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Assessing and conveying risks and benefits of imaging in neonates using ionizing radiation and sedation/anesthesia
Gary R Schooler1, Joseph P Cravero2, Michael J Callahan3
1Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA. gary.schooler@utsouthwestern.edu.
Insights
Choosing between CT and MRI for neonates involves balancing risks. CT may offer a better benefit-to-risk ratio when sedation is needed for MRI, but the best imaging choice requires careful patient consideration.
Area of Science:
- Medical Imaging
- Neonatal Care
- Pediatric Radiology
Background:
- Neonates are a vulnerable population requiring specialized imaging considerations.
- Computed tomography (CT) involves ionizing radiation, while magnetic resonance imaging (MRI) may necessitate sedation/anesthesia.
- Both modalities carry risks that must be weighed against diagnostic benefits in neonates.
Purpose of the Study:
- To review the risks associated with CT (ionizing radiation) and MRI (sedation/anesthesia) in neonates.
- To compare the benefit-to-risk ratios of CT and MRI in the neonatal population.
- To guide the selection of appropriate advanced cross-sectional imaging for neonates.
Main Methods:
- Review of perceived risks of ionizing radiation from CT.
- Review of concrete risks of sedation/anesthesia for MRI in term and preterm neonates.
- Analysis of imaging paradigms in the context of neonatal susceptibility.
Main Results:
- CT and MRI may have similar diagnostic yields in neonates.
- CT may present a higher benefit-to-risk ratio when sedation is required for MRI but not for CT.
- Individual patient factors and multidisciplinary discussions are crucial.
Conclusions:
- The choice between CT and MRI in neonates requires careful consideration of individual patient needs and potential risks.
- In cases with similar diagnostic yield where MRI requires sedation, CT might be preferable due to a better benefit-to-risk profile.
- Informed discussions among radiology, anesthesia, neonatology, and caregivers are essential for optimal imaging modality selection.
Abstract:
Neonates represent a unique subset of the pediatric population that requires special attention and careful thought when implementing advanced cross-sectional imaging with CT or MRI. The ionizing radiation associated with CT and the sedation/anesthesia occasionally required for MRI present risks that must be balanced against the perceived benefit of the imaging examination in the unique and particularly susceptible neonatal population. We review the perceived risks of ionizing radiation and the more concrete risks of sedation/anesthesia in term and preterm neonates in the context of an imaging paradigm. When the expected diagnostic yield from CT and MRI is similar, and sedation is required for MRI but not for CT, CT likely has the higher benefit-to-risk ratio in the neonate. However, despite the risks, the most appropriate imaging modality should always be chosen after thoughtful consideration is given to each unique patient and informed discussions including radiology, anesthesia, neonatology and the parents/caregivers are pursued.
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