Medical radiation exposure in children and dose reduction

Article information

J Korean Med Assoc. 2011;54(12):1277-1283
Publication date (electronic) : 2011 December 13
doi : https://doi.org/10.5124/jkma.2011.54.12.1277
Department of Radiology, Kangnam Sacred Heare Hospital, Seoul, Korea.
Corresponding author: Ah Young Jung, jeanjung@medimail.co.kr
Received 2011 September 26; Accepted 2011 October 10.

Abstract

Medical imaging is an indispensible diagnostic tool in modern medicine enabling fast and accurate diagnosis. However, recent technological advances in medical equipment and increased utilization of the imaging modality have resulted in a significant increase in the exposure to ionizing radiation. The risk from radiation must be carefully considered in all examinations using ionizing radiation, especially in children. The risk of cancer in children from radiation exposure is higher than adults because pediatric patients are more radiosensitive and have more years ahead in which cancerous changes might occur. Therefore, pediatric protocols specifically designed for children must be used. However, many exams are still conducted using inappropriate adult protocols, which can result in excessive radiation. The most efficient way to reduce radiation is to avoid the examination if not justified. It has been suggested that one third to one half of pediatric CT exams are unnecessary or replaceable by other imaging modalities. If the exam is justified, then the parameters must be optimized to the imaging indication, scan area, body size, age, or weight of the patient according to the "as low as reasonably achievable" (ALARA) principle. The physician should always assess the radiation risk-benefit for each patient before ordering an examination using radiation.

References

1. National Council on Radiation Protection and Measurements. Ionizing radiation exposure of the population of the United States 2009. Bethesda (MD): National Council on Radiation Protection & Measurements;
2. Brenner DJ, Hall EJ. Computed tomography: an increasing source of radiation exposure. N Engl J Med 2007. 3572277–2284.
3. Brody AS, Frush DP, Huda W, Brent RL. American Academy of Pediatrics Section on Radiology. Radiation risk to children from computed tomography. Pediatrics 2007. 120677–682.
4. Mettler FA Jr, Wiest PW, Locken JA, Kelsey CA. CT scanning: patterns of use and dose. J Radiol Prot 2000. 20353–359.
5. Dorfman AL, Fazel R, Einstein AJ, Applegate KE, Krumholz HM, Wang Y, Christodoulou E, Chen J, Sanchez R, Nallamothu BK. Use of medical imaging procedures with ionizing radiation in children: a population-based study. Arch Pediatr Adolesc Med 2011. 165458–464.
6. Larson DB, Johnson LW, Schnell BM, Goske MJ, Salisbury SR, Forman HP. Rising use of CT in child visits to the emergency department in the United States, 1995-2008. Radiology 2011. 259793–801.
7. Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001. 176289–296.
8. National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2 2006. Washington DC: National Academies Press;
9. Goske MJ, Phillips RR, Mandel K, McLinden D, Racadio JM, Hall S. Image gently: a web-based practice quality improvement program in CT safety for children. AJR Am J Roentgenol 2010. 1941177–1182.
10. Hernanz-Schulman M, Goske MJ, Bercha IH, Strauss KJ. Pause and pulse: ten steps that help manage radiation dose during pediatric fluoroscopy. AJR Am J Roentgenol 2011. 197475–481.
11. Sidhu M, Goske MJ, Connolly B, Racadio J, Yoshizumi TT, Strauss KJ, Coley BD, Utley T. Image Gently, Step Lightly: promoting radiation safety in pediatric interventional radiology. AJR Am J Roentgenol 2010. 195W299–W301.
12. Sidhu M. Radiation safety in pediatric interventional radiology: Step Lightly. Pediatr Radiol 2010. 40511–513.
13. Goske MJ, Applegate KE, Bell C, Boylan J, Bulas D, Butler P, Callahan MJ, Coley BD, Farley S, Frush DP, McElveny C, Hernanz-Schulman M, Johnson ND, Kaste SC, Morrison G, Strauss KJ. Image Gently: providing practical educational tools and advocacy to accelerate radiation protection for children worldwide. Semin Ultrasound CT MR 2010. 3157–63.
14. Ron E. Ionizing radiation and cancer risk: evidence from epidemiology. Pediatr Radiol 2002. 32232–237.
15. Korley FK, Pham JC, Kirsch TD. Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998-2007. JAMA 2010. 3041465–1471.
16. Newman B. Ultrasound body applications in children. Pediatr Radiol 2011. 41Suppl 2. 555–561.
17. Strouse PJ. Pediatric appendicitis: an argument for US. Radiology 2010. 2558–13.
18. Nazarian LN. The top 10 reasons musculoskeletal sonography is an important complementary or alternative technique to MRI. AJR Am J Roentgenol 2008. 1901621–1626.
19. Leyendecker JR, Barnes CE, Zagoria RJ. MR urography: techniques and clinical applications. Radiographics 2008. 2823–46.
20. Grattan-Smith JD, Little SB, Jones RA. MR urography in children: how we do it. Pediatr Radiol 2008. 38Suppl 1. S3–S17.
21. Chong AL, Grant RM, Ahmed BA, Thomas KE, Connolly BL, Greenberg M. Imaging in pediatric patients: time to think again about surveillance. Pediatr Blood Cancer 2010. 55407–413.
22. Ahmed BA, Connolly BL, Shroff P, Chong AL, Gordon C, Grant R, Greenberg ML, Thomas KE. Cumulative effective doses from radiologic procedures for pediatric oncology patients. Pediatrics 2010. 126e851–e858.
23. Goo HW. Regional and whole-body imaging in pediatric oncology. Pediatr Radiol 2011. 41Suppl 1. S186–S194.
24. Strauss KJ, Goske MJ, Kaste SC, Bulas D, Frush DP, Butler P, Morrison G, Callahan MJ, Applegate KE. Image gently: Ten steps you can take to optimize image quality and lower CT dose for pediatric patients. AJR Am J Roentgenol 2010. 194868–873.
25. Callahan MJ. CT dose reduction in practice. Pediatr Radiol 2011. 41Suppl 2. 488–492.
26. McCollough CH, Bruesewitz MR, Kofler JM Jr. CT dose reduction and dose management tools: overview of available options. Radiographics 2006. 26503–512.
27. McCollough CH, Primak AN, Braun N, Kofler J, Yu L, Christner J. Strategies for reducing radiation dose in CT. Radiol Clin North Am 2009. 4727–40.
28. Kim JE, Newman B. Evaluation of a radiation dose reduction strategy for pediatric chest CT. AJR Am J Roentgenol 2010. 1941188–1193.
29. Nievelstein RA, van Dam IM, van der Molen AJ. Multidetector CT in children: current concepts and dose reduction strategies. Pediatr Radiol 2010. 401324–1344.
30. Yu L, Bruesewitz MR, Thomas KB, Fletcher JG, Kofler JM, McCollough CH. Optimal tube potential for radiation dose reduction in pediatric CT: principles, clinical implementations, and pitfalls. Radiographics 2011. 31835–848.
31. Goo HW. Individualized volume CT dose index determined by cross-sectional area and mean density of the body to achieve uniform image noise of contrast-enhanced pediatric chest CT obtained at variable kV levels and with combined tube current modulation. Pediatr Radiol 2011. 41839–847.
32. Schilham A, van der Molen AJ, Prokop M, de Jong HW. Overranging at multisection CT: an underestimated source of excess radiation exposure. Radiographics 2010. 301057–1067.
33. Lee CH, Goo JM, Ye HJ, Ye SJ, Park CM, Chun EJ, Im JG. Radiation dose modulation techniques in the multidetector CT era: from basics to practice. Radiographics 2008. 281451–1459.
34. Frush DP. CT dose and risk estimates in children. Pediatr Radiol 2011. 41Suppl 2. 483–487.
35. Strauss KJ, Goske MJ. Estimated pediatric radiation dose during CT. Pediatr Radiol 2011. 41Suppl 2. 472–482.
36. Radiological protection and safety in medicine. A report of the International Commission on Radiological Protection. Ann ICRP 1996. 261–47.
37. Verdun FR, Gutierrez D, Vader JP, Aroua A, Alamo-Maestre LT, Bochud F, Gudinchet F. CT radiation dose in children: a survey to establish age-based diagnostic reference levels in Switzerland. Eur Radiol 2008. 181980–1986.
38. Yakoumakis E, Karlatira M, Gialousis G, Dimitriadis A, Makri T, Georgiou E. Effective dose variation in pediatric computed tomography: dose reference levels in Greece. Health Phys 2009. 97595–603.
39. Muhogora WE, Ahmed NA, Alsuwaidi JS, Beganovic A, Ciraj-Bjelac O, Gershan V, Gershkevitsh E, Grupetta E, Kharita MH, Manatrakul N, Maroufi B, Milakovic M, Ohno K, Ben Omrane L, Ptacek J, Schandorf C, Shaaban MS, Toutaoui N, Sakkas D, Wambani JS, Rehani MM. Paediatric CT examinations in 19 developing countries: frequency and radiation dose. Radiat Prot Dosimetry 2010. 14049–58.
40. Kim DS. Guideline for diagnostic reference level of the radiation exposure of CT examination 2009. Seoul: National Institute of Food and Drug Safety Evaluation;
41. National Institute of Food and Drug Safety Evaluation. Technical standard for the performance of pediatric radiography 2010. Seoul: National Institute of Food and Drug Safety Evaluation;
42. Jung AY. Dose reduction strategies in pediatric CT. Radat Health Newsl 2011. 181–4.

Article information Continued