How Boston Children’s reduces radiation exposure

The medical journal The Lancet recently released a study that reports that children who get multiple computed tomography (CT) scans are at slightly increased risk for brain cancer and leukemia.

While the news may alarm parents, it’s something Boston Children’s Hospital has been aware of for some time. In fact, Boston Children’s has for years been at the forefront of a movement to reduce the levels of radiation exposure to young patients.

CT scans produce high-quality images of inside patient’s bodies and are especially helpful in diagnosing certain illness or injury, like severe brain trauma or problems inside a person’s lungs. To produce their images, CT scanners use focused, small doses of ionizing radiation. The patient’s level of exposure to radiation is relatively low, but it’s believed that even a small exposure to ionizing radiation could potentially lead to an increased risk of cancer. Children are especially susceptible to this exposure because their developing tissues are more sensitive to the effects of radiation than are the mature tissues in adults. Children also generally have a longer life expectancy than adults, and as a result, have a greater chance of developing a radiation-induced cancer during their lifetime.

Because they work almost exclusively with young patients, the physicians and staff at Boston Children’s Department of Radiology are well aware of these risks and committed to reducing them.

CT scanner at Boston Children's have pediatric settings and have been modified to look less intimidating.

Michael Callahan, MD, Boston Children’s director of CT imaging, is a member of the Alliance For Radiation Safety in Pediatric Imaging’s steering committee, and is actively involved in the Image Gently campaign, an international organization dedicated to educating medical professionals and parents about the potential risks associated with CT scans in children. Together with a team of radiologic technologists and radiation physicists, Callahan is leading an effort within Boston Children’s to reduce the amount of radiation used for CT scans, and to reduce the overall number of CT scans in children.

Here are just a few of the methods Boston Children’s uses to achieve this goal:

Advocate for alternatives when appropriate. In some clinical situations Ultrasounds or MRI examinations—imaging procedures that do not utilize ionizing radiation—can be as accurate as CT scans, and are used when ever possible. Ultrasound uses sound waves to image the body and can answer some of the same questions as CT. Ultrasound also doesn’t require the child to stay completely still during the exam so it’s often the study of choice in very young children.  Because MRIs requires patients to remain very still for several minutes, young patients or older children who have a problem staying still may require sedation or anesthesia to have an MRI. In an attempt to reduce the need for sedation, our staff is specifically trained to work with children. We have many techniques—games, specially designed video goggles and music—that keep many of our younger patients entertained—and motionless—for their MRI. Thanks to these techniques children as young as four-years-old are often able to sit through the MRI without the need for sedation or anesthesia.

In cases of non-severe head injury, Boston Children’s researcher Lise Nigrovic, MD, MPH, recently released a study in the journal Pediatrics stating that when emergency department clinicians carefully observe patients at intermediate risk of head trauma for a few hours following injury, they should be able to accurately determine the severity of the injury without a CT scan. She also found that prolonged observation did not compromise patient safety in any way.

Use “child-friendly” CT machines. When a CT scan is the best option for obtaining a clear diagnosis, radiologists at Boston Children’s use the smallest radiation dose possible to produce images of diagnostic quality. In the medial field at large not all CT scans are performed with pediatric settings, however, CT imaging at Boston Children’s is adjusted for each patient’s individual size and reason for exam, ensuring the greatest safety by using the lowest necessary radiation exposure.

Take a unique, organ-focused approach. Members of our team subspecialize in the disease or organ being imaged. Working together with your child’s other doctors, our expert radiologists are able to determine what imaging test is best and avoid unnecessary radiation exposure whenever possible. Boston Children’s is the first pediatric hospital in the country to take this approach.

It’s possible that this new study may alert others in the medical field about the need for caution when using CT scans on children. Increased awareness among doctors is important, but parents still need to play an active role in advocating for their child’s safety. If your child requires testing you aren’t familiar with, ask the following questions:

  • What is the name of the test you are suggesting for my child?
  • Does the test involve ionizing radiation?
  • How will the test improve my child’s care?
  • Are there any non-ionizing radiation tests that could be safely used?
  • Will my child receive a “kid-sized” dose of radiation?
  • Is this facility accredited by the American College of Radiology?

To learn more about the value of choosing Boston Children’s for your pediatric imaging needs, please visit the following sites:

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