“Primum non nocere.” First, do no harm. My, how far we have come from that oath, especially when it comes to medical imaging in our children.
Let’s clarify something: CT scans give you a boatload of radiation exposure. As an example, a single CT scan of the chest is equal to about 133 two-view x-rays of the chest. But few of us think of this danger from the medical imaging because the doctor needs the information. Right…?
If they practice in one of these 7 healthcare systems, the answer is probably no.
In this particular study, researchers looked at the number of CT scans done on children from 1996 to 2010. Most commonly were abdomen/pelvis scans, spine scans and chest scans. Obviously the spine scans fall well within my area of expertise and rarely would a CT scan be needed, with the exception of serious trauma. We already know (from a previous blog article that can be read by clicking here) that the number of CT scans done in the ER on children has been climbing, with no notable benefit on the health or diagnosis in the child. In other words, mass exposure to radiation without any added benefit over ultrasound or MRI.
Did physicians in this particular study fare any better? Sadly, the results can be seen here:
- CT use doubled for children younger than 5 years of age up until 2005, although they seemed to be on the decline after 2007.
- CT use tripled for children 5 to 14 years of age, with a similar hint at a decline after 2007.
- 5-10 million pediatric CT scans are performed annually in the US
Ok. So what? Some kids had some CT scans that they maybe (probably??) didn’t need, where an MRI, ultrasound or just good ‘ole fashioned diagnostic skills would’ve done just as well. Given the high radiation dosages of CT scans, what does this high level of exposure translate to? You’d better sit down:
- Projected lifetime risks of solid cancers were higher for younger patients and girls.
- CT scans of the abdomen/pelvis or spine produced the highest risk.
- In girls, a radiation-induced solid cancer will likely be caused from every 300 to 390 abdomen/pelvis scans, 330 to 480 chest scans, and 270 to 800 spine scans.
- CT scans in kids younger than 5, there will likely be 1.9 cases of leukemia for every 10 000 head CT scans (doesn’t sound like much until you do the math).
- An estimated 4 million pediatric CT scans of the head, abdomen/pelvis, chest, or spine performed each year are projected to cause 4870 future cancers.
Almost 5,000 cancers ANNUALLY.
Do the math on what this means over the course of a decade. If your pediatrician recommends a CT scan for your child, they better have a damn good reason. All too often, in both adults and children, I have patients whose PCPs have ordered CT scans for reasons that are unacceptable. In many cases, MRI would have actually been the better choice of imaging.
If your child had a CT scan, did your pediatrician explain why CT was the absolute best option for that particular situation?