A new article was published in the current issue of JAMA Pediatrics. (Abstract here) It was a retrospective look at children under the age of 15 who were administered a CT Scan from 1996 to 2010including just over 4.8M child years of observation. The researchers used The Biological Effects of Ionizing Radiation II Report for most major cancers that was published by the National Cancer Institute. (Find it here: NCI)
The researchers were able to conduct the study (Full Article here) with patient populations from Group Health in Washington, Marshfield Clinic in WI, and Kaiser Permanente Colorado, Hawaii, Georgia, and Northwest. The researchers calculated the dose from CT Scans of 744 procedures that were performed during that time in these patients.
The essence of what was found in the research was that there was a higher than expected dose of radiation exposure for head exams in the following: 7% in children under 5 yoa, 8% in children 5-9 yoa, and 14% in children 10-14 yoa with a dose of 50 mGy or higher.
In addition with the dose modeling of radiation exposure to normal tissues there is a potential of just over 4800 future cancers could be induced by pediatric CT scans.
Which leads me to a few thoughts.
1. As a healthcare community the advantage of CT scans is that we can see inside the body and see potential things that could be wrong when our children get hurt. However, the technological advancement has also backed some physicians into a corner to potential order a CT Scan vs watchful waiting due to the liability of malpractice.
2. Since CT Scans are prevalent in medical clinics, private practice offices, imaging centers, and hospitals has it become second nature for patients to expect a CT Scan to be ordered by their physicians? Have physicians relied on CT Scans vs lower technological options due to costs, consumer demand, and liability?
3. With the adoption of CT Scans and other radiation imaging devices, has the role of the radiation safety officer, Chair of Radiology or Radiation Oncology, or Medical Officer elevated to a role of authority to ensure that there are set protocols in place? That those protocols are followed in a 80/20 fashion? Is there on going education, reviews, and training to look at the dose exposure to patients and adherence to imaging protocols?
4. Will the adoption of dose reporting be driven by the states with legislature? Will healthcare organizations increase their uptake on this technology to help with differentiation in competitive markets? Will consumerism dive into this space and patients begin to demand to know what their radiation exposure was, what it is over their lifetime, and what is the risk vs benefit of a scan?
5. When it comes to children, will parents begin to ask the right questions: Is this scan necessary? Can we opt to have an MR, X-ray, or another option to care for our child’s problem? Do you have low dose technology and protocols, or are you low dose certified?
Granted, in the scheme of major trauma or injury to a child, all any of us want is for them to be cared for, to be safe, and to be on the mend as quickly as possible. As consumers become more educated in their healthcare options, become more engaged in the decision making process, and become cost conscious it will be interesting to see these questions answered.
What do you think?
As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM