The American College of Radiology (ACR) urges parents not to delay or forgo needed medical imaging care for their children based solely on a study (Miglioretti et al) on radiation risk from pediatric computed tomography (CT) scans to be published online in JAMA Pediatrics. Parents should, however, discuss the risks and benefits of any procedure, including CT scans, with their child’s physician and factor this important information into their joint decision-making.
Medical imaging exams are directly linked to greater life expectancy, declines in mortality rates, and are generally safer and less expensive than the invasive procedures that they replace, such as exploratory surgery. Diagnostic scans reduce the number of invasive surgeries, unnecessary hospital admissions and the length of hospital stays. However, they must be used judiciously, when indicated, and when the needed information cannot be obtained in other ways, in order to minimize radiation exposure to all Americans — particularly children.
“CT scans are most often performed on children who have experienced trauma to the head, neck or spine, may suffer from neurological disorders or injury, or may need fast and accurate evaluation for complex and life threatening clinical issues — including complications of chest infections, such as lung abscess in patients with pneumonia. If an imaging scan is warranted, the immediate benefits outweigh a potential and very small long-term risk. Parents should certainly discuss such potential risk with their physician, but this appropriate concern should not translate into refusal of necessary and potentially life-saving care,” said Marta Hernanz-Schulman, MD, FACR, FAAP, chair of the American College of Radiology Pediatric Imaging Commission.
Parents should keep a record of their child’s X-ray history, the type of study done, place and date. Before any scan is done, appropriate questions to ask the physician include:
Government can help ensure appropriate imaging and lower the radiation dose that Americans (including children) receive from scans each year by:
Regarding the specifics of the JAMA Pediatrics study:
Children who get CT scans should have them when there is an immediate and significant health condition, whose treatment will be guided by the findings on the CT scan. The absolute potential lifetime cancer risks reported in the study are very small compared with the lifetime risk of developing cancer in the general population, in comparison with the definitive and clear benefits of a clinically justified scan. Modern CT scanners use radiation doses that are up to 90 percent lower than those of even 10 years ago.
Providers are far more aware of the potential risks involved than in years past, more apt to ensure the necessity for the exam and to consider alternatives. This is evidenced by the declining number of CT scans performed in children since 2007 (as cited by Miglioretti et al). Caution has governed the ACR’s long history of efforts to reduce dose and ensure appropriate imaging including:
While opportunities remain to ensure appropriate requesting of CT scans, growth in use of pediatric CT scans has leveled in recent years. Reports by the Neiman Health Policy Institute and the Moran Company show that overall use of CT scans has declined since 2008 and imaging is the slowest growing of all physician services according to the Health Care Cost Institute.
“We urge government to work with ACR and other stakeholders to streamline, enhance and promote Electronic Health Records that promote universal access to prior imaging scans and avoid duplicative testing. We also urge providers, patients and parents to take advantage of the many ACR quality and safety programs, such as facility accreditation, ACR Appropriateness Criteria, decision support systems to guide providers to the right test for their patients, and initiatives such as Image Gently and Image Wisely, in order to help ensure children and adults receive safe, appropriate, high quality care,” said Dr. Hernanz-Schulman.
For additional information regarding radiation exposure from medical imaging exams, the ACR urges patients and providers to visit the radiology safety section of the ACR website and the radiation safety section of RadiologyInfo.org, the patient information site co-managed by the ACR and the RSNA.
To arrange an interview with an ACR spokesperson, contact Heather Curry at 703-390-9822 or PR@acr.org.