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Radiation from CT scans in paediatric trauma patients: Indications, effective dose, and impact on surgical decisions
Michael H Livingston1, Ana Igric, Kelly Vogt
1Division of General Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada.
Insights
Computed tomography (CT) scans deliver significant radiation doses to pediatric trauma patients, averaging 13.5 mSv per patient. Careful consideration of CT scan indications is crucial, especially for non-resuscitation imaging in severe trauma cases.
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Radiation Dosimetry
Background:
- Computed tomography (CT) is essential for diagnosing severe injuries in pediatric trauma patients.
- Assessing radiation exposure from CT scans is critical due to potential long-term health risks in children.
Purpose of the Study:
- To determine the effective radiation dose from CT scans in pediatric trauma patients.
- To explore the indications and subsequent actions resulting from CT scans in this population.
Main Methods:
- Retrospective review of pediatric trauma patients (January 2007-December 2008) at a Canadian level 1 trauma center.
- Inclusion of all CT scans during resuscitation, hospital stay, and up to 6 months post-trauma.
- Calculation of effective dose using dose length product and age/region-specific conversion factors.
Main Results:
- 157 pediatric trauma patients identified; 133 underwent at least one CT scan.
- Average radiation dose was 13.5 mSv per patient, 4.5 times background levels.
- CT of the body (chest/abdomen/pelvis) yielded the highest effective dose; most scans led to no further action or additional imaging.
Conclusions:
- CT scans represent a substantial source of radiation exposure for pediatric trauma patients.
- Clinical judgment regarding CT indications, particularly for non-resuscitation scans, is vital.
- Development of evidence-based algorithms is needed to guide appropriate imaging selection in severe multisystem trauma.
Objectives:
The purpose of this study was to determine the effective dose of radiation due to computed tomography (CT) scans in paediatric trauma patients at a level 1 Canadian paediatric trauma centre. We also explored the indications and actions taken as a result of these scans.
Patients And Methods:
We performed a retrospective review of paediatric trauma patients presenting to our centre from January 1, 2007 to December 31, 2008. All CT scans performed during the initial trauma resuscitation, hospital stay, and 6 months afterwards were included. Effective dose was calculated using the reported dose length product for each scan and conversion factors specific for body region and age of the patient.
Results:
157 paediatric trauma patients were identified during the 2-year study period. Mean Injury Severity Score was 22.5 (range 12-75). 133 patients received at least one CT scan. The mean number of scans per patient was 2.6 (range 0-16). Most scans resulted in no further action (56%) or additional imaging (32%). A decision to perform a procedure (2%), surgery (8%), or withdrawal of life support (2%) was less common. The average dose per patient was 13.5mSv, which is 4.5 times the background radiation compared to the general population. CT head was the most commonly performed type of scan and was most likely to be repeated. CT body, defined as a scan of the chest, abdomen, and/or pelvis, was associated with the highest effective dose.
Conclusions:
CT is a significant source of radiation in paediatric trauma patients. Clinicians should carefully consider the indications for each scan, especially when performing non-resuscitation scans. There is a need for evidence-based treatment algorithms to assist clinicians in selecting appropriate imaging for patients with severe multisystem trauma.
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