Assessing the appropriateness of CT scans

among pediatric ortho patients

Traditio all , there has ot ee e ough dis ussio o ho e a disse i ate

i for atio to est treat hildre ith the least possi le e posure to radiatio ,
Dr. David H. Godfried told HCB Ne s. A CT s a a e a solutel e essar for
a child. But whenever there is an option, physicians should choose to obtain this
i for atio a other a .

He is senior research author of the analysis, and serves as clinical associate

professor of orthopaedic surgery and pediatrics at NYU Langone Medical Center.
Dr. Ayesha Rahman, a fifth-year resident in the department of Orthopedic Surgery
at NYU Langone, helped in the research.

Sifting through peer-reviewed studies on different options in imaging technology

used in pediatric orthopedic injuries, the two doctors quantified the amount of
radiation in each of the CT scans radiation and X-rays for spines, pelvis, hip and
other body parts. They discovered that children who require surgery for hip
dysplasia, scoliosis and leg-length discrepancy undergo X-rays or CT scans, and are
the children most vulnerable to exposure risk.
 Ma do tors re ert a k to pra ti es that they learned while still in training.
However, when presented with the current data, virtually all were willing to
ha ge pra ti e, he said. Although there is o se sus a o g e perts a out
methods to decrease frequency of imaging for specific pediatric orthopaedic
conditions, there does not seem to be a readily available summary of "best
pra ti es" that pra titio ers routi el refer to.

Organizations such as "The Image Gently Alliance" have done much to bring
together current information and compile information and best practices. This
approach needs to be woven into presentations at local grand rounds and
national meetings so that the physicians on the front lines are exposed to this
information, he added.

X-rays ct scan radiation used judiciously play a very important role in providing
care for scoliosis. We need to focus on efforts to keep X-rays to a minimum and
employ newer technology to decrease the amount of X-ra e posure, Godfried
said. If patie ts are too fearful of X-ray, it may compromise physicians' ability to
provide appropriate screening and treatment. This being said, there a very few
reasons CT scans should be used for pediatric spine conditions, short of
preoperati e pla i g i er o ple ases.

Hospital audits of the number of X-rays obtained for pediatric scoliosis patients in
a given year may provide data for individual physicians to assess their usage
versus local and national norms.

M e perie e is that the ast ajorit of ph si ia s a t to do hat is est for

their patie ts, Godfried said.
The most important lessons learned from this analysis are that child/family and
health care providers must work as team. All must acknowledge that patient
safety is a priority and that imaging technology used appropriately can improve
care, but that current practices need to be reexamined based on nationally
accepted best practices, he said.

The research that Godfried and Rahman reviewed included a lot of variation in
age and radiation doses.
"Radiation doses generally increase with patient age proportional to the size and
eight of the patie t, Rah a told HCB Ne s. The risk of a er, ho e er, is
increased in younger children compared to older children. The relationship
between female patients having twice the risk of adverse events as male patients
remains generally constant throughout all age groups. These numbers really
highlight the unique susceptibility of younger patients and female patients to
radiation exposure."

For example in one finding, female scoliosis patients received two times more X-
rays than non-surgical patients, amounting to twice the radiation exposure to the
breasts, ovaries and bone marrow. That correlated to an over two percent
increased lifetime risk of fatal breast cancer, almost one percent risk of fatal
leukemia and three percent risk of genetic defects. Non-surgical patients had
approximately half that risk.
 Contact Us
General:
Donald Frush, MD
Professor of Radiology, Vice-Chair of Radiology
Duke University
Medical Center Department of Radiology Box 3808 DUMC
1905 Childrens Health Center
Durham, NC 27710
imagegently@aol.com

Keith Strauss, MSc

Assistant Professor
Cincinnati Childrens Hospital
University of Cincinnati School of Medicine
Department of Radiology, ML 5031
3333 Burnet Avenue
Cincinnati, OH 45229
imagegently@aol.com
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Medical Physics:
Keith J. Strauss, MSc
Cincinnati Childrens Hospital Medical Center
3333 Burnet Avenue ML 5031
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513-636-7775
Keith.Strauss@cchmc.org