Reviewing 20 years’ worth of data, researchers have found children with Down syndrome are imaged more often than others and, in the process, get exposed to significantly more ionizing radiation.
The researchers call on clinicians to take this information into account when ordering imaging for these patients, especially when non-radiative modalities like ultrasound and MRI could do the job.
For the analysis, senior study author Diana Miglioretti, PhD, of UC-Davis and colleagues gathered records of more than 4.3 million children served by six integrated care systems from 1996 to 2016.
Just under 3,100 of these patients had Down syndrome.
Calculating imaging rates per 100 person years and associated absorbed radiation (red bone marrow) dose in milligray units (mGy), the team found:
- Compared to other children, children with Down syndrome received imaging using ionizing radiation at 9.5 times the rate when age is below 1 year and 2.3 times the rate between ages 1 and 18 years.
- Imaging rates by modality in children prior to first birthday with Down syndrome compared with other children were: computed tomography, 6.6 vs. 2.0; fluoroscopy, 37.1 vs. 3.1; angiography, 7.6 vs. 0.2; nuclear medicine, 6.0 vs. 0.6; X-ray, 419.7 vs. 36.9; MRI, 7.3 vs. 1.5; and ultrasound, 231.2 vs. 16.4.
- Mean cumulative red bone marrow dose from imaging over a mean of 4.2 years was twice as high in children with Down syndrome compared with other children (4.7 vs. 1.9 mGy).
In their discussion, Miglioretti and co-authors recommend imaging referrers review case-management strategies for pediatric Down patients.
Such review is warranted, they suggest, because these patients not only receive more imaging with radiation-emitting modalities overall but also do so at younger ages, “when they are most sensitive to ionizing radiation.”
More:
“While pediatric imaging using ionizing radiation has generally decreased in the last decade, imaging use increased in children with Down syndrome. … [F]uture research should evaluate whether imaging with ultrasound and MRI that do not use ionizing radiation could replace some of the imaging with CT and angiography to reduce the risk of radiation-induced cancer.”
PLOS One has published the study in full for free.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.