Page 14 - Delaware Medical Journal - December 2015

CT Utilization for Pediatric Orthopedic Trauma
Michael Kern, MD; Ashley Tucker, PA-C;
Kenneth Rogers, PhD; ATC: Richard W. Kruse, MBA, DO
and
Background: The use of computed tomography (CT) scanning in trauma has tripled in the past decade in adults
children alike. There is growing concern about the long-term risks of radiation delivery in childhood. There is little information in the literature on radiation exposure during extremity CT in children. This study evaluated the radiation dose and geographic bodily exposure to the child/adolescent during extremity CT.
Methods: A retrospective review of 163 patients (girls aged 0.5-19 years and boys aged 3.1-19 years) who sustained an orthopedic extremity injury that required a CT scan in 2012 was performed. Data collected included sex, age, height, weight, body mass index (BMI), joint, upper extremity position, body position, scout start, scout end, CTDlvol (mGy), and dose length product (CTDLP (mGy-cm)).
Results: Lower extremity scans were more frequent (124/163, 76 percent) and had higher radiation doses overall. Only the elbow varied for upper extermity positioning. Five of nine were on the side of body with a corresponding 66 percent lower mean radiation dose. All lower extremity scans were in the supine position. Scout CT start and end varied among all joints except for femur to tibia.
Conclusions: Lower extremity CT scans had the highest radiation doses. Variability in positioning and delineation of scout contributed to variation in radiation exposure of extremity and adjacent body area. Improved localization and consistent positioning can effectively lower radiation exposure in children undergoing extremity CT scan.
Key words: CT scan, dose radiation, pediatric, extremity
IntroductionIn the past several decades, computed
tomography (CT) has emerged as an essential imaging modality for assessing disorders in pediatric patients among a wide range of disciplines, including pediatric trauma. There are now more than 7 million CT studies performed in children each year and 33 percent of these studies are performed in children younger than 10 years. The number of pediatric CT scans increases
by approximately 10 percent each year, and current estimates attribute 49 percent of the collective radiation dose in children to CT scans alone.1,2
The pediatric population carries unique risks in regards to radiation dosing compared to the adult population. Perhaps the most evident of these risks is the increased time for radiation- related malignancy to develop because of their longer life expectancy.3 Additionally, pediatric patients demonstrate
adults — particularly the thyroid, gonads, and breast tissues.4

overall dose.5
In response to the growing concerns about radiation dose
in children, the Image Gently and As Low As Reasonably Achievable (ALARA) campaigns were started. These initiatives have increased awareness of the risks inherent in advanced imaging techniques, and they also provide protocols and recommendations for reducing radiation exposure in pediatric patients.6-8 A critical initiative in both campaigns is accurately determining the radiation dose to which pediatric patients are have reported radiation doses in head and body CT scans.9-12 However, literature on radiation exposure during extremity
CT in pediatric patients is scant. The aim of this study was to evaluate the radiation dose and geographic bodily exposure to pediatric patients during extremity CT.
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Del Med J | December 2015 | Vol. 87 | No. 12
Abstract