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[Chest computed tomography in children: indications, efficiency and effective dose]
C Mordacq1, A Deschildre1, L Petyt2
1Service de pneumologie et allergologie pédiatriques, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
Insights
Chest CT aids pediatric lung disease diagnosis and management, but radiation exposure is a concern. Lower radiation doses were observed with newer CT technology, highlighting the need for dose reduction strategies in pediatric imaging.
Area of Science:
- Pediatric Pulmonology
- Radiology
- Medical Imaging
Background:
- Advancements in multidetector row computed tomography (CT) have expanded its use in diagnosing pediatric respiratory diseases.
- Computed tomography (CT) involves radiation exposure, a significant concern in pediatric patients due to their increased sensitivity and longer life expectancy.
Purpose of the Study:
- To evaluate the primary indications for chest CT in pediatric pulmonology.
- To assess the diagnostic and management contributions of chest CT in children.
- To analyze the radiation doses associated with pediatric chest CT examinations.
Main Methods:
- An observational, prospective study included 135 children undergoing chest CT from November 2009 to April 2010.
- Data collected included demographics, CT findings, diagnostic/management contributions, and radiation doses (dose-length product and effective dose).
- Radiation doses were compared across different CT scanners (128-slice dual-source, 64-slice single-source) and institutions.
Main Results:
- The main indications for chest CT were bronchial disease (44%), infectious disease (16%), and interstitial disease (14%).
- Chest CT directly contributed to diagnosis in 48% of diagnostic scans and 38% of follow-up scans, and to treatment in 24% and 19% of cases, respectively.
- Effective radiation doses were significantly lower with the 128-slice CT (0.61 mSv) compared to 64-slice CT (1.24 mSv) and scans performed outside the university hospital (2.56 mSv).
Conclusions:
- Chest CT plays a crucial role in diagnosing and managing pediatric lung diseases.
- Minimizing radiation exposure is paramount in pediatric CT due to increased radiosensitivity and long-term risks.
- Significant variations in radiation doses necessitate concerted efforts by radiologists and pediatricians to reduce exposure in children.
Introduction:
New multidetector row computed tomography (CT) has made the imaging of younger children more feasible and extending CT indications to a wide range of pediatric respiratory diseases in the last few years. However, CT is a source of radiation exposure. The aim of this study was to evaluate the main indications and the contribution of chest CT in pediatric pulmonology as well as induced radiation.
Methods:
This was an observational, prospective study. Children whose chest CTs were analyzed during multidisciplinary meetings (radiologist, pulmonary pediatrician) were included from November 2009 to April 2010. We collected demographic data, CT results, contribution of CT to diagnosis and management, and radiation doses (dose-length product [DLP] and effective dose). Radiation doses were compared according to the CT scans (Lille University Hospital with 128-slice dual-source CT or Lille University Hospital single-source 64-slice CT, or CT performed outside the university hospital).
Results:
One hundred thirty-five patients were included. The mean age was 6.4 years old. The main indications were analysis of bronchial disease (44%), infectious disease (16%), interstitial disease (14%), or a malformation (9%). The aim of CT was diagnosis (61%) or follow-up of previous lung diseases (39%). Diagnosis chest-CT directly contributed to diagnosis in 48% of cases and to treatment in 24%. Follow-up CT contributed to diagnosis in 38% and treatment in 19% of cases. DLP and effective doses were significantly lower for CT performed in the university hospital, especially with the 128-slice CT compared to the others (P<0.001). The effective doses were: 128-slice CT, 0.61 mSv ± 0.32; 64-slice CT, 1.24 mSv ± 0.97; outside university hospital, 2.56 mSv ± 1.98.
Conclusion:
This study confirms the role played by chest CT in children, which contributes to diagnosis and management of lung diseases. The main concern of CT application, especially in children, is the radiation burden. Children are more susceptible to the effects of radiation than adults and have a longer life expectancy to develop complications. Both radiologists and pediatricians should be aware of a potential risk and have to conjugate their efforts in reducing this risk. The wide range of radiation doses in this study for the same CT procedures underlines the extensive efforts still needed to limit radiation exposure in children.
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