J Korean Med Assoc.  2011 Dec;54(12):1277-1283. 10.5124/jkma.2011.54.12.1277.

Medical radiation exposure in children and dose reduction

Affiliations
  • 1Department of Radiology, Kangnam Sacred Heare Hospital, Seoul, Korea. jeanjung@medimail.co.kr

Abstract

Medical imaging is an indispensible diagnostic tool in modern medicine enabling fast and accurate diagnosis. However, recent technological advances in medical equipment and increased utilization of the imaging modality have resulted in a significant increase in the exposure to ionizing radiation. The risk from radiation must be carefully considered in all examinations using ionizing radiation, especially in children. The risk of cancer in children from radiation exposure is higher than adults because pediatric patients are more radiosensitive and have more years ahead in which cancerous changes might occur. Therefore, pediatric protocols specifically designed for children must be used. However, many exams are still conducted using inappropriate adult protocols, which can result in excessive radiation. The most efficient way to reduce radiation is to avoid the examination if not justified. It has been suggested that one third to one half of pediatric CT exams are unnecessary or replaceable by other imaging modalities. If the exam is justified, then the parameters must be optimized to the imaging indication, scan area, body size, age, or weight of the patient according to the "as low as reasonably achievable" (ALARA) principle. The physician should always assess the radiation risk-benefit for each patient before ordering an examination using radiation.

Keyword

Radiation; Child; Computed tomography; Justification; Optimization

MeSH Terms

Adult
Body Size
Child
Diagnostic Imaging
History, Modern 1601-
Humans
Radiation, Ionizing

Cited by  1 articles

Strategies of computed tomography radiation dose reduction: justification and optimization
Kyung-Hyun Do, Dong-Wook Sung
J Korean Med Assoc. 2015;58(6):534-541.    doi: 10.5124/jkma.2015.58.6.534.


Reference

1. National Council on Radiation Protection and Measurements. Ionizing radiation exposure of the population of the United States. 2009. Bethesda (MD): National Council on Radiation Protection & Measurements.
2. Brenner DJ, Hall EJ. Computed tomography: an increasing source of radiation exposure. N Engl J Med. 2007. 357:2277–2284.
Article
3. Brody AS, Frush DP, Huda W, Brent RL. American Academy of Pediatrics Section on Radiology. Radiation risk to children from computed tomography. Pediatrics. 2007. 120:677–682.
Article
4. Mettler FA Jr, Wiest PW, Locken JA, Kelsey CA. CT scanning: patterns of use and dose. J Radiol Prot. 2000. 20:353–359.
Article
5. Dorfman AL, Fazel R, Einstein AJ, Applegate KE, Krumholz HM, Wang Y, Christodoulou E, Chen J, Sanchez R, Nallamothu BK. Use of medical imaging procedures with ionizing radiation in children: a population-based study. Arch Pediatr Adolesc Med. 2011. 165:458–464.
6. Larson DB, Johnson LW, Schnell BM, Goske MJ, Salisbury SR, Forman HP. Rising use of CT in child visits to the emergency department in the United States, 1995-2008. Radiology. 2011. 259:793–801.
Article
7. Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001. 176:289–296.
Article
8. National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. 2006. Washington DC: National Academies Press.
9. Goske MJ, Phillips RR, Mandel K, McLinden D, Racadio JM, Hall S. Image gently: a web-based practice quality improvement program in CT safety for children. AJR Am J Roentgenol. 2010. 194:1177–1182.
Article
10. Hernanz-Schulman M, Goske MJ, Bercha IH, Strauss KJ. Pause and pulse: ten steps that help manage radiation dose during pediatric fluoroscopy. AJR Am J Roentgenol. 2011. 197:475–481.
Article
11. Sidhu M, Goske MJ, Connolly B, Racadio J, Yoshizumi TT, Strauss KJ, Coley BD, Utley T. Image Gently, Step Lightly: promoting radiation safety in pediatric interventional radiology. AJR Am J Roentgenol. 2010. 195:W299–W301.
Article
12. Sidhu M. Radiation safety in pediatric interventional radiology: Step Lightly. Pediatr Radiol. 2010. 40:511–513.
Article
13. Goske MJ, Applegate KE, Bell C, Boylan J, Bulas D, Butler P, Callahan MJ, Coley BD, Farley S, Frush DP, McElveny C, Hernanz-Schulman M, Johnson ND, Kaste SC, Morrison G, Strauss KJ. Image Gently: providing practical educational tools and advocacy to accelerate radiation protection for children worldwide. Semin Ultrasound CT MR. 2010. 31:57–63.
Article
14. Ron E. Ionizing radiation and cancer risk: evidence from epidemiology. Pediatr Radiol. 2002. 32:232–237.
Article
15. Korley FK, Pham JC, Kirsch TD. Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998-2007. JAMA. 2010. 304:1465–1471.
Article
16. Newman B. Ultrasound body applications in children. Pediatr Radiol. 2011. 41:Suppl 2. 555–561.
Article
17. Strouse PJ. Pediatric appendicitis: an argument for US. Radiology. 2010. 255:8–13.
Article
18. Nazarian LN. The top 10 reasons musculoskeletal sonography is an important complementary or alternative technique to MRI. AJR Am J Roentgenol. 2008. 190:1621–1626.
Article
19. Leyendecker JR, Barnes CE, Zagoria RJ. MR urography: techniques and clinical applications. Radiographics. 2008. 28:23–46.
Article
20. Grattan-Smith JD, Little SB, Jones RA. MR urography in children: how we do it. Pediatr Radiol. 2008. 38:Suppl 1. S3–S17.
Article
21. Chong AL, Grant RM, Ahmed BA, Thomas KE, Connolly BL, Greenberg M. Imaging in pediatric patients: time to think again about surveillance. Pediatr Blood Cancer. 2010. 55:407–413.
Article
22. Ahmed BA, Connolly BL, Shroff P, Chong AL, Gordon C, Grant R, Greenberg ML, Thomas KE. Cumulative effective doses from radiologic procedures for pediatric oncology patients. Pediatrics. 2010. 126:e851–e858.
Article
23. Goo HW. Regional and whole-body imaging in pediatric oncology. Pediatr Radiol. 2011. 41:Suppl 1. S186–S194.
Article
24. Strauss KJ, Goske MJ, Kaste SC, Bulas D, Frush DP, Butler P, Morrison G, Callahan MJ, Applegate KE. Image gently: Ten steps you can take to optimize image quality and lower CT dose for pediatric patients. AJR Am J Roentgenol. 2010. 194:868–873.
Article
25. Callahan MJ. CT dose reduction in practice. Pediatr Radiol. 2011. 41:Suppl 2. 488–492.
Article
26. McCollough CH, Bruesewitz MR, Kofler JM Jr. CT dose reduction and dose management tools: overview of available options. Radiographics. 2006. 26:503–512.
Article
27. McCollough CH, Primak AN, Braun N, Kofler J, Yu L, Christner J. Strategies for reducing radiation dose in CT. Radiol Clin North Am. 2009. 47:27–40.
Article
28. Kim JE, Newman B. Evaluation of a radiation dose reduction strategy for pediatric chest CT. AJR Am J Roentgenol. 2010. 194:1188–1193.
Article
29. Nievelstein RA, van Dam IM, van der Molen AJ. Multidetector CT in children: current concepts and dose reduction strategies. Pediatr Radiol. 2010. 40:1324–1344.
Article
30. Yu L, Bruesewitz MR, Thomas KB, Fletcher JG, Kofler JM, McCollough CH. Optimal tube potential for radiation dose reduction in pediatric CT: principles, clinical implementations, and pitfalls. Radiographics. 2011. 31:835–848.
Article
31. Goo HW. Individualized volume CT dose index determined by cross-sectional area and mean density of the body to achieve uniform image noise of contrast-enhanced pediatric chest CT obtained at variable kV levels and with combined tube current modulation. Pediatr Radiol. 2011. 41:839–847.
Article
32. Schilham A, van der Molen AJ, Prokop M, de Jong HW. Overranging at multisection CT: an underestimated source of excess radiation exposure. Radiographics. 2010. 30:1057–1067.
Article
33. Lee CH, Goo JM, Ye HJ, Ye SJ, Park CM, Chun EJ, Im JG. Radiation dose modulation techniques in the multidetector CT era: from basics to practice. Radiographics. 2008. 28:1451–1459.
Article
34. Frush DP. CT dose and risk estimates in children. Pediatr Radiol. 2011. 41:Suppl 2. 483–487.
Article
35. Strauss KJ, Goske MJ. Estimated pediatric radiation dose during CT. Pediatr Radiol. 2011. 41:Suppl 2. 472–482.
Article
36. Radiological protection and safety in medicine. A report of the International Commission on Radiological Protection. Ann ICRP. 1996. 26:1–47.
37. Verdun FR, Gutierrez D, Vader JP, Aroua A, Alamo-Maestre LT, Bochud F, Gudinchet F. CT radiation dose in children: a survey to establish age-based diagnostic reference levels in Switzerland. Eur Radiol. 2008. 18:1980–1986.
Article
38. Yakoumakis E, Karlatira M, Gialousis G, Dimitriadis A, Makri T, Georgiou E. Effective dose variation in pediatric computed tomography: dose reference levels in Greece. Health Phys. 2009. 97:595–603.
Article
39. Muhogora WE, Ahmed NA, Alsuwaidi JS, Beganovic A, Ciraj-Bjelac O, Gershan V, Gershkevitsh E, Grupetta E, Kharita MH, Manatrakul N, Maroufi B, Milakovic M, Ohno K, Ben Omrane L, Ptacek J, Schandorf C, Shaaban MS, Toutaoui N, Sakkas D, Wambani JS, Rehani MM. Paediatric CT examinations in 19 developing countries: frequency and radiation dose. Radiat Prot Dosimetry. 2010. 140:49–58.
Article
40. Kim DS. Guideline for diagnostic reference level of the radiation exposure of CT examination. 2009. Seoul: National Institute of Food and Drug Safety Evaluation.
41. National Institute of Food and Drug Safety Evaluation. Technical standard for the performance of pediatric radiography. 2010. Seoul: National Institute of Food and Drug Safety Evaluation.
42. Jung AY. Dose reduction strategies in pediatric CT. Radat Health Newsl. 2011. 18:1–4.
Full Text Links
  • JKMA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr