AJR: U.S. pediatric CT use continues to decrease
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Brent A. Townsend, MD, from the department of radiology at Children's Hospital Boston, and colleagues said that despite an increase in the overall number and speed of available scanners, CT volumes at their institution have been on the decline since 2005.
“We hypothesized that this trend was not isolated to our institution but, rather, was emblematic of a larger regional or national trend,” they wrote.
In the article, Townsend pointed to several recent studies and its consequent media publicity as potential reasons for the decline, as they have focused on CT’s use of ionizing radiation which may increase lifetime cancer risk. This has posed a concern, especially in the pediatric patient population, as children are more sensitive to radiation than adult patients, noted the authors.
To collect the data, the authors sent Internet-based surveys electronically to the members of the Society of Chairmen of Radiology at Children's Hospitals (SCORCH). The respondents were asked to record the total number of annual imaging studies and the number of CT, MRI and ultrasound studies performed each year from 2003 through 2007. Of the 63 member institutions, complete data sets were available for 23 institutions, they wrote.
From 2003-2007, relative CT usage declined steadily, becoming significantly lower in 2006 and 2007. In addition, Townsend and colleagues said that the relative use of MRI studies increased steadily, particularly from 2005-2007 and ultrasound examinations has not changed significantly over the course of the observed years.
Moreover, the authors found that while a decrease in relative CT utilization was seen in most of the institutions surveyed, the greatest rate of decrease was noted in hospitals with fewer than 250 beds from 2005-2007.
“Possible explanations for the national trend are likely multifactorial and may be related to increased parental pressure, especially as studies about radiation and the potential cancer risk circulate in the popular press,” hypothesized Townsend and colleagues. “Increased access to MRI may also have facilitated a decrease in CT volumes, particularly in small hospitals where ready access to MRI may have been more limited in the past.”
Townsend and colleagues also explained that in may be challenging for clinicians at non-pediatric specific institutions to keep in mind that the risk-versus-reward equation is different for children than it is for adults, and noted that the Image Gently campaign was established in 2006 by the Alliance for Radiation Safety in Pediatric Imaging of the Society of Pediatric Radiology, in order to raise awareness of the different radiation safety needs of children and to use protocols appropriate for the pediatric population.
While the reasons for this trend are not clearly understood, noted the authors, they believe that further research is needed. “Better understanding of the forces driving CT utilization may help us ensure that this powerful technique is used in the most efficient and safest way possible,” the authors concluded.