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January 03, 2011

Avoidable Pediatric Radiation Exposure

Children and teens often get diagnostic tests that expose them to radiation, increasing the risk of cancer later in life. Over just a 3 year span, 42.5% of kids got some form of ionizing radiation from a diagnostic medical procedure whether it be a chest x-ray, CT scan, dental scan, etc. Click here to calculate the cumulative risk of cancer with each type of test.

It also estimated that 1/3 of CT scans are unnecessary and that by limiting CT scans to when it is truly needed would reduce the number of cancers by 43%.

From an ENT standpoint, common diagnostic tests that expose patients to radiation include CT scans of the head, facial x-rays, and neck x-rays.

Why would kids get such scans done?

CT scans are often performed to evaluate for sinusitis as well as to figure out what is causing chronic headaches. Neck x-rays are often done to evaluate for adenoid hypertrophy while facial x-rays are done after facial trauma to look for a nasal fracture.

It is my personal bias to avoid such diagnostics tests if at all possible, ESPECIALLY because there are alternative options.

Nasal endoscopy can be performed to evaluate for sinusitis as well as adenoid hypertrophy thereby making unnecessary the need for neck x-rays as well as CT scans. X-rays to evaluate sinusitis is NEVER indicated as it is wrong 50% of the time (click here for more info on this).

Nasal fractures are easily appreciated on exam thereby making unnecessary facial x-rays. In cases of trauma, an x-ray can be considered from a purely medico-legal documentation standpoint, but is not really necessary from a medical standpoint. Read more here why.

Read a story about this in Reuters and in the LA Times.

References:
The Use of Computed Tomography in Pediatrics and the Associated Radiation Exposure and Estimated Cancer Risk. JAMA Pediatr. 2013;():1-8. doi:10.1001/jamapediatrics.2013.311.

Computed Tomography — An Increasing Source of Radiation Exposure. N Engl J Med 2007; 357:2277-2284November 29, 2007DOI: 10.1056/NEJMra072149

Children, computed tomography radiation dose, and the As Low As Reasonably Achievable (ALARA) concept. Pediatrics. 2003 Oct;112(4):971-2.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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