Safer Radiologic Imaging to Help Children with Otolaryngologic Disease

Recent developments in diagnostic imaging have benefited children with otolaryngologic disease, resulting in fewer invasive procedures, shorter hospital stays, more targeted surgical procedures, and earlier and more precise diagnoses. However, in spite of improved technology, worries about exposure of children to ionizing radiation have recently come to the forefront.

Children have more radiosensitive body tissues than adults, and also tend to live longer, giving the effects of radiation exposure time to manifest. According to sources mentioned in the study, approximately seven million computed tomography (CT) scans are performed on children yearly in the United States alone and medical source radiation exposure accounts for almost half of the total radiation exposure in the United States.

A commentary, written by David E. Tunkel, MD, associate professor of otolaryngology-head and neck surgery and pediatrics division director, Johns Hopkins School of Medicine (Baltimore, MD, USA); Sandra L. Wootton-Gorges, MD from the department of radiology, University of California, Davis Medical Center (Sacramento, California, USA), and Julie L. Wei, MD, from the department of otolaryngology-head and neck surgery, University of Kansas, School of Medicine (Kansas City, USA) and published in the July 2012 issue of the journal Otolaryngology-Head and Neck Surgery, discussed efforts “to reduce the exposure of children to radiation from diagnostic imaging, with focus on the responsibilities of the otolaryngologist in such efforts.” The problem lies, according to the authors, in determining when CT scans are necessary, and making this information widely available to otolaryngologists and others.

Several suggestions and resources are provided. The authors discussed the ALARA principle (as low as reasonably achievable) and suggest that reducing radiation dosage is as simple as scanning only the targeted region. Two online resources exist: The American College of Radiology (Reston, VA, USA) has provided Appropriateness Criteria and the Alliance for Radiation Safety in Pediatric Imaging has created a Website (Please see Related Links below).

Other sources cited in the study provide three strategies to reduce radiation exposure from CT scans (1) order fewer CT scans, (2) use another imaging modality that does not use ionizing radiation when possible, and (3) reduce the radiation dose of each study.

The authors concluded, “Safer imaging of children is a shared responsibility.” It is imperative to order the right test at the right time, and to “consider the appropriateness of imaging, assuring that the best modality is being ordered, that the imaging actually influences management, and that the timing of imaging is ideal.”

Related Links:
Johns Hopkins School of Medicine
University of California, Davis Medical Center
Alliance for Radiation Safety in Pediatric Imaging