“Are you certain my child needs a brain CT?” asked Lydia, whose son had fallen off the monkey bars and hit his head while playing at school. “I have heard that CT scans can cause cancer in children.”
If you’re a parent like Lydia, you’re used to the bumps, bruises and skinned knees. But sometimes a fall is more serious and requires an X-ray or a CT scan. As a protective mom or dad, you likely have the same concerns as Lydia, but medical imaging procedures are safe and necessary for the correct diagnosis of your child’s injury or illness.
What is a medical imaging procedure?
A medical imaging procedure is any procedure that creates images or pictures to make a diagnosis or guide treatment. Common medical imaging procedures are X-rays and CT-computed tomography, which provide X-ray pictures showing internal detail of the body.
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There are other medical imaging procedures that do not use ionizing radiation. Ultrasonography (using sound waves) or MRI (radiofrequency and electromagnetic waves) are also used for imaging children.
The value of imaging while exposing your child to a minimal amount of radiation for the diagnosis of a pediatric illness or injury is unquestionable and saves lives. The CT scan done on Lydia’s son showed a bleed in his brain that required emergency surgery. The CT scan and surgery saved her son’s life.
Are there risks from medical imaging?
The risk of developing cancer from low-dose radiation used in X-rays and CT scans is generally very small. The lifetime risk of developing cancer if you have never had any radiology exam is about one in three. The low radiation doses used in diagnostic imaging only increase the risk marginally.
Unfortunately, there has been a lot of media speculation that CTs cause cancer. However, what has not been emphasized enough is that the risk is extremely small. When considering benefits and risks, it is important to recognize the risk of not performing an exam. If a CT is not done it could result in missing a diagnosis and initiating treatment that might result in a poor medical outcome. The potential to improve a child’s life expectancy due to an early diagnosis and treatment must be weighed in comparison to the minimal increase in cancer risk from imaging.
While the risk of cancer from medical imaging procedures is extremely small, inappropriate or unskilled use of such technologies may result in unnecessary exposure that could increase risk and provide no added benefit to pediatric patients. To prevent unnecessary exposure, a culture of radiation safety needs to be promoted and practiced in hospitals and imaging centers that scan children.
Encouraging a culture of radiation safety
There are many opportunities to reduce radiation doses when imaging without loss of diagnostic information. The Image Gently campaign was launched in 2008 to raise awareness about methods to reduce radiation during pediatric medical imaging procedures. As part of their campaign, the ALARA (As Low As Reasonably Achievable) concept was introduced. It implies that the lowest possible radiation doses should be used to acquire adequate diagnostic images. The message from the Image Gently campaign is threefold:
▪ Medical imaging helps us save lives.
▪ When you image, radiation matters.
▪ So when you image, “Image Gently.”
“Image Gently” is a concept that has been adopted at UHealth — the University of Miami Health System. For more information, visit www.imagegently.com. The site provides information about pediatric imaging exams for parents, patients, pediatricians and radiologists.
You can also play a part in your child’s safety when undergoing medical imaging. Pediatric radiologists performing imaging studies in children should encourage and be willing to answer questions from both the referring physician and the parent. After learning more on the Image Gently website, don’t be afraid to ask:
▪ Is the right imaging study being performed?
▪ Is there an alternative to the study where radiation is not used, such as ultrasound or MRI?
▪ Has the dose been adjusted for the child and is the least possible radiation dose being used?
▪ Is dose reduction a priority in your hospital when imaging children?
▪ Does the facility have experience in performing such studies?
▪ Are the staff specialized and adequately trained to handle such procedures in children?
▪ Will my child receive the lowest possible dose without decreasing the diagnostic quality of the exam?
While the prospect of your child needing an X-ray or CT scan might be scary, remember that the benefit of these procedures outweighs the harm of the minimal radiation exposure. For more information about pediatric radiology at UHealth, visit www.radiology.med.miami.edu/sections/pediatric-radiology.
Gaurav Saigal, M.D., is a pediatric radiologist, neuroradiologist and director of pediatric imaging at UHealth – the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.