St. Louis Children’s Hospital Calls for Hospitals, Clinics to Track Radiation Exposure Levels for Children’s Imaging Tests

A safe imaging measure from St. Louis Children’s Hospital has been recommended nationwide implementation by a subcommittee of the National Advisory Council for Healthcare Research and Quality.  

The measure calls for hospitals and clinics using computed tomography (CT) systems to record the intensity of X-ray radiation exposure after each test. The exposure amount would be listed in a pediatric patient’s electronic medical record. St. Louis Children’s Hospital has tracked exposure data since 2009.

The recommendation, forwarded in September, calls for including the St. Louis Children’s Hospital measure in the Children’s Health Insurance Program Reauthorization Act 2013 Core Set of Children’s Health Care Quality Measures. The act includes provisions to strengthen the quality of care provided and health outcomes of children in Medicaid and the Children’s Health Insurance Program (CHIP). 

“A better understanding of X-ray use in children is needed to improve the balance between the risks and benefits of imaging,” says James Duncan, MD, PhD, interventional radiologist with St. Louis Children’s Hospital, associate professor of radiology at Washington University School of Medicine and chief quality and safety officer for the Mallinckrodt Institute of Radiology. “The St. Louis Children’s Hospital measure will track how well each facility captures its data.”

A CT scanner uses X-rays to take cross-section pictures of the inside of the body in “slices.” Children frequently undergo computed tomography (CT) scans to determine the cause of their illness and guide subsequent treatment.   While CT and other imaging studies have revolutionized health care, the number of CT scans performed on children nationally has increased five-fold over the last 15 years. Ninety percent of those scans were performed at non-pediatric hospitals, where adult rather than “child sized” doses of X-rays might be used. 

“We see this when families bring in outside CT studies for us to review,” Duncan says.  “The result is that we sometimes see exposures that are 10 times higher than would have occurred at St. Louis Children’s Hospital.  Our concern is that these X-ray exposures could lead to future health problems such as cancer.  While the risk to any single child is extremely small, a large number of CT scans can heighten the risk.”

St. Louis Children’s Hospital performs about 100,000 imaging exams annually, and about 6,000 of those are CT scans. St. Louis Children’s Hospital manually customizes the dosage of CT scans for patients, cutting dosage by about half and thereby minimizing a child’s risk. St. Louis Children’s Hospital has protocols in place to ensure doctors always choose the imaging procedure that uses the least amount of radiation. Duncan says the hospital uses MRI and ultrasound whenever possible because they do not use ionizing radiation, but the exams are not always the most appropriate diagnostic tools.

“A child should never be exposed to the amount of radiation we would consider appropriate for an adult patient,” says Robert McKinstry, MD, PhD, Chief of Radiology, St. Louis Children’s Hospital. “We ensure all of our patients receive the lowest possible dose in the safest environment of care.”

View the Radiation Exposure Recommendation

About CT Scans:

While an X-ray can provide a great deal of diagnostic information, a CT scan offers far greater detail about internal organs and other structures.  A CT uses X-rays to take cross-section pictures of the inside of the body in “slices”.  The slices are then reconstructed into an image.  That level of detail can significantly advance a child’s medical treatment.  However, clinicians must weigh the diagnostic benefit of CT against the risk posed by radiation exposure.

• A typical adult chest CT emits approximately 175-times-greater the dose of radiation as a routine chest X-ray.
• Using Flash CT technology, a pediatric CT scan performed at St. Louis Children’s Hospital is comparable to only 44 X-rays (75% less than a standard adult  CT).
• No other center in the region offers pediatric scans at such a significantly reduced dose.
• The number of CT scans performed on children has increased five-fold over the last 15 years. 
• 90% of CT scans are performed at non-pediatric hospitals.
• Since 2005, the number of CT scans performed at St. Louis Children’s Hospital has decreased by half.