Pediatric Imaging: Radiation Exposure and How We Image

1. Terry L. Levin, MD 1. Children’s Hospital at Montefiore Medical Center, Bronx, NY 1. 1. Strauss KJ, 2. Goske MJ, 3. Kaste SC, 4. et al Ten Steps You Can Take to Optimize Image Quality and Lower CT Dose for Pediatric Patients. Strauss KJ, Goske MJ, Kaste SC, et al. Am J Roentgenol. 2010;194(4):868–873. doi:10.2214/AJR.09.4091 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] 2. 1. Frush DP CT Dose and Risk Estimates in Children. Frush DP. Pediatr Radiol. 2011;41(suppl 2):S483–S487. doi:10.1007/s00247-011-2098-z [OpenUrl][5] 3. 1. Mahesh M Update on Radiation Safety and Dose Reduction in Pediatric Neuroradiology. Mahesh M. Pediatr Radiol. 2015;45(suppl 3):S370–S374. doi:10.1007/s00247-015-3379-8 [OpenUrl][6] 4. 1. Andropoulos DB, 2. Greene MF Anesthesia and Developing Brains: Implications of the FDA Warning. Andropoulos DB, Greene MF. N Engl J Med. 2017;376(10):905–907. doi:10.1056/NEJMp1700196 [OpenUrl][7] During the past decade, technological advances have improved the accessibility, accuracy, and speed of medical imaging. This is particularly true of the newest computed tomography (CT) scanners equipped with multirow detectors that provide exceptional diagnostic accuracy and capture multiple images in seconds, obviating the need for patient sedation. These advances, although resulting in significantly improved diagnostic benefits, have led to a rapid increase in CT scanning, particularly in children. In the United States, CT contributes to half of all medical radiation exposures; pediatric CT scans compose 10% of all CT scans. Although the benefits of CT are significant, debate is ongoing about potential risks posed by the low-level radiation exposure associated with CT, especially in children. Children may be particularly susceptible to developing cancer because of the increased radiosensitivity of their growing organs and their long expected life spans. However, the risk from exposure to low-level radiation is uncertain, and the dose actually delivered by CT is estimated. Furthermore, the estimates of risk for cancers related to radiation are based on extrapolation from studies of atomic bomb survivors who received substantially higher doses of radiation than those used in medical imaging. Nevertheless, techniques to significantly reduce the dose of radiation from CT have been implemented. A variety of imaging modalities are available to the radiologist: radiography, fluoroscopy, nuclear scintigraphy, CT, and positron emission tomography (PET) use ionizing radiation; and magnetic resonance (MR) imaging and ultrasonography do not. The choice of modality can be confusing. Some examinations optimize anatomic detail or are complementary when used in conjunction with another modality. Others provide functional data or offer unique information not provided by other imaging … [1]: {openurl}?query=rft.jtitle%253DAmerican%2BJournal%2Bof%2BRoentgenology%26rft.stitle%253DAm.%2BJ.%2BRoentgenol.%26rft.aulast%253DStrauss%26rft.auinit1%253DK.%2BJ.%26rft.volume%253D194%26rft.issue%253D4%26rft.spage%253D868%26rft.epage%253D873%26rft.atitle%253DImage%2BGently%253A%2BTen%2BSteps%2BYou%2BCan%2BTake%2Bto%2BOptimize%2BImage%2BQuality%2Band%2BLower%2BCT%2BDose%2Bfor%2BPediatric%2BPatients%26rft_id%253Dinfo%253Adoi%252F10.2214%252FAJR.09.4091%26rft_id%253Dinfo%253Apmid%252F20308484%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.2214/AJR.09.4091&link_type=DOI [3]: /lookup/external-ref?access_num=20308484&link_type=MED&atom=%2Fpedsinreview%2F39%2F1%2F50.atom [4]: /lookup/external-ref?access_num=000275863300003&link_type=ISI [5]: {openurl}?query=rft.jtitle%253DPediatr%2BRadiol%26rft.volume%253D41%26rft.spage%253DS483%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: {openurl}?query=rft.jtitle%253DPediatr%2BRadiol%26rft.volume%253D45%26rft.spage%253DS370%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [7]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.volume%253D376%26rft.spage%253D905%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx