Computed Tomography Associated Radiation Exposure in Children with Craniosynostosis
Madeleine K. Bruce, BA1, Aditya M. Mittal, BS2, Darunee S. Whitt, MS, DABR3, Lynda L. Flom, MD1, Miles J. Pfaff, MD, MHS1, Joseph E. Losee, MD1, Jesse A. Goldstein, MD1
1UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, School of Medicine, 2University of Pittsburgh, Pittsburgh, PA, 3Office of Research Protections Radiation Safety, University of Pittsburgh, Pittsburgh, PA
Background: The role of computed tomography (CT) for diagnosis and surgical planning for craniosynostosis (CS) is well-established. While CT imaging is readily accessible at most hospitals, relatively inexpensive, and can be performed rapidly, cumulative radiation exposure remains a downside of this imaging modality. The aim of this study was to quantify the cumulative medical radiation exposure from CT in patients with CS at a tertiary care children’s hospital.
Methods: Medical records of patients who presented at <2 years of age and underwent surgical intervention for CS were examined for demographic information. Effective radiation dose (ERD) in mSv was calculated for each head CT. Descriptive statistics and ANOVA were performed. Mean ± SD is reported, p <0.05 was considered significant.
Results: 272 patients met inclusion criteria: 241 nonsyndromic, 31 with syndromic diagnoses. For nonsyndromic patients, mean age at first head CT was 6.0 ± 4.9 months, mean number of CT scans obtained was 2.1 ± 1.1, and the mean total combined ERD was 9.1 ± 4.8 mSv. CT scans obtained at <6 months of age had a significantly greater ERD than those obtained at >6 months, 5.3 ± 1.9 versus 4.3 ± 1.4 mSv, respectively (p=0.001). The mean number of CTs obtained in patients with syndromic diagnoses was greater than in the nonsyndromic cohort, 6.6 ± 6.0 versus 2.1 ± 1.1, respectively (p<0.001). Mean total ERD was greater in children with syndromic than nonsyndromic diagnoses, 22.3 ± 12.4 versus 9.1 ± 4.8 mSv, respectively (p<0.001).
Conclusions: Patients with nonsyndromic CS undergo 2 CT scans on average related to their diagnosis, with a mean total ERD of 9.1 mSv; this is equivalent to 1.5 years of the average annual background radiation dose a person living in the US will encounter from environmental radiation, medical exposures and consumer products. Children with syndromic diagnoses will undergo a greater number of CT scans on average and subsequently be exposed to a larger total ERD. A CT obtained at <6months is associated with a significantly higher ERD. Based on this data, we recommend avoiding obtaining a CT scan unless otherwise necessary until the age of 6 months. When planning surgical intervention, delaying CT imaging until the time of pre-operative planning will decrease radiation exposure.
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