Pediatric Imaging Techniques Shifting Away From Computerized Tomography

Children’s hospitals are shifting away from imaging techniques that use ionizing radiation and moving toward alternatives that do not pose potential hazards. Accumulating evidence suggests that high dosages of ionizing radiation used in computerized tomography (CT) scans is linked to increased cancer risk.

Researchers from leading children’s hospitals, including The Children’s Hospital of Philadelphia, analyzed data from more than 150,000 children admitted to 33 U.S. pediatric hospitals from January 2004 to December 2012. They obtained the records from the Pediatric Health Information System of the Children’s Hospital Association.

Compared to 10 years ago, hospitalized children are significantly less likely to receive CT scans for common pediatric diagnoses, and more likely to receive magnetic resonance imaging (MRI) and ultrasound imaging, neither of which use ionizing radiation. The researchers assessed trends in the 10 most common diagnoses for which CT scans are performed in children’s hospitals, including seizures, concussions, upper respiratory tract infections, and abdominal pain.

“This study reinforces our commitment in the pediatric community to shift away from medical technology with potential for harm from ionizing radiation, towards alternatives that do not pose those risks,” said CHOP pediatrician and health services researcher Evan S. Fieldston, MD, a co-author of the study.

In addition to safety concerns, the study team attributed the shift in imaging tools to growing confidence in and ability to perform MRIs and ultrasounds. The increasing use of electronic health records also expedites the transference of imaging data between centers, reducing the use of duplicate scans.

“While there may still be times when a CT scan is the more appropriate imaging tool to use, parents should question whether an alternate imaging technology is available and appropriate, or what techniques the facility uses to limit radiation dose,”

Dr. Fieldston said. Dr. Fieldston added that Image Gently, for example, is a resource that can help patients, families and providers understand imaging approaches. CHOP’s radiologist-in-chief, Diego Jaramillo, MD, helped found Image Gently in 2007.

Co-authors of the study with Dr. Fieldston were from Cincinnati Children’s Hospital Medical Center; Children’s Medical Center, Dallas; and the Children’s Hospital Association. They published these findings online in Pediatrics on Aug. 24, and in the journal’s September print issue.