Computed Tomography and Radiation Risks

            “Computed Tomography and Radiation Risks,” written by Drs. Donald P. Frush, Lane F. Donnelly, and Nancy S. Rosen, focuses on the issue of the use of computed tomography in the field of pediatrics. The article, which contains an abstract and is broken down into six sections, begins stating that it has been over three decades since computed tomography (CT) first became available for diagnostic image. Since then, due to great technological advancements, CT has been increasingly used as a medical tool.

However, according to the authors, there is one great risk of CT usage: an inappropriate amount of radiation can be used, and this can result in the increase of cancer in those exposed to said inappropriate radiation amounts. As a result, the role of pediatric care providers with regard to CT usage is paramount for two main reasons: they are responsible for ordering and providing indications and justifications for the CT exams, and in many situations, they are the principal or only source of information concerning CT exams and potential risks linked to them.

            The first section, entitled Importance of CT for Children, begins by stating that CT is “a standard modality is assessing a variety of disorders in children, including cancer detection and surveillance, trauma, and evaluation for inflammation” (951). Furthermore, the authors provide statistical information to support this opening statement: a recent review showing that there was a 600% increase in all CT exams from the mid-1980s to the mid-1990s, with an increase in the pediatric population from 4% to approximately 11%; and, approximately 33% of all pediatric CT exams being performed in children are done in the first ten years of life, with 17% being done on children five years old and younger.

This statistical information is important to consider due to the fact that the organs and tissues of younger children are more likely to develop radiation-induced cancer. The section concludes by pointing out that while there has been increased use and attention with regard to CT use in children, there has not been a parallel increase in understanding the risks or the development of techniques to reduce the risks associated with excessive CT radiation.

            The second section, entitled Historical Perspective: CT and the Discovery of Xrays, provides a brief history of the discovery of x-rays, which occurred in 1895. The important points of this section are as follows: first, within a few years of their discovery, a connection between x-rays and cancer was noted; second, it was not until the 1920s that the first safety measures regarding x-rays were implemented; third, parallels can be seen between the early use of x-rays and the modern use of CT, such as the increase and potential misuse of CT exams, the lack of attention to risks regarding children, and a delay in risk reduction strategies; finally, in 1958, the Society for Pediatric Radiology was established, focusing on the use of medical imaging on children.

            The third section, entitled CT and Radiation: Unique Considerations in Children, presents several points concerning the use of Ct among children. The authors write that the increase of CT in pediatrics is notable for the following reasons: first, CT is a large source of radiation exposure and accounts for the largest amount of medical radiation usage; second, although CT makes up only 5% of all x-ray imaging, 40-67% of medical radiation comes from CT exams; finally, when a CT exam is not needed or when the settings used provide an excessively high dosage, there will be a greater population dose, thus making it a potential public health issue. The authors continue on by stating that there are unique considerations with regard to children, which include increased radiosensitivity of certain tissues, especially in infants, a longer lifetime for the development of radiation-related cancer, and a lack of technique adjustments regarding the size of the child.

            The fourth section, entitled Risks of Low-Level Radiation and CT, focuses on the debate of whether or not low-level radiation provides a significantly increased risk of developing cancer. According to the authors, there is support for and against this debate. On the one hand is the theory of hormesis, which states that low levels of radiation can be beneficial and protective. On the other hand is the belief that any amount of radiation can result in the development of cancer. The section concludes by stating that one major issue with this topic is that there is a lack of consensus with regard to radiation dose estimations and the risks involved.

            The fifth section, entitled Strategies That Should Be Used For Minimizing Radiation Exposure, focuses on various tactics that can be used to reduce radiation exposure overall. There should be a fair use of CT, meaning that the need for the CT should be a real one, and if not necessary, then alternate methods should be used. The CT technique should be adjusted in the following ways: reduce the number of scans for each CT exam; limit coverage to answer clinical questions; consider the use of a breast shield; adjust settings based on indication, the area to be scanned, and the size of the child; and finally, the use new technology that makes automatic adjustments to radiation dosage during scanning.

            The article concludes in the final section by stating that CT usage is extremely important with regard to infants and children. Therefore, it is important for pediatric health care providers understand the benefits and risks of CT radiation exposure, and work with radiologists to develop ways to reduce the radiation levels children and infants are exposed to. This in turn will lead to a diminishment in the risk of cancer development. Thus, the goal of the article, which was to present a concise picture of the issue of CT usage and radiation exposure with regard to children has been fully met. What remains to be seen is if the methods suggested for reducing risks associated with CT usage among children will be implemented.

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