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Radiation Dose for Pediatric Patients With Cystic FibrosisRadiation Dose in Children With Cystic Fibrosis: A Continuous Adjustment Process and Remaining Concern FREE TO VIEW

Pim A. de Jong, MD, PhD; Catherine M. Owens
Author and Funding Information

From the Radiology Department (Dr de Jong), University Medical Center Utrecht; and Radiology Department (Dr Owens), Great Ormond Street Hospital for Children.

Correspondence to: Pim A. de Jong, MD, PhD, Radiology Department, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands; e-mail: pimdejong@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):1077. doi:10.1378/chest.12-1433
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To the Editor:

There is growing concern that CT scanning in children may be associated with a small excess risk of malignancy, which remains difficult to prove because there are few robust data to support the hypothesis.1 It is vital to remember that CT scans are performed to answer a clinical question posed to help patients through their diagnostic and therapeutic pathway; that is, a CT scan must be justified before it is performed. Subsequently, radiologists must optimize the CT scan so that the images are obtained at the lowest possible radiation dose and of suitable quality for making the relevant diagnoses. Additionally, an awareness of cumulative effective dose is important, especially in children with chronic disorders. Therefore, in an issue of CHEST (June 2012), O’Connell et al2 investigated a timely and important topic, namely the trend in cumulative effective dose in cystic fibrosis (CF) radiologic imaging over the past 17 years.

Unfortunately, the authors did not optimize their imaging protocols and kept the radiation dose per examination constant, whereas most CF centers have adopted low-dose imaging protocols and systematically lowered the dose during the past 17 years. Therefore, the study must not be regarded as normal practice within most dedicated centers. It may well be that in most centers, the trend in cumulative dose remained constant (or even reduced) as the dose per examination decreased, given technical advances and increased awareness. Additionally, O’Connell et al2 did not adopt pediatric CT scanning protocols that were published many years ago. The dose per CT scan examination used in their center was up to 28.5 times more than what is regarded as state of the art for many years now.3 We urge centers caring for pediatric patients with CF to pay close attention to imaging protocols with respect to the radiation dose administered. Apparently, centers apply up to 28.5 times higher doses than what is, in our opinion, necessary for diagnosis.

In conclusion, imaging protocols in CF need continuous adjustment. Centers caring for children with CF should adhere to state-of-the-art imaging acquisition protocols. Because O’Connell et al2 did not apply these principles in their study, their findings are not applicable to most pediatric CF centers, and it remains uncertain whether cumulative effective dose increased for patients with CF.

Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. In press.
 
O’Connell OJ, McWilliams S, McGarrigle AM, et al. Radiologic imaging in cystic fibrosis: cumulative effective dose and changing trends over 2 decades. Chest. 2012;141(6):1575-1583. [PubMed] [CrossRef]
 
Papaioannou G, Young C, Owens CM. Multidetector row CT for imaging the paediatric tracheobronchial tree. Pediatr Radiol. 2007;37(6):515-529.
 

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References

Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. In press.
 
O’Connell OJ, McWilliams S, McGarrigle AM, et al. Radiologic imaging in cystic fibrosis: cumulative effective dose and changing trends over 2 decades. Chest. 2012;141(6):1575-1583. [PubMed] [CrossRef]
 
Papaioannou G, Young C, Owens CM. Multidetector row CT for imaging the paediatric tracheobronchial tree. Pediatr Radiol. 2007;37(6):515-529.
 
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