The number of children receiving a CT scan in the emergency department has increased fivefold in recent years, according to a new study, leading some experts to urge better collaboration between doctors and device makers to ensure appropriate utilization.

"We need to think creatively about how to partner with each other," lead author Dr. David B. Larson, director of quality improvement in the department of radiology at Cincinnati Children's Hospital Medical Center in Ohio, said in a statement.

In the study, published online and in the June issue of the journal Radiology, the researchers pored over the National Hospital Ambulatory Medical Care Survey. They found the number of pediatric emergency department visits rocketed from 330,000 in 1995 to 1.65 million in 2008, with a compound annual growth rate of 14.3 percent.
Most children showed up to the ED for headache, abdominal pain or head injury, with abdominal pain-associated scanning increasing the most, in part because of the development of helical scanning, Larson said.

"By 2008, helical scanning had helped make CT very useful for abdominal imaging. It's widely available, it's fast and there are a lot of great reasons to do it, but it does carry a higher radiation dose," he said.

Abdominal CT imaging was almost never used in 1995 but grew to represent 15 to 21 percent of visits for the last four years of the study, Larson said.

This is significant because abdominal CT imaging carries seven times the dose of head CT imaging. According to the Radiological Society of North America, abdominal CT imaging produces an effective dose of up to 15 mSv, and head CT a dose of up to 2 mSv. (Reported doses are for adults -- for children, exposures are often significantly lower, RSNA said.)

In the study, most radiologists who performed the exams were not trained in the pediatric radiology sub-specialty and almost 90 percent of ED visits happened in departments that were not children-focused.

"The performance of CT in children requires special oversight, especially in regards to the selection of size-based CT scan parameters and sedation techniques," Larson said.

Children are thought to be more vulnerable to exposures from ionizing radiation because their tissues are more "radiosensitive" and they have longer lives ahead of them in which to develop cancers.

In 2007, the Alliance for Radiation Safety in Pediatric Imaging launched its Image Gently campaign, to raise awareness about medical radiation risks in children.

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