Children’s Hospitals Are Shifting Away from CT Use to Other Imaging Tools

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Compared to 10 years ago, hospitalized children are significantly less likely to receive computerized tomography (CT) scans for common pediatric diagnoses, and more likely to receive magnetic resonance imaging (MRI) and ultrasound imaging, neither of which use ionizing radiation.

Researchers from leading children’s hospitals published these findings online in Pediatrics on Aug. 24, and in the journal’s September print issue. The study team analyzed records of over 150,000 children admitted to 33 U.S. pediatric hospitals from Jan. 2004 to Dec. 2012. The data were obtained from the Pediatric Health Information System of the Children’s Hospital Association.

“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, MBA, MSHP, a co-author of the study.

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.

The study team attributed the shift in imaging tools to accumulating evidence linking ionizing radiation from CT scans to increased cancer risk, as well as to growing confidence in and ability to perform the alternate types of imaging, such as MRI and ultrasound. In addition, the increasing use of electronic health records may expedite the transference of imaging data between centers, reducing the use of duplicate scans.

Ionizing radiation is the high-energy type of radiation used in conventional X-rays and at higher dosages in CT scans. Ionizing radiation does not occur in MRIs or ultrasounds. “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,” said Fieldston.

He 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 Fieldston were from Cincinnati Children’s Hospital Medical Center; Children’s Medical Center, Dallas; and the Children’s Hospital Association.