I just recently read two articles on the risks of radiation exposure through CT scans in children - one on-line via Fox News, and one in the local Washington Post newspaper.
A 20 year study was recently published combining data from the US, Canada and Great Britain. The results show that exposure in childhood to the radiation equivalent of 2-3 Head CT scans can triple the risk of developing brain cancer later in life, and a child exposed to 5-10 CT scans is three times as likely to develop leukemia than a child who had no scans done.
Children are more sensitive to radiation than adults due to growing bones and tissues, as well as their relatively lower body weights.
This is sobering information that doctors have been alerted to for awhile -- I have been to several conferences at which childhood radiation exposure was discussed, from X rays to CT scans. A CT scan gives great definition, and is useful in looking for bleeds (in the case of head trauma) and solid tumors. Many emergency rooms use CT scans as part of an evaluation of abdominal pain, when the diagnosis of appendicitis is entertained, but not clear cut. Yes, doctors do sometimes practice defensive medicine, but no one wants to miss the appendicitis, the brain tumor or a devestating bleed from a case of head trauma in an otherwise healthy child.
There are alternatives: ultrasound exams do not expose one to radiation, and an MRI (Magnetic Resonance imaging) exam may give great definition of some structures without radiation. An MRI is typically more expensive, may be denied by your insurance company, and requires your child to remain motionless for a more prolonged period of time.
Many experts have weighed in on either side. Per Dr. Raymond Sze at Children's Hospital in Washington DC, "If the benefit to the child is greater than the theoretical risk, then (the CT scan) is appropriate".
A campaign called Image Gently is designed to alleviate concerns of providers and parents, and reduce radiation exposure through greater education. In addition to recommending that scans only be performed when medical benefits are clear, it also recommends limited scanning -- only the area of the body absolutely necessary. Image Gently also recommends evaluation of other imaging modalities like ultrasound and MRI. Donald Frush, chairman of the American College of Radiology's pediatric radiology commission, has said "People need to ask: Is it necessary? Can you do another test, such as an MRI? Can you wait a couple of days?"
Doctors suggest parents discuss CTs with the ordering provider and act as advocates for the children by asking if facilities take steps to reduce radiation exposure in children.
As a parent, I do understand the concerns of exposing one's child to radiation unnecessarily. At the same time, I am a doctor, and need to weigh the risks and benefits with my parents whenever I am ordering studies of any kind.
