CT versus plain radiographs for evaluation of c-spine injury in young children: do benefits outweigh risks?
BACKGROUND
Various reports support the use of cervical spine (c-spine) CT over conventional radiography in screening of c-spine injury. Interest now exists in diagnostic radiation-induced morbidity.


OBJECTIVE
To estimate excess relative risk for developing cancer from c-spine high-resolution CT radiation exposure.


METHODS
We conducted a retrospective review of children evaluated for c-spine injury using CT. The study population was divided into three age groups, 0-4 years (group 1), 5-8 years (group 2), and older than 8 years (group 3). Anthropomorphic 1-year-old and 5-year-old phantoms were used to measure radiation at the thyroid during radiography and CT. Excess relative risk for thyroid cancer was estimated using these measurements.


RESULTS
A total of 557 patients were evaluated with CT. The radiographic method most commonly used was head CT/c-spine CT in 363 (65%). Only 179 children (32%) had any type of prior radiography. The use of c-spine CT exposes the thyroid to 90-200 times more radiation than multiple conventional radiographs. The mean excess relative risk for thyroid cancer after CT was 2.0 for group 1 and 0.6 for group 2. There were no comparison data for group 3.


CONCLUSIONS
C-spine CT is associated with a significant exposure to ionizing radiation and increases excess relative risk for thyroid cancer in young children.
Jimenez
Ricardo R
RR
Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA. rrjimenez@hotmail.com
Deguzman
Michael A
MA
Shiran
Shelly
S
Karrellas
Andrew
A
Lorenzo
Robert L
RL
D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019047:Phantoms, Imaging; D011832:Radiation Injuries / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013124:Spinal Injuries / Q000175:diagnosis*; D013964:Thyroid Neoplasms / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*