Abstract
Background
Despite the medical benefits of CT, there are concerns about increased cancer risks following CT scans in childhood.
Objective
To assess Australian temporal trends in pediatric CT scans funded through Medicare over the period 1985 to 2005, as well as changes in the types of CT scanners used.
Materials and methods
We studied de-identified electronic records of Medicare-funded services, including CT scans, that were available for children and adults younger than 20 years between 1985 and 2005. We assessed temporal trends using CT imaging rates by age, gender and anatomical region. Regulators provided CT scanner registration lists to identify new models installed in Australia and to date the introduction of new technologies.
Results
Between 1985 and 2005, 896,306 Medicare-funded CT services were performed on 688,260 individuals younger than 20 years. The imaging rate more than doubled during that time period. There were more than 1,000 CT scanners on registration lists during the study period. There were both a sharp increase in the availability of helical scanning capabilities from 1994 and significant growth in multi-detector CT scanners from 2000.
Conclusion
Significant increases in the rate of pediatric CT scanning have occurred in Australia. This rate has stabilized since 2000, possibly a result of better understanding of cancer risks.
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References
Brady Z, Cain TM, Johnston PN (2011) Paediatric CT imaging trends in Australia. J Med Imaging Radiat Oncol 55:132–142
Miglioretti DL, Johnson E, Williams A et al (2013) The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 167:700–707
Brady Z, Cain TM, Johnston PN (2012) Justifying referrals for paediatric CT. Med J Aust 197:95–98
Mathews JD, Forsythe AV, Brady Z et al (2013) Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 346:f2360
Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505
United Nations Scientific Committee on the Effects of Atomic Radiation (2013) Sources, effects and risks of ionizing radiation, UNSCEAR 2013 report, volume II, scientific annex B: effects of radiation exposure of children. United Nations, New York
Walsh L, Shore R, Auvinen A et al (2014) Risks from CT scans — what do recent studies tell us? J Radiol Prot 34:E1–E5
Journy N, Rehel JL, Ducou Le Pointe H et al (2015) Are the studies on cancer risk from CT scans biased by indication? Elements of answer from a large-scale cohort study in France. Br J Cancer 112:185–193
Brenner DJ, Elliston CD, Hall EJ et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296
Chodick G, Ronckers C, Ron E et al (2006) The utilization of pediatric computed tomography in a large Israeli Health Maintenance Organization. Pediatr Radiol 36:485–490
Hoshiko S, Smith D, Fan C et al (2014) Trends in CT scan rates in children and pregnant women: teaching, private, public and nonprofit facilities. Pediatr Radiol 44:522–528
Menoch MJA, Hirsh DA, Khan NS et al (2012) Trends in computed tomography utilization in the pediatric emergency department. Pediatrics 129:E690–E697
Roudsari BS, Psoter KJ, Vavilala MS et al (2013) CT use in hospitalized pediatric trauma patients: 15-year trends in a level I pediatric and adult trauma center. Radiology 267:479–486
Bosch de Basea M, Salotti J, Pearce M et al (2015) Trends and patterns in the use of computed tomography in children and young adults in Catalonia — results from the EPI-CT study. Pediatr Radiol 46:119–129
Pearce MS, Salotti JA, McHugh K et al (2011) CT scans in young people in Northern England: trends and patterns 1993–2002. Pediatr Radiol 41:832–838
Pearce MS (2011) Patterns in paediatric CT use: an international and epidemiological perspective. J Med Imaging Radiat Oncol 55:107–109
Australian Bureau of Statistics (2008) Australian historical population statistics (Cat. No.3105.0.65.001). Canberra, Australian Capital Territory, Australia
Thomson JEM, Tingey DRC (1997) Radiation doses from computed tomography in Australia. Commonwealth of Australia, Department of Health and Family Services, Australian Radiation Laboratory, Yallambie
Frush DP (2014) Overview of CT technologies for children. Pediatr Radiol 44:422–426
Seibert JA (2014) Iterative reconstruction: how it works, how to apply it. Pediatr Radiol 44:431–439
Khawaja RDA, Singh S, Otrakji A et al (2015) Dose reduction in pediatric abdominal CT: use of iterative reconstruction techniques across different CT platforms. Pediatr Radiol 45:1046–1055
Santos J, Foley S, Paulo G et al (2015) The impact of pediatric-specific dose modulation curves on radiation dose and image quality in head computed tomography. Pediatr Radiol 45:1814–1822
Spearman JV, Schoepf UJ, Rottenkolber M et al (2015) Effect of automated attenuation-based tube voltage selection on radiation dose at CT: an observational study on a global scale. Radiology. doi:10.1148/radiol.2015141507
United Nations Scientific Committee on the Effects of Atomic Radiation (2010) Sources and effects of ionizing radiation, UNSCEAR 2008 report, volume I, scientific annex A: medical radiation exposures. United Nations, New York
Bernier MO, Rehel JL, Brisse HJ et al (2012) Radiation exposure from CT in early childhood: a French large-scale multicentre study. Br J Radiol 85:53–60
Meulepas JM, Ronckers CM, Smets AM et al (2014) Leukemia and brain tumors among children after radiation exposure from CT scans: design and methodological opportunities of the Dutch Pediatric CT Study. Eur J Epidemiol 29:293–301
Dorfman AL, Fazel R, Einstein AJ et al (2011) Use of medical imaging procedures with ionizing radiation in children: a population-based study. Arch Pediatr Adolesc Med 165:458–464
Acknowledgments
This study was supported by project grants 509190 and 1027368 from the National Health and Medical Research Council. We thank state and territory radiation regulators for data on CT scanner registrations, the Department of Health for the provision of detailed Medicare data sets and Mita Pederson, chief medical imaging technologist at The Royal Children’s Hospital Melbourne, for CT billing data.
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Brady, Z., Forsythe, A.V. & Mathews, J.D. The changing use of pediatric CT in Australia. Pediatr Radiol 46, 1199–1208 (2016). https://doi.org/10.1007/s00247-016-3563-5
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DOI: https://doi.org/10.1007/s00247-016-3563-5