Additional vertebrae are imaged in 44% of pediatric patients when limited CTs are ordered: a pilot study

To determine how often physician-ordered limited CTs in pediatric spine patients are not followed, and if this leads to excess radiation.

Single-center retrospective review of a tertiary pediatric spine practice.

CT scans ordered for specific vertebrae (e.g., L4-5) Exclusion: generalized regions (cervical, thoracic, lumbar). Demographics, CT orders and scans, and radiation data were obtained from electronic records. A vertebra was considered imaged only if the entire vertebral body was imaged. Analyses used descriptive statistics, chi-square tests, and one-way ANOVA with Tukey-adjusted post-hoc pairwise comparison.

93 patients (mean age 16.1 ± 3.4) with 121 CT scans met criteria. In 53 (44%) CTs, more vertebrae were imaged than ordered, yielding a mean of 2.1 times more radiation. Scans occurred at 30 sites. A tertiary medical center with a new limited CT protocol performed 61 (50.4%) scans, with 49.2% scanning additional vertebrae. A private network of 3 outpatient imaging centers with established imaging protocols performed 26 scans, with 3.8% scanning additional vertebrae. The remaining 34 scans were performed at 23 external sites, with 64.7% scanning additional. The imaging center was significantly associated with additional vertebrae imaging frequency (X² = 23.6, P = 0.0002).

44% of patients with limited CT scans of the spine had additional vertebrae scanned compared to what was ordered. This corresponded to an estimated mean of twice the intended radiation dose. Limited CTs at centers with established imaging protocols do not image additional vertebrae in > 96% of patients. Pediatric spine centers should look to develop specific limited CT protocols to help decrease radiation exposure.