Kids' CT scans increase fivefold
April 5th, 2011
09:55 AM ET

Kids' CT scans increase fivefold

The number of children getting computed tomography, or CT scans when visiting an emergency room increased fivefold over a 14-year period according to a new study in the journal Radiology.

The study analyzed data from the National Hospital Ambulatory Medical Care Survey between 1995 and 2008 and looked at more than 7,300 emergency room visits a year. Researchers say during that time ER visits that included at CT exam increased from approximately 330,000 to 1.65 million visits.

Eighty-nine percent of those visits were to non-pediatric hospitals and the study's lead author Dr. David Larson, director of quality improvement, Department of Radiology at Cincinnati Children's Hospital Medical Center, says most radiologists who oversaw and interpreted scans were most likely not trained in pediatric radiology.

The researchers say better collaboration is needed to make sure pediatric scans are ordered, performed and interpreted correctly.

"We need to think creatively about how to partner with each other, with ordering clinicians and with CT manufacturers to ensure that all children are scanned only when it is appropriate and with appropriate techniques."

Injuries most often resulting in a CT scan are head injuries, abdominal pain, and headache. Scans for abdominal pain saw the biggest increase, much of that is due to improvements in the technology. Researchers say abdominal CT imaging went from almost never being used in 1995 to being used in up to 21% of visits in the last four years of the study.

"In 1995, abdominal CT took much longer, the resolution was not as good and the research hadn't been done to support it," Larson said. "By 2008, helical scanning had helped make CT very useful for abdominal imaging. It's widely available, it's fast and there are a lot of great reasons to do it, but it does carry a higher radiation dose."

According to Larson, the radiation dose in abdominal CT's is up to seven times that of a CT of the head.

Dr. James Chamberlain, division chief, Emergency Medicine & Trauma Services at Children's National Medical Center in Washington, D.C., says this is an incredibly important study because it confirms on a national level that parents are more likely to push for these scans and doctors are willing to perform them. "Doctors are afraid of missing things, afraid of missing a diagnosis. They are afraid of malpractice and parents are more likely to advocate for their children than they were 10-15 years ago."

But Chamberlain says the data are also troubling because there are downsides to these scans.

"This study needs to be widely publicized as part of a public education campaign to have people question their doctors: Does my child really need a CT scan? This study is alarming and should make all of us very concerned about radiation and children's' brains and abdomens," he said. "Hospitals should be examining their practices, they should be benchmarking individual doctors against each other and against national standards and they should be assuring that appropriate doses of radiation are used for children."

According to Chamberlain, a lot of non-pediatric hospitals don't alter their doses appropriately for children. He says the two main issue are the skill and comfort level of the radiologist interpreting the CT scan and the dose of radiation that is administered during that scan.

Chamberlain says the vast majority of CT's are normal and that criteria have already been developed on who actually needs one for a head injury. Those patients include people who have been unconscious, have a deformed head, are vomiting, suffered a severe injury such as being in a car that has rolled over. The setting of criteria for abdominal scans is under way.

There is a movement toward safer imaging. The Alliance for Radiation Safety in Pediatric Imaging has kicked off a national campaign called "Image Gently," the  goal of which is to increase awareness about lowering radiation doses in children, and harness the expertise of pediatric hospitals to teach non-pediatric hospitals how to use the appropriate dosages of radiation. Chamberlain is participating in a national study that is trying to try to determine rules for how doctors order CT scans and cut down on overuse.

soundoff (45 Responses)
  1. John

    But how will they pay for the machines if they're forced to stop overusing them?

    April 5, 2011 at 11:19 | Report abuse | Reply
  2. Frankie

    I dont see why they are going to stop over using the machines. is it just cause of the radiation or what?

    April 5, 2011 at 11:49 | Report abuse | Reply
    • kirstyloo

      Exactly. My 11 mo daughter had a head CT (standard version not pediatric version) last year after falling a little over 2 feet. We didn't have any indication that she hit her head, but we took her to the ER just in case because we were scared parents and my Ped wouldn't see her. Despite seeming fine, the Dr ordered a head CT scan with little in the way of informed consent...and as scared parents we consented. My daughter's little head got the same amount of radiation to look for a major brain bleed as an adult male will a pin point tumor would get. The estimated life time risk of a cancer death from the procedure is in 1 in 1500. That number doesn't include her risk of getting cancer that doesn't kill her or that head CTs have been linked to decreased IQ. There are 4 existing guidelines in the US and Britian...and none of them indicated that she should she have had a head CT. She should have simple been watched for a few hours. While there are clear indications where CTs are medically justified, they are clearly being over used (as noted above). And they shouldn't be over used because of the risks...and costs.

      April 5, 2011 at 14:29 | Report abuse |
  3. PennyNot

    If parents want to advocate for their children, they should find out what caused the belly ache before running off to the ER. Bad diet, lack of exercise, stress, none of these require visits to the ER. How many were uninsured and couldn't go to a regular doctor. CT scans for a non injury related belly ache seem awfully overkill.

    April 5, 2011 at 13:00 | Report abuse | Reply
    • kirstyloo

      An abdominal CT scan is one way to identify an appendicitis. It isn't used for little issues.

      April 5, 2011 at 14:32 | Report abuse |
    • pediatricerdoc

      nowadays, ultrasound is preferred over CT scan for diagnosis of appendicitis in pediatric ERs. ultrasounds are safer because there is no exposure to radiation. also, abdominal pain as the sole presenting symptom of appendicitis is uncommon – often there is also fever, vomiting, and an abnormal physical exam. many children get CT scans of their abdomen for abdominal pain without associated symptoms and get transferred to my hospital with negative scans for further workup, or incidental findings on CT scans that are unrealated to their abdominal pain. these kids are exposed to large doses of radiation unnecessarily.

      April 5, 2011 at 17:20 | Report abuse |
    • Schlebe

      Couldn't agree more. Overutilization of the ER for non-emergent things is now just commonplace with families. As for the diagnosis of appendicitis, it is a clinical diagnosis 90% of the time, CT should be reserved for those with abdominal symptoms and normal appendix ultrasound. Parents don't realize that doctors in general are forced to do things due to increased lawsuits for missed diagnosis'. It's the worst thing that has happened to medicine over the past century. Attorneys dictating what should and shouldn't be done to diagnose, treat, and care for patients. Can anyone say Tort Reform?

      April 6, 2011 at 14:31 | Report abuse |
  4. memee

    Back in the day prior to defensive medicine, appendicitis was diagnosed without a Cat Scan. You could determine if a nasogastric tube was in the right place without an xray. It is not just radation. Many abdominal cat scans require oral and IV contrast, which requires IV access. Many small children and children with developmental disorders cannot lie still, which requires repeating the scan, which increase the radiation exposure, or sedating them, which increases the risk of a negative reaction, or death. Many parents don't understand any of this, they just demand it, and doctors who practice defensive medicine give in so their Press-Ganey scores don't look bad. Just like parents or adult patients demanding an antibiotic for a "cold" and now we have a problem with antibiotic resistance.

    April 5, 2011 at 13:17 | Report abuse | Reply
    • thirdparty

      This is so true. Hospital administrators worship Press-Gainey surveys filled out by patients. If a doctor or his department gets bad survey results even from a handfull of patients the administration comes down on them. The problem is usually the only people who fill out those surveys are the ones who think that they didn't get good care. If a patient wants a CT scan or antiobiotics and the ER doctor doesn't give it to them the patient fills out the survey with a bad review and admimistration puts pressure on the doctor to improve his Press-Gainey scores.

      April 5, 2011 at 15:47 | Report abuse |
  5. kat

    I work in an ER & many times I've seen a child or young adult who comes in after a bump on the head (he hit it on open door/she leaned over bed & hit bedside table,etc), sometimed injury is greater than 24 hrs old, but parent demands ct. The parent states 'I don't care' when I or other providers try to discuss risk/benefit ratio of test/radiaton with they. Out of all ct's that I've been forced to do by a parent, 100% have been normal. I support abdominal guidelines & do use head guidelines, yet many parents will not listen.

    April 5, 2011 at 13:37 | Report abuse | Reply
  6. Dave Fisher

    The improvements in CT technology over the past 15 years have provided tremendous benefit to patients. Still, ensuring the appropriate use of CT scans is critical to reducing unnecessary exposure to radiation, particularly for children. To promote the safe and effective use of pediatric CT, many of our members at the Medical Imaging & Technology Alliance (MITA) are involved in the Image Gently campaign, helping to raise awareness about methods to reduce radiation dose during pediatric medical imaging exams.

    Beyond pediatrics, MITA’s commitment to reducing exposure to unnecessary radiation also includes the expansion and promotion of appropriateness criteria, used to guide physicians in making the optimal imaging and treatment decisions for all of their patients. As the author notes in this article, today, CT scans can quickly create clear images for immediate interpretation and diagnosis. This is critical when time is short and lives are in the balance. Our members remain dedicated to ensuring that physicians and technicians are properly trained, so that CT and other imaging technologies are used correctly, no child or adult is put at risk and patients continue to benefit from this life-saving technology.

    -Dave Fisher, Executive Director, Medical Imaging & Technology Alliance

    April 5, 2011 at 18:13 | Report abuse | Reply
  7. Kennedy

    This is a very important finding becuase many kids are recieving high doses of radiaiotion because of overuse...The cost of a machine should not matter; we have to make more responsible decisions as a society.

    April 14, 2011 at 15:21 | Report abuse | Reply
  8. Amanda

    I am a 22 year old first time mom, and I had an incident recently were I thought my infant (two month old boy) was having seizure's. I kinda panicked and brought him to the E.R. I had briefly looked up the tests they might perform on him, and came to the conclusion that an mri and eeg were what I would consent to.... but when I got there. It was like a fire drill, they rushed him in and said that they wanted to perform a spinal tap and a ct scan... I started to object saying "what about an mri can't we do that?" The doctor said "No, that takes too long." I was so freaked out by the way they were acting, I consented. I didn't know the full gravity of the situation or how harmful ct scans actually were, and they did not tell me the risks... they acted like it was no big deal... I wish I had been told of the risks, because then I could've stood up for my little boy and demanded an mri instead. He's just so young and now I am heavily burdened with grief. I eat organic and I didn't even take tums or tylenol while pregnant... this really hurts me that I did a 180 like this... I'm not a big fan of medical intervention unless absolutely necessary. This sucks!

    July 29, 2011 at 02:43 | Report abuse | Reply
  9. Amanda

    I just wanted to add.... He wasn't having seizure's. Which was found out later from the eeg. What I don't get is why would they do tests to see why he's having seizure's before doing tests to see if he's even having seizure's?

    July 29, 2011 at 02:49 | Report abuse | Reply
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