Trends and patterns of computed tomography scan use among children in The Netherlands: 1990–2012
To evaluate trends and patterns in CT usage among children (aged 0–17 years) in The Netherlands during the period 1990–2012.
Lists of electronically archived paediatric CT scans were requested from the Radiology Information Systems (RIS) of Dutch hospitals which reported >10 paediatric CT scans annually in a survey conducted in 2010. Data included patient identification, birth date, gender, scan date and body part scanned. For non-participating hospitals and for years prior to electronic archiving in some participating hospitals, data were imputed by calendar year and hospital type (academic, general with <500 beds, general with ≥ 500 beds).
Based on 236,066 CT scans among 146,368 patients performed between 1990 and 2012, estimated annual numbers of paediatric CT scans in The Netherlands increased from 7,731 in 1990 to 26,023 in 2012. More than 70 % of all scans were of the head and neck. During the last decade, substantial increases of more than 5 % per year were observed in general hospitals with fewer than 500 beds and among children aged 10 years or older.
The estimated number of paediatric CT scans has more than tripled in The Netherlands during the last two decades.
• Paediatric CT in The Netherlands has tripled during the last two decades.
• The number of paediatric CTs increased through 2012 in general hospitals.
• Paediatric CTs continued to increase among children aged 10 years or older.
KeywordsComputed tomography Trends Patterns Child Paediatric
We sincerely thank the staff members, clinicians and board of directors of all hospitals who provided data for our study (AMC Amsterdam, Amphia Ziekenhuis, Albert Schweitzer Ziekenhuis, Bethesda Ziekenhuis, Canisius-Wilhelmina Ziekenhuis, Diaconessenhuis Leiden, Isala Diaconessenhuis Meppel, Diakonessenhuis Utrecht, Elkerliek Ziekenhuis, Erasmus MC, Flevoziekenhuis, Groene Hart Ziekenhuis, Medisch Centrum Haaglanden, HagaZiekenhuis, Ikazia Ziekenhuis, Isala Ziekenhuis, Jeroen Bosch Ziekenhuis, Kennemer Gasthuis, Streekziekenhuis Koningin Beatrix, Leids Universitair Medisch Centrum, Medisch Centrum Alkmaar, Medisch Centrum Leeuwaarden, Meander Medisch Centrum, Medisch Spectrum Twente, Onze Lieve Vrouwe Gasthuis, Radboudumc, Rijnland Ziekenhuis, Rijnstate, Rivas Beatrix ziekenhuis, Saxenburgh groep Röpcke-Zweers Ziekenhuis, Sint Franciscus Gasthuis, Slotervaartziekenhuis, St. Antonius Ziekenhuis, St. Elisabeth Ziekenhuis, Sint Maartenskliniek, Maastricht UMC, UMC Groningen, UMC Utrecht, Het Van Weel-Bethesda Ziekenhuis, VUMC Amsterdam, Ziekenhuisgroep Twente, ZorgSaam Zeeuws-Vlaanderen). Without the dedicated support of numerous professionals in the participating radiology departments, this study would not have been possible.
The scientific guarantor of this publication is Dr. M. Hauptmann. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by the European Community Seventh Framework Programme [grant number FP7/2007-2013] under Grant Agreement Number 269912-EPI-CT: ‘Epidemiological study to quantify risks for paediatric computerized tomography and to optimize doses’ and by Worldwide Cancer Research formerly known as Association for International Cancer Research (AICR) [grant number 12-1155]. Dr. Cecile Ronckers is supported by the Dutch Cancer Society. Funders had no involvement in the study design, data collection, analysis and interpretation, the writing of the report, or the decision to submit the paper for publication. One of the authors has significant statistical expertise (p < 0.001). Institutional Review Board approval and written informed consent was not required because the study concerns secondary use of personal and medical data from medical files. In The Netherlands, a self-regulatory Code of Conduct for the use of data in Health Research generally mandates explicit written individual patient consent to the physician to authorize release of personal medical information for scientific purposes. In compliance with the Code, radiologists are nonetheless allowed to provide data without consent, because (1) the resources needed to trace large cohorts render research infeasible, (2) a high potential of selective participation leading to biased cancer risk and loss of statistical power, and (3) the study invitation letter likely causes worries among children and parents, particularly because it cannot take the individual indication (and justification) for a CT scan into account. In compliance with the Code of Conduct, we prepared a data protection regulation document and defined data flow and data access policies. Methodology: retrospective, observational, multicentre study.
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