In an effort to lower children’s exposure to ionizing radiation, pediatric healthcare providers are beginning to use MRIs more than CTs. Findings from a study of 33 children’s hospitals shows that between 2004 and 2012, there has been a drop in the volume of pediatric CT scans for the 10 most common diagnostic groups in children, and it could be due to increased use of alternate imaging modalities. In fact, rates for MRI and ultrasound increased in 8 of the 10 groups. Michelle W. Parker, MD, and five colleagues from the Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Ohio, published their findings, “Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children,” in Pediatrics on August 24, 2015.
The group used a cross-sectional study of children admitted to 33 pediatric tertiary-care hospitals participating in the Pediatric Health Information System between 2004 and 2012. Using billing data to determine usage rates, they followed the top 10 All-Patient Refined Diagnosis Related Groups (APR-DRGs) during this period, beginning with a base-line of CTs performed in 2004. During the study, the group monitored CT rates as well as MRI and ultrasound usage.
The group found that imaging with any modality for all of the APR-DRGs increased during the study, with the exception of ventricular shunt procedures and nonbacterial gastroenteritis. CT usage decreased for all groups (P values < .001); the decrease in CT was associated with a significant rise in alternate imaging modalities (P values ≤ .005). Eight of the 10 most common APR-DRGs saw a decrease in CT usage in 2012 when CT was the only modality used for those groups in 2004.
Increased use of MRI and ultrasound in children
In the article “Fewer CTs, More MRI and Ultrasounds for Kids” on Medscape.com, Marcia Frellick discusses the findings of Parker and her colleagues. According to Frellick, the group believes the shift could be attributed to concerns about ionizing radiation and cancer risk, as well as increased confidence in MRI and ultrasound due to advances in diagnostic imaging quality for non-radiation imaging and more staffing, such as sedation teams, which may be needed for MRI. Interestingly, Frellick mentions that Parker and colleagues point to a push in 2006 by the Alliance for Radiation in Pediatric Imaging as raising awareness for the need for lower doses and radiation exposure in children as having an impact in the increase in MRI and ultrasound usage.
An Alliance for Radiation in Pediatric Imaging is a group that ranges from medical professionals to concerned parents and exists to advance thoughtful, safe and judicious use of radiation in children. Image Gently® is the group’s registered trademark. The website, imagegently.org, contains many resources – and even a pledge – to ensure safe usage of diagnostic imaging in pediatrics. The website has also published protocols for ultrasound to promote appropriate use of imaging that does not involve ionizing radiation when possible.
Final thoughts | Pediatric Radiology Patients
It’s no secret that children have a higher risk of developing cancer from receiving radiation than adults. Exposure to ionizing radiation from even one CT exam increases the risk for cancer. And because radiation stays in the body, that risk rises with each subsequent exam. As part of its mission to promote quality and safety for patients, especially children, RadSite accreditation includes a review of pediatric studies and policies in facilities where children are seen. This review ensures that that radiation dose is being reduced for young patients who are more susceptible to radiation and best-practice guidelines from groups such as Image Gently are being followed. The recent study by Parker and her colleagues has significant ramifications for increased pediatric usage of MRI and ultrasound modalities and, ultimately, the safety of children.