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Updated: Mar 23, 2026
X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
Published on: September 11, 2011
Imaging before transfer to designated pediatric trauma centers exposes children to excess radiation
Yana Puckett1, Louis Bonacorsi, Matthew Caley
1From the Departments of Pediatric Surgery (Y.P., L.B., C.F., K.C., Y.G., D.W.V.), and Pediatric Radiology (M.C., J.F.), Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri.
Insights
Pediatric trauma patients often receive excess radiation from imaging before transfer to trauma centers. Adhering to Advanced Trauma Life Support (ATLS) guidelines can reduce unnecessary radiation exposure in pediatric imaging.
Area of Science:
- Medical Imaging
- Pediatric Traumatology
- Radiation Oncology
Background:
- Pediatric trauma patients frequently undergo imaging at originating hospitals before transfer to pediatric trauma centers (PTCs).
- Increasing computed tomography (CT) use raises concerns about radiation-induced malignancy risk.
- PTCs often implement radiation dose reduction strategies.
Purpose of the Study:
- To investigate whether pediatric trauma patients are exposed to excess ionizing radiation from imaging performed at originating hospitals prior to transfer.
- To compare radiation doses delivered at originating hospitals versus PTCs.
Main Methods:
- Retrospective review of 1,383 CT scans from 673 pediatric trauma patients transferred to a Level I PTC (2010-2014).
- Analysis included demographics, imaging type, necessity, appropriateness (Advanced Trauma Life Support - ATLS criteria), and radiation dose (dose-length product - DLP).
- Comparative analysis of DLP between originating hospitals (OH) and PTCs, excluding specific CT scan types due to data limitations.
Main Results:
- Mean DLP was 54% lower at PTCs compared to OH across all analyzed scans.
- Significant dose reductions observed for CT of the abdomen/pelvis (51%) and head (62%) at PTCs.
- Children received substantial excess radiation doses at OH, particularly for scans deemed unnecessary or not fully meeting ATLS criteria.
Conclusions:
- Imaging at transferring institutions often exceeds recommended ionizing radiation dosages and may not align with ATLS guidelines.
- The findings support prompt patient transfer without unnecessary imaging delays.
- Implementing pediatric radiation reduction strategies at PTCs significantly lowers radiation exposure compared to originating hospitals.
Background:
Pediatric trauma patients transferred to pediatric trauma centers (PTCs) often have imaging at the originating hospital (OH). The increased use of computed tomography (CT) raises concerns about malignancy risk from ionizing radiation leading many PTCs to adopt radiation dose reduction strategies. We hypothesized that pediatric trauma patients are exposed to excess radiation from imaging before transfer.
Methods:
A retrospective review of 1,383 scans was performed on all trauma patients with CT imaging before transfer to our Level I PTC from 2010 to 2014. Demographics, type of imaging, necessity for repeat imaging, appropriateness of imaging, and radiation dose delivered were recorded. Comparative radiation dosing was calculated using the dose-length product (DLP [expressed in mGy-cm]). All CT scans except for CT of the abdomen and pelvis and CT of the head were excluded for complete DLP data issues. Scans were considered clinically appropriate if they met Advanced Trauma Life Support (ATLS) recommendations (ATLS+) and not indicated if they did not meet ATLS criteria (ATLS-). Some scans were repeated because of technical issues. Median ΔDLP represents the difference in dose patients received at OH versus at PTC.
Results:
A total of 673 patients were analyzed. Average age was 11 years, and 65.4% were male. Mean DLP at PTC was 54% lower for all analyzed scans compared with OH (p < 0.0001). DLP at PTC was 51% lower for CT of the abdomen and pelvis and 62% lower for CT of the head. Children received excess dose of 578.62 mGy-cm for scans at OH that were unnecessary. For ATLS+ imaging, children received a median excess of 444.42 mGy-cm of radiation at OH than they would have received had the scans been performed at PTCs using pediatric radiation reduction strategies.
Conclusion:
Pediatric trauma imaging performed at transferring institutions often does not adhere to ATLS recommendations and exceeds required ionizing radiation dosages. This study further confirms ATLS recommendations supporting prompt patient transfer without delay for imaging.
Level Of Evidence:
Therapeutic study, level IV.
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