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Published on: September 11, 2011
Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan
Michael J LaQuaglia1, Melissa Anderson, Catherine J Goodhue
1From the Division of Pediatric Surgery (M.J.L., R.S., S.O., D.B.), Children's Hospital Los Angeles; Department of Surgery (M.J.L., R.S., S.O., D.B.), Keck School of Medicine, University of Southern California; Division of Pediatric Surgery (M.A., C.J.G., M.B.-D.) and Department of Radiology (L.L., P.S.), Children's Hospital Los Angeles; Department of Radiology (L.L., P.S.), Keck School of Medicine, University of Southern California; and Division of Emergency and Transport Medicine (P.P.C.), Children's Hospital Los Angeles, California.
Insights
Pediatric trauma centers deliver lower head CT radiation doses to injured children compared to adult general hospitals. Implementing standardized protocols can optimize radiation safety for pediatric head CT scans.
Area of Science:
- Pediatric Radiology
- Medical Imaging Safety
- Radiation Oncology
Background:
- Head computed tomography (CT) radiation doses vary significantly across institutions for head-injured children.
- This variability poses risks of excess radiation exposure and potential long-term malignancy.
- Comparing radiation doses between pediatric trauma centers (PTCs) and adult general hospitals (AGHs) is crucial for patient safety.
Purpose of the Study:
- To compare radiation doses from head CTs in head-injured children at a PTC versus AGHs.
- To determine if PTCs deliver significantly lower radiation doses than AGHs for similar injury profiles.
Main Methods:
- Retrospective review of head CT scans in patients under 18 with head injuries.
- Analysis of demographic and clinical data, including volumetric CT dose index (CTDIvol) and dose-length product (DLP).
- Comparison of radiation doses using bivariate and multivariable linear regression, adjusting for age, weight, and sex.
Main Results:
- Mean radiation dose was significantly lower at the PTC (CTDIvol 20.3/DLP 408.7) compared to AGHs (CTDIvol 30.6/DLP 533).
- This dose reduction was consistent regardless of whether the AGH was a trauma center.
- Children receiving a second CT at the PTC after an initial scan at an AGH also received lower radiation doses.
Conclusions:
- Head-injured children consistently receive lower radiation doses during initial head CTs at PTCs compared to AGHs.
- Findings support developing protocols to minimize radiation exposure in pediatric head CTs.
- Optimizing radiation delivery is essential for reducing long-term health risks in children.
Background:
When head injured children undergo head computed tomography (CT), radiation dosing can vary considerably between institutions, potentially exposing children to excess radiation, increasing risk for malignancies later in life. We compared radiation delivery from head CTs at a level 1 pediatric trauma center (PTC) versus scans performed at referring adult general hospitals (AGHs). We hypothesized that children at our PTC receive a significantly lower radiation dose than children who underwent CT at AGHs for similar injury profiles.
Methods:
We retrospectively reviewed the charts of all patients younger than 18 years who underwent CT for head injury at our PTC or at an AGH before transfer between January 1 and December 31, 2019. We analyzed demographic and clinical data. Our primary outcome was head CT radiation dose, as calculated by volumetric CT dose index (CTDIvol) and dose-length product (DLP; the product of CTDIvol and scan length). We used unadjusted bivariate and multivariable linear regression (adjusting for age, weight, sex) to compare doses between Children's Hospital Los Angeles and AGHs.
Results:
Of 429 scans reviewed, 193 were performed at our PTC, while 236 were performed at AGHs. Mean radiation dose administered was significantly lower at our PTC compared with AGHs (CTDIvol 20.3/DLP 408.7 vs. CTDIvol 30.6/DLP 533, p < 0.0001). This was true whether the AGH was a trauma center or not. After adjusting for covariates, findings were similar for both CTDIvol and DLP. Patients who underwent initial CT at an AGH and then underwent a second CT at our PTC received less radiation for the second CT (CTDIvol 25.6 vs. 36.5, p < 0.0001).
Conclusions:
Head-injured children consistently receive a lower radiation dose when undergoing initial head CT at a PTC compared with AGHs. This provides a basis for programs aimed at establishing protocols to deliver only as much radiation as necessary to children undergoing head CT.
Level Of Evidence:
Care Management/Therapeutic, level IV.
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