Academic pediatric facilities deliver lowest CT radiation doses to young patients

Academic pediatric facilities expose pediatric patients to lower CT radiation doses than nonacademic pediatric facilities and all adult facilities, according to a new study published in Radiology.

“Reports of improved pediatric and adult CT technique changes based on patient size appeared beginning in 2008 with the Image Gently Alliance and were followed by publications from the American Association of Physicists in Medicine in 2016 and 2017,” wrote Keith J. Strauss, department of radiology at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio, and colleagues. “Despite these available recommendations, opportunities for improvement in the management of pediatric CT doses remain.”

The authors explored data from more than 239,000 CT examinations from the American College of Radiology’s dose index registry, including brain without contrast enhancement studies, chest without contrast enhancement studies and abdomen-pelvis with intravenous contrast enhancement studies. All patients were 21 years old or younger. The mean age was 9-10 years old at pediatric facilities and 15 years old at adult facilities.

The team studied three dose indexes—volume CT dose index (CTDIvol), size-specific dose estimate (SSDE), and dose-length product (DLP)—for six different patient size groups and compared data from four different facility types: academic pediatric, nonacademic pediatric, academic adult and nonacademic adult.

Overall, Strauss and colleagues found that the pediatric radiation dose in academic pediatric facilities was “significantly lower” with less variance for all brain studies, 78 percent of chest studies and 89 percent of abdomen-pelvis studies across the six size groups and three dose descriptors.

“Substantial progress has been made in pediatric CT dose reduction,” the authors wrote. 

However, they added, their findings also show that there is still room for improvement when it comes to pediatric imaging practices. Adult facilities are exposing these patients to as much as double the dose they would receive at an academic pediatric facility, for example.

“It is recommended that each facility charge a team of their radiologists, technologists, and medical physicists to compare patient CT dose indexes with the values in this national survey,” the authors concluded. “A serious dose analysis and protocol review should be conducted to identify possible ways to better manage CT doses.”