Computed tomography (CT) scan is a widely used medical imaging procedure that generates cross-sectional images of the body's structures through the combination of X-ray images obtained from multiple angles. It is diagnostic capabilities and image quality set it apart from other imaging modalities, leading to its increasing prevalence worldwide. In Australia, the utilization of CT scans has shown a significant rise, with a 36% increase observed from 2006/07 to 2011/12 [7]. The advancements in CT technology, such as faster gantry rotations and the use of multi-slice detectors, have contributed to its expanded application among various patient groups. While CT scans offer detailed information for diagnosis and evaluation, it is crucial to minimize radiation risks associated with their usage through appropriate justification, optimization, and dose limitation [23].
The potential adverse effects of radiation exposure are of particular concern in pediatric patients, who may undergo CT scans for various medical reasons. Previous studies have indicated that nearly half of pediatric patients with head injuries received unnecessary CT scans [1]. Children are more vulnerable to radiation-induced risks and cancer development compared to adults [8]. Although the overall lifetime attributable risk of cancer incidence due to pediatric chest CT scans remains low, certain groups such as female neonates, exhibit a slightly higher rate [18]. Prolonged life expectancy in children provides radiation-induced tumors more time to develop. Additionally, repeat CT scans may occur due to factors like positioning errors, inadequate image data transfer, or poor image quality. Nevertheless, repeated CT scans carry inherent risks, primarily an increased radiation dose to patients, which may not be widely recognized since CT scans deliver higher radiation doses compared to other diagnostic radiation procedures. For pediatric cases within the older age range of 13 to 15 years, female gender, obesity, and multiphase or repeat scanning are associated with increased effective doses from abdomen/pelvis CT scans [4].
The use of CT scans has also risen in the context of trauma injuries in Emergency Rooms. Trauma patients often undergo repeated CT scans, commonly attributed to concerns regarding image quality and the potential for missed diagnoses [25]. For pediatric patients with minor head injuries, the initial CT scans often do not reveal clinically significant abnormalities necessitating neurosurgical intervention [3]. However, subsequent CT scans may detect pathologic findings, such as skull fractures and subarachnoid hemorrhage, leading to revised treatment decisions [22].
Considering the potential risks associated with CT scan radiation exposure, it becomes crucial to identify factors that contribute to cancer risk. While several general risk factors for cancer exist (e.g., age, family history, tobacco use, alcohol consumption, exposure to specific chemicals, and radiation exposure), the stochastic effect of radiation, which induces genetic mutations, poses a primary concern in the context of CT scans. Studies have indicated a significant association between predicted radiation doses from CT scans and the subsequent incidence of leukemia and brain cancers [21]. However, the global literature on this topic is inconsistent, with variations in epidemiological patterns observed across different studies. For example, an Australian study revealed an increase in malignancies previously not associated with radiation, while a Taiwanese study found a reduction in the risk of benign tumors with increasing age at the time of CT scans [14, 11]. Furthermore, female patients under 5 years old who undergo spiral CT imaging for brain scans face a heightened risk of thyroid cancer [13]. Despite the potential risks, the benefits of CT scans outweigh them. Therefore, the management of repeated CT scans becomes a critical question that necessitates an examination of the factors influencing the decision-making process.
Overall, this study aims to conduct a systematic review and meta-analysis to investigate the factors associated with CT scan repetition among pediatric patients and its relationship with cancer risk. By understanding these factors, we can inform clinical practice and develop strategies to minimize unnecessary repeat scans, thereby reducing radiation exposure and potential health risks.
Review Aim
The aim of the research is to conduct a comprehensive systematic review and meta-analysis in order to investigate the factors contributing to the decision of repeated CT scans in pediatrics and assess their correlation with the risk of cancer. The specific objectives of the study include:
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Identifying the factors associated with repeated CT scans in pediatric patients.
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Exploring the relationship between the relative risk of cancer incidence and the exposure of pediatric patients to repeated CT scans.
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Identifying the types of cancer that are most associated with repeated radiation exposure from CT scans in children.
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Determining the rate of CT-scan repetition, cumulative doses, and reasons for multiple CT-scan exposures among pediatric patients.
Overall, the research aims to provide valuable insights into the factors influencing the decision for repeated CT scans in pediatrics and their potential impact on cancer risk. By synthesizing existing evidence through a systematic review and meta-analysis, the study aims to contribute to the understanding of this important clinical issue and inform future medical practices and policies.