New Guidance for Child X-ray Exams

The U.S. Food and Drug Administration (FDA; Silver Spring, MD, USA) has issued a new guidance that recommends medical X-ray imaging exams in children and younger patients be optimized to use the lowest radiation dose needed.

 

In addition, the new guidance recommends that optimization of image quality and radiation dose in the X-ray imaging depend more on a patient’s size than their age, as smaller patients require less radiation to obtain a medically useful image. However, X-rays and computerized tomography (CT) scans should never be withheld from a child or adult who has a medical condition, if the exam may provide important healthcare information that may aid in the diagnosis or treatment of a serious or life-threatening illness.

 

The FDA guidance adds that healthcare professionals are responsible for ensuring there is justification for all X-ray imaging exams--including CT, fluoroscopy, dental, and conventional X-rays--performed on pediatric patients, and that they should also consider if a different type of imaging exam, which does not expose the patient to ionizing radiation, such as ultrasound or magnetic resonance imaging (MRI), could be used to obtain the same result.

 

“Technically, the patient’s body thickness, the distance an X-ray travels through the body to create the image, is the most important consideration when “child-sizing” an image protocol,” declared the FDA Center for Devices and Radiological Health (CDRH) in the new guidance. “Because children have longer expected lifetimes ahead of them for potential effects to appear, and the risk for cancer is not fully understood, it’s important to use the lowest radiation dose necessary to provide a diagnostic exam.”

 

Information is limited on cancer risks associated with diagnostic radiographic, CT, and fluoroscopically guided procedures during early childhood. Because of the dramatic increase in the numbers of children undergoing CT examinations internationally, it is particularly urgent to study occurrence of pediatric, adolescent, and adult cancer risks associated with these procedures.