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Published on: September 11, 2011
The Clinical Impact of a Web-Based Image Repository on Radiation Exposure in Injured Children
Rosemary Nabaweesi1, Raghu H Ramakrishnaiah2, Mallikarjuna R Rettiganti1
1Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Arkansas Children's Research Institute, Little Rock, Arkansas.
Insights
A web-based image repository (WBIR) reduced repeat CT scans in transferred injured children, lowering radiation exposure. This technology is especially beneficial for pediatric trauma centers and head imaging.
Area of Science:
- Medical Imaging
- Pediatric Radiology
- Radiation Safety
Background:
- Children face higher cancer risks from radiologic imaging due to increased radiation sensitivity and longer lifetime exposure.
- Repeat CT scans are common for injured children transferred between hospitals, leading to cumulative radiation doses.
Purpose of the Study:
- To evaluate the impact of a statewide web-based image repository (WBIR) on reducing repeat CT imaging in transferred injured children.
- To assess the effectiveness of WBIR in minimizing radiation exposure for pediatric patients.
Main Methods:
- A comparative study analyzed injured children undergoing CT scans before (2010) and after (2013) WBIR implementation at a pediatric trauma center (PTC).
- Patient demographics, injury severity, scan region, and ED disposition were examined.
- The rate of repeat imaging at the PTC was compared between the pre-WBIR and post-WBIR periods.
Main Results:
- Repeat imaging at the PTC decreased from 33% pre-WBIR to 20% post-WBIR (OR 0.54, P = .005).
- Significant reductions were observed in head CT repeat imaging (60% to 33%).
- Repeat imaging was less frequent after WBIR implementation for children transferred from Level II and III trauma centers.
Conclusions:
- The WBIR effectively reduced repeat imaging in transferred injured children, particularly those from lower-level trauma centers and with initial head scans.
- The reduction in repeat imaging is expected to yield significant radiation dose savings for children.
- Implementing WBIR is a promising strategy for improving radiation safety in pediatric trauma care.
Purpose:
The long-term cancer risks for children exposed to radiologic images can be two to three times higher than for adults because children are more sensitive to radiation and have a longer lifetime in which to accumulate exposure from CT scans. Injured children often undergo repeat CT imaging if they are transferred from non-pediatric hospitals to a Level I pediatric trauma center (PTC). This study determined the impact of a statewide web-based image repository (WBIR) on repeat imaging among transferred injured children.
Methods:
All injured children who underwent CT imaging and were transferred to the PTC in 2010 (pre-WBIR) and 2013 (post-WBIR) were included. Patient-level factors studied included demographics, body region of scan, Injury Severity Score, and Emergency Department (ED) disposition. Change from pre to post on rate of repeat imaging was assessed.
Results:
Two hundred fifty-four and 233 children, with a median age of 7.3 years, were transferred to the Children's Hospital in 2010 and 2013, respectively. Repeat imaging levels at the PTC were lower post-WBIR than pre-WBIR (20% versus 33%, odds ratio [OR] 0.54, P = .005). Images of the head decreased most significantly (60% versus 33%, OR 0.33). Images performed at Level II and III trauma centers were repeated less often after WBIR.
Conclusions:
The WBIR significantly reduced repeat imaging among injured children transferred to a PTC, especially children transferred from Level II and Level III trauma centers, children with lower-acuity injuries, and children with initial scans of the head. Radiation savings are expected to be beneficial to children.
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