Education, protocols needed for pediatric radiation dose reduction

Though most trauma centers in Washington use pediatric dose-reduction protocols for head CTs, a wide variation in radiation dose suggests the need for educational efforts and institutional protocols to reduce pediatric radiation dose from head CTs, according to a study published in the February issue of the Journal of the American College of Radiology.

Risks associated with ionizing radiation exposure mean that the lowest dose possible for pediatric patients in need of imaging should be pursued. “To optimize pediatric dose reduction efforts, it is important to understand how often and where appropriate pediatric CT protocols are used and explore variations in the possible radiation risks from CT imaging,” wrote the study’s lead author, Janessa M. Graves, PhD, MPH, of the University of Washington in Seattle, and colleagues.

Graves and colleagues examined the variation in pediatric trauma head CT imaging protocols in Washington trauma centers in 2012 and compared them with a previous study that was conducted from 2008 to 2009. The researchers distributed an online and paper survey to all adult and pediatric Washington level one through five trauma centers. Participants provided information about the CT scanner used for pediatric head scans, as well as technical information about pediatric dose reduction protocols.

Of the 76 trauma centers given the 2012 survey, 61 responded. Of these respondents, 91.7 percent reported having a dedicated pediatric protocol. Use of protective shielding ranged from 80 to 100 percent across both study years. Two and a half times more trauma centers gave sufficient information to conduct dose calculations in 2012 than in 2009.

The mean CT dose index decreased from 34.8 milliGray (mGy) to 23.1 mGy between the two study periods. The study’s authors noticed a wide variation in mean effective dose for level three and four trauma centers in 2012, which was similarly seen in 2009 in level four trauma centers.

Though the study was limited by several factors, including a small comparison group from the 2009 survey responses, it was evident that “Educational efforts and institutional protocols are necessary to reduce pediatric radiation dose from head CTs,” wrote Graves and colleagues. “Involvement on the part of the radiologist, technologist, and physicist, if available, is critical for dose-reduction efforts. Forming a CT protocol review committee and reviewing protocols periodically aids in dose reduction.”