Will Parents Understand JAMA Pediatrics Study on CTs and Cancer Risk?

The study made headlines with the authors’ data on the growth in CT scan use in children and their estimate that 4,870 future cancers could be caused by the 4 million pediatric CT scans performed each year. However, the ACR cautions that parents should not overestimate their child’s individual risk or underestimate the necessity of CT imaging. “If an imaging scan is warranted, the immediate benefits outweigh a potential and very small long-term risk, said Marta Hernanz-Schulman, M.D., FACR, FAAP, chair of the ACR’s Pediatric Imaging Commission in the college’s statement on the JAMA Pediatrics study. “Parents should certainly discuss such potential risk with their physician, but this appropriate concern should not translate into refusal of necessary and potentially life-saving care.” The study entitled “The Use of Computed Tomography in Pediatrics and the Associated Radiation Exposure and Estimated Cancer Risk” was a retrospective observational study using data from seven U.S. health care systems on patients younger than 15 who were evaluated with a CT scan in the time period from 1996 to 2010. Based on the data, the use of CT at the health care systems doubled for children younger than 5 years old and tripled for children 5 to 14 years of age between 1996 and 2005 before leveling off between 2006 and 2007 and then declining. This correlates with a study last year in JAMA on imaging use in all patients during the same time period. The authors also found that the risk of developing solid cancer was higher for younger patients and girls. In addition, abdominal/pelvic and spine CT scans increased cancer risk more than other types of CT scans. The authors suggested that based on their calculations, reducing the highest 25 percent of pediatric CT radiation doses to the median (midpoint) may prevent 43 percent of cancers, and said that more research to determine when a pediatric CT leads to improved outcomes is “urgently needed.” Last summer, a similar study published in the Lancet also made headlines with its finding that pediatric CTs could triple the risk of brain cancer. Of course, pediatric brain cancer is very rare, so triple the risk is still a very low risk. The ACR urged parents whose children might need a CT test to take practical steps like keeping a record of their child’s imaging history that includes the type of study done and the place and date it was done. This can help the ordering physician weigh the relative risks and benefits of CT imaging. Parents should also ask:   ·       How will having this exam improve my child’s health care? ·       Are there alternatives that do not use radiation, which in this case might be equally effective? ·       Will my child receive a “child-sized” radiation dose? ·       Is this facility ACR-accredited?   The ACR also noted that legislators can help ensure appropriate imaging and lower the radiation dose that Americans (including children) receive by requiring imaging facilities to be accredited, incentivizing the use of computerized physician order entry systems that include the ACR’s imaging appropriateness criteria, and incentivizing facilities to participate in the ACR’s dose index registry. “We urge government to work with ACR and other stakeholders to streamline, enhance and promote Electronic Health Records that promote universal access to prior imaging scans and avoid duplicative testing. We also urge providers, patients and parents to take advantage of the many ACR quality and safety programs, such as facility accreditation, ACR Appropriateness Criteria, decision support systems to guide providers to the right test for their patients, and initiatives such as Image Gently and Image Wisely, in order to help ensure children and adults receive safe, appropriate, high quality care,” said Dr. Hernanz-Schulman in the ACR’s statement.