The use of children's Computed Tomography (CT) as an imaging tool in radiology has been increasing in the past decade. However, due to potential side effects on the children undergoing this medical procedure, children's CT scan has become a public health concern that continues to be debated across different platforms and forums. In addition, it turns out that there are alternatives for CT scans. Moreover, many CT scans are not really necessary.
As other medical tools and interventions, particularly in radiology, CT scans have their pros and cons.
This paper outlines the pros and cons of children's CT scans. In addition, it addresses alternative procedures or tools that can be used in children's diagnostics.
According to National Cancer Institute (2013), Computed Tomography (CT) is an imaging tool or method that employs special X-Ray equipment to generate a set of detailed scans or images of tissues or organs inside the body. It is also known as computerized axial tomography (CAT) scanning or computerized tomography (NCI, Computed Tomography (CT) Scans and Cancer, 2013). Modern CT machines take continuous images in a spiral or helical way rather than generating a series of scans of single slices of the body. This implies that new CT machines are fast, sensitive, accurate and generate better 3-D images. As of this writing, the newest CT scanners, called multidetector CT multislice CT scanners could produce more slices within a very short time (NCI, Computed Tomography (CT) Scans and Cancer, 2013). CT is different from conventional X-Rays in the sense that x-rays produce a one-dimensional image since the emitter is stationary, whereas CT scan produces 3-D images attributed to the rotating scanner. A CT scanner takes multiple shots of the examined tissue or organ from various angles which are united by the computer to produce a detailed image of a child's anatomy (UCDMC, 2013).
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One of the most common circumstances in pediatrics for a CT scan is the evaluation of head trauma. Head trauma is a critical problem since it can lead to both short and long-term disabilities. Children damage their heads frequently because they are reckless and always move. The challenge is to determine which head injury is likely to lead to complications that need to be addressed as early as possible, and which head traumas have to lead to pathology that can only be diagnosed and treated using the results of a CT scan. CT scans can be life to save radiological intervention for diagnosing injury and illness in children (RSNA, 2013). CT is also beneficial in the sense that doctors use the results generated by the scanners to diagnose and manage the condition in question. CT scan is an incredible diagnostic intervention tool because it provides a wonderful way to peer inside the body without any surgery. This has been supplemented by the fact that there has been a tremendous development in minimizing the dose of radiation associated with pediatric CT scans. Therefore, with the introduction of the new techniques in CT scan, radiation dose was reduced to the minimum.
The quality of images, speed of access and accessibility of the CT scan results to patients makes it relevant when medical questions rise pertaining to the head, spine, chest and abdomen among other body tissues. CT scan is used to diagnose an array of conditions that are either caused by a disease or an injury. In pediatrics, CT scan is typically used to diagnose causes of spinal pain, assess traumatic injuries and monitor the response to cancer treatment (RSNA, 2013). In addition, CT is used to diagnose and stage cancer as well as monitor inflammatory or infectious diseases. Moreover, CT scan can be used to evaluate blood vessels in child's body. CT is valuable in the sense that it generates very detailed images of blood vessels and the heart in children. Besides X-rays, CT is the most commonly used tool for evaluating problems with the chest. Given that CT scans generate quality and 3D (3-Dimentional) images, it is suitable for evaluating birth defect, the trauma of the lung or blood vessel and airway diseases in children, and even newborn infants (RSNA, 2013). Other organs that can be evaluated by CT scan include kidneys, spleen and liver. New CT scanners use a multidetector CT unit which are faster than the old ones. This minimizes the need for general anesthesia and sedation (NCI, Computed Tomography (CT) Scans and Cancer, 2013; RSNA, 2013).
The other benefit of CT scanning is its painlessness, accurate and non-invasive (RSNA, 2013). A central advantage of CT lies in its ability to image soft tissue, blood vessels and the bone at the same time. Unlike conventional X-Ray scanning, CT generated detailed images of various types of tissues, bones, lungs and blood vessel. The other key advantage of CT scanning is that it is simple and fast. This is essential in emergency scenarios linked to children injuries. Consequently, CT scan can reveal internal bleeding or injuries quickly for lifesavers to make the critical decision on the way forward. Comparing to MRI, CT scanning is less sensitive to children movement. Unlike MRI, CT scan can be performed if a child has any kind of an implanted medical device (RSNA, 2013). Moreover, CT scanning provides real-time images. This makes it an effective intervention for guiding invasive procedures such as needle aspirations and needle biopsies of many body parts particularly abdomen, pelvis, bones and lungs. Lastly, diagnosis through CT scan may eliminate the need for surgical biopsy and exploratory surgery.
Whenever a CT scan is ordered for a child, parents or guardians should question if there are alternative interventions that would address the question in hand without any radiation. For example, MRI (Magnetic Resonance Imaging) or ultrasound can provide solutions to the problem at hand without exposing the child to any risky radiation. In addition, parents should ensure that the health community performing the CT scan uses size appropriate procedures and configurations to limit the dose of radiation. That is, adult-sized doses should not be used on children. In reference to the equipment used, people must collaborate with relevant accredited agencies to ensure that the equipments used for CT scans is accredited. Magnetic Resonance Imaging does not involve the utilization of ionizing radiation. This avoids exposing children to the potential harms of ionized radiations. In addition, the magnetic fields involved in MRI are not harmful. The main disadvantage of this option is that it is very expensive, which implies that the number of MRI scanners is limited. According to RSNA (2013), ultrasound can substitute CT scan as a medical method of imaging in guiding minimally invasive procedures such as needle aspirations and needle biopsies of various body parts, particularly, bones, lungs, pelvis and abdomen.
We have to recognise the fact that everything we do in the medical realm carries some small risk. When not performing CT scan can harm the patient, performing this medical procedure is done irrespective of the risk concerning the exposure to radiation.
The most debatable concern surrounding CT scan is exposure to radiation. To produce CT images, radiation is needed. Medically, and according to various researches, high levels of radiations have been documented and reported to cause cancer. Modern CT techniques and equipment result in the low-level exposure. The question of whether these levels cause cancer is debatable, but since it is possible, the radiologist takes every possible effort to reduce the amount of radiation that children receive during the process. In the same context, doctors discourage unnecessary CT scans. The other recommended strategy is to consider other alternative tests such as ultrasound and MRI while they may provide the same details.
According to the study conducted by National Institutes of Health (NIH), 2012, children scanned multiple times by CT have a considerably increased risk of brain tumors and leukemia after a decade starting from their first scan (NIH, 2012). In other words, CT scan elevates cancer risks.
Compared to standard medical X-ray procedures, CT scans generate much higher resolution scans. Unfortunately, these scans expose patients to more radiations. The X-rays used in CT scanning are a form of ionizing radiation. According to NCI (2013), continuous exposure to ionizing radiations increases the risk of cancer. However, NIC (2013) points that the standard X-ray procedures including mammography and chest X-rays utilize relatively low levels of these radiations. Further, the National Cancer Institute (2013), theorizes that the radiation exposure from CT scans is more than that from standard X-ray interventions, but the risk from a single CT scan is minimal. This implies that having the procedure is less risky than not having it, particularly when the procedure is used to diagnose a serious condition or cancer in a patient who exhibits its signs or symptoms.
The other risk associated with CT scans is linked to increasing exposure to radiation due to the equipment that is faulty or not accredited. Such equipment is likely to increase the quantity of radiation. In addition, settings designed for adults increases the exposure of children to radiation. Additionally, complications from sedation or general anesthesia are associated to CT scans. However, doctors always take several measures to protect patient's welfare. This includes close monitoring of the child before, during and after the scan. Since children are more sensitive to radiation than adults, CT examinations should only be conducted if they are critical for making a diagnosis. Children are more sensitive to radiation because of their biological development and the rapid pace at which their cells divide (NCI, Computed Tomography (CT) Scans and Cancer, 2013). Additionally, children have better life expectancy than adults. This creates a larger window for radiation-related diseases to develop. The other risk linked to CT scan is that of potential allergic reaction to material that contains iodine. However, this reaction is mild and most radiology units are usually equipped to respond to them. Among other preventive measures undertaken is the examination of the scan influence on the body. Additionally, radiologists configure their equipment to expose children to radiation that matches their age and size. Since different organs and tissues have different sensitivity to the radiations exposed to them, effective dose accounts are used.
Children's CT remains to be a vital tool or radiological intervention for pediatric treatment. In spite of this, parents considering having their children undergo CT scans should consult qualified doctors about whether CT scans are vital for their children and about the benefits and risks involved. In addition, CT scans may be unnecessary. Furthermore, there are alternatives for CT scans in pediatrics health. However, when CT scan is used optimally and prudently, it serves as one of the most valuable imaging tool in radiology for both children and adults. If the scan is clinically justified, then patients can be reassured that the benefits of the intervention outweigh other risks. Therefore, it is important for patricians and radiologist to collaborate and to minimize radiation dose to children. Children should only be exposed to radiations from CT scans as the last option. In addition, the radiologist should minimize exposure as low as practically achievable by using exposure configurations customized for children. Besides, health community needs long-term strategies to minimize CT radiation exposure in both children and adults. Risks can be minimized through the development and implementation of pediatric CT scan protocols. Selective strategies should also be encouraged for pediatric imaging. In addition, people within and outside radiology specialties should be educated on how to improve exposure configurations, as well as evaluate the need for CT scan in an individual patient.
- Faloon, W. (2010, August). Lethal danger of CT scans. Retrieved April 9, 2014, from Life Extension Magazine.
- NCI. (2013, July 16). Computed tomography (CT) scans and cancer. Retrieved April 9, 2014, from National Cancer Institute
- NCI. (2012). Radiation risks and pediatric computed tomography (CT): A guide for healthcare providers. Retrieved April 9, 2014, from National Cancer Institute.
- NIH. (2012, June). NIH study finds childhood CT scans linked to leukemia and brain cancer later in life. Retrieved April 9, 2014.
- RSNA. (2013, August). Children's (Pediatric) CT (Computed Tomography). Retrieved April 9, 2014, from Radiological Society of North America.
- UCDMC. (2013). Computed tomography: Frequently asked questions. Retrieved April 9, 2014, from The University of California.