Dangers
of CT Scans for Children
Excerpt
By Colette Bouchez, HealthScoutNews
(HealthScoutNews) -- They're high-powered X-rays known as CT
scans, and each year more than 1.5 million American children receive
at least one.
Now, the U.S. Food and Drug Administration (FDA) is warning that
radiologists often expose those children to doses of radiation far
greater than is safe for their age and weight -- by some estimates,
up to six times more than what is needed to produce clear images.
In a public health notification, FDA officials warned recently
that, despite earlier efforts by the American College of Radiology
to warn doctors to reduce radiation levels when imaging children,
the problem still exists.
"This is a very hot topic in radiology right now. It's
well known that in many instances children are receiving far too
much radiation, and the primary reason is because adjustments
are not being made to the machines to accommodate the children's
weight and overall smaller size," says Dr. Kevin Roche, a
pediatric radiologist at New York University Medical Center.
CT scans -- short for "computerized tomography" --
differ from traditional X-rays in that they take pictures, or
"slices" as they're called, of cross sections of the
body. This lets doctors "see inside" many areas -- such
as the chest, abdomen or brain -- that would only be visible as
a flat, one-dimensional picture on a traditional X-ray.
In children, CT scans are most often used to diagnose appendicitis,
trauma from injury and tumors.
The pictures that result from a CT scan definitely make diagnosis
easier and more definitive. However, when radiation levels aren't
adjusted to a child's size and weight, serious health threats
can ensue.
"Because children are still growing and their cells are
rapidly dividing, they are more susceptible to cell damage from
radiation," explains Roche.
"This, combined with their longer life expectancy, increases
their odds significantly over adults that they will develop cancer
from radiation," he says.
According to the American College of Radiology, many CT scan
machines are equipped with software that automatically calibrates
the system for optimal image quality. However, those calibrations
are almost always based on adult size and weight. Children can
easily end up with far too much radiation, even from a single
session.
"If they don't bother to change the settings, then this
is invariably going to occur," says Roche.
While there are guidelines for calibrating the machines according
to the patient's weight, studies have shown that few institutions
are paying attention.
In a study of pediatric CT scans published last year in the
American Journal of Roentgenology, researchers found machines
were not being adjusted to suit the children's smaller size, and
90 percent of children getting CT scans were receiving twice the
radiation they should.
Compounding the problem, it's not always easy to tell when a
CT scan's levels are in the danger zone.
When radiation levels are too high on traditional X-rays, images
appear overexposed; it's easy to see that something is wrong.
With CT scans, the picture is so good it's not likely to be compromised,
even when radiation levels are way above normal, according to
the American College of Radiology.
"This is one reason that many centers don't even recognize
that there is a problem," says Roche.
The FDA says something must be done to correct the situation.
In its recent public health notification, it not only hoped to
raise awareness of the problem, but to reinforce a series of guidelines
issued early last year that included recommendations urging technicians
to pay more attention to machine settings as they pertain to children.
In addition, the FDA is calling on technicians to reduce the
number of unnecessary exposures on children by eliminating "pre-contrast"
pictures, a kind of base-line image that is often taken before
the actual CT scan is performed.
In one final measure, the FDA is also urging doctors to reduce
the number of referrals for CT scans in children, suggesting they
make better use of conventional X-rays, as well as ultrasounds
or MRIs. All of these techniques deliver little or no radiation,
says Dr. David W. Feigal Jr., director of the FDA's Center for
Devices and Radiological Health.
Roche says parents can also play a role, simply by asking the
radiologist a couple of key questions.
"Ask them if their machine is calibrated for pediatric
use, if they are going to adjust the radiation to coincide with
the weight of your child, and if they are following both ACR and
FDA guidelines for radiation exposure in children," says
Roche.
If they can't -- or won't -- answer these questions, then, say
experts, parents should consider a different facility.
"As long as it's not an emergency, parents should feel
free to call various radiology centers or hospitals and ask about
their ability to safely give CT scans to kids," says Roche.
What to Do: For a simple primer on what CT scans do and
how they work, visit Brigham
and Women's Hospital's radiology department. To learn more
about the effects of radiation on children's health, visit The
Children's Hospital Medical Center of Cincinnati.
Reference
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