurements at different angles, facilitating multiplanar examinations and threedimensional (3D) reconstructions. The technique is relatively rapid -a whole-body CT scan can be performed in the duration of a single breath-hold (compared with 30 minutes or more for a conventional radiographic skeletal survey), but whole-body CT scans are not commonly performed and, therefore, CT is not used to provide an overview of proportions.…”

<strong>Value of Low-dose CT and Ultralow-Dose CT Protocols in Clinical Practice: A Narrative Review</strong>

“…Nevertheless, some centres have implemented low-dose WBCT protocols, featuring a mean radiation dosage of 4.8 mSv, in contrast to normal dose protocols with an average radiation dosage of about 20.6 mSv. Therefore, low-dose WBCT significantly reduces the radiation dose by approximately 77% (29).…”