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      Multidetector CT in children: current concepts and dose reduction strategies

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          Abstract

          The recent technical development of multidetector CT (MDCT) has contributed to a substantial increase in its diagnostic applications and accuracy in children. A major drawback of MDCT is the use of ionising radiation with the risk of inducing secondary cancer. Therefore, justification and optimisation of paediatric MDCT is of great importance in order to minimise these risks (“as low as reasonably achievable” principle). This review will focus on all technical and non-technical aspects relevant for paediatric MDCT optimisation and includes guidelines for radiation dose level-based CT protocols.

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          Most cited references62

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          Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults.

          To estimate cumulative radiation exposure and lifetime attributable risk (LAR) of radiation-induced cancer from computed tomographic (CT) scanning of adult patients at a tertiary care academic medical center. This HIPAA-compliant study was approved by the institutional review board with waiver of informed consent. The cohort comprised 31,462 patients who underwent diagnostic CT in 2007 and had undergone 190,712 CT examinations over the prior 22 years. Each patient's cumulative CT radiation exposure was estimated by summing typical CT effective doses, and the Biological Effects of Ionizing Radiation (BEIR) VII methodology was used to estimate LAR on the basis of sex and age at each exposure. Billing ICD9 codes and electronic order entry information were used to stratify patients with LAR greater than 1%. Thirty-three percent of patients underwent five or more lifetime CT examinations, and 5% underwent between 22 and 132 examinations. Fifteen percent received estimated cumulative effective doses of more than 100 mSv, and 4% received between 250 and 1375 mSv. Associated LAR had mean and maximum values of 0.3% and 12% for cancer incidence and 0.2% and 6.8% for cancer mortality, respectively. CT exposures were estimated to produce 0.7% of total expected baseline cancer incidence and 1% of total cancer mortality. Seven percent of the cohort had estimated LAR greater than 1%, of which 40% had either no malignancy history or a cancer history without evidence of residual disease. Cumulative CT radiation exposure added incrementally to baseline cancer risk in the cohort. While most patients accrue low radiation-induced cancer risks, a subgroup is potentially at higher risk due to recurrent CT imaging.
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            Cancer risks from diagnostic radiology.

            In recent years, there has been a rapid increase in the number of CT scans performed, both in the US and the UK, which has fuelled concern about the long-term consequences of these exposures, particularly in terms of cancer induction. Statistics from the US and the UK indicate a 20-fold and 12-fold increase, respectively, in CT usage over the past two decades, with per caput CT usage in the US being about five times that in the UK. In both countries, most of the collective dose from diagnostic radiology comes from high-dose (in the radiological context) procedures such as CT, interventional radiology and barium enemas; for these procedures, the relevant organ doses are in the range for which there is now direct credible epidemiological evidence of an excess risk of cancer, without the need to extrapolate risks from higher doses. Even for high-dose radiological procedures, the risk to the individual patient is small, so that the benefit/risk balance is generally in the patients' favour. Concerns arise when CT examinations are used without a proven clinical rationale, when alternative modalities could be used with equal efficacy, or when CT scans are repeated unnecessarily. It has been estimated, at least in the US, that these scenarios account for up to one-third of all CT scans. A further issue is the increasing use of CT scans as a screening procedure in asymptomatic patients; at this time, the benefit/risk balance for any of the commonly suggested CT screening techniques has yet to be established.
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              Strategies for reducing radiation dose in CT.

              In recent years, the media has focused on the potential danger of radiation exposure from CT, even though the potential benefit of a medically indicated CT far outweighs the potential risks. This attention has reminded the radiology community that doses must be as low as reasonably achievable (ALARA) while maintaining diagnostic image quality. To satisfy the ALARA principle, the dose reduction strategies described in this article must be well understood and properly used. The use of CT must also be justified for the specific diagnostic task.
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                Author and article information

                Contributors
                R.A.J.Nievelstein@umcutrecht.nl
                Journal
                Pediatr Radiol
                Pediatric Radiology
                Springer-Verlag (Berlin/Heidelberg )
                0301-0449
                1432-1998
                10 June 2010
                10 June 2010
                August 2010
                : 40
                : 8
                : 1324-1344
                Affiliations
                [1 ]Department of Pediatric Radiology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
                [2 ]Department of Radiology, C-2S, Leiden University Medical Centre, Leiden, The Netherlands
                Article
                1714
                10.1007/s00247-010-1714-7
                2895901
                20535463
                645981a3-3ed6-4292-959f-8d7c23bc9f8f
                © The Author(s) 2010
                History
                : 27 October 2009
                : 30 March 2010
                : 6 April 2010
                Categories
                Review
                Custom metadata
                © Springer-Verlag 2010

                Pediatrics
                optimisation,justification,multidetector ct,technique,child
                Pediatrics
                optimisation, justification, multidetector ct, technique, child

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