title: Dose reduction efforts for pediatric head CT imaging in Washington State trauma centers: follow-up survey results.
abstract: OBJECTIVE
  To examine variation in pediatric trauma head CT imaging protocols in Washington State trauma centers (TCs) in 2012 and compare to a previous survey conducted in 2008-2009.
  
  
  METHODS
  A mixed-mode (online and paper) survey was sent to all adult and pediatric Washington State TCs (levels 1-5). Respondents provided information about the CT scanner used for pediatric head scans and technical information about pediatric dose reduction protocols. Mean head effective dose and organ dose for a female baby were estimated. Results were compared with previous data.
  
  
  RESULTS
  Sixty-one of 76 TCs responded to the 2012 survey (response rate, 80.3%, versus 76% for 2008-2009 survey). In 2012, 91.7% reported having a dedicated pediatric protocol (87.7% in 2008-2009). Protective shielding use ranged from 80% to 100% across both survey years. In 2012, 2.5 times more TCs provided sufficient information to conduct dose calculations than in 2008-2009. Estimated mean CT dose index was 23.1 milliGray (mGy) in 2012, compared with 34.8 mGy in 2008-2009 (P = .01). Estimated mean dose length product was also significantly lower in 2012 than 2008-2009 (307.6 mGy × cm versus 430.1 mGy × cm, respectively; P = .04). Wide variation in mean effective dose was observed for level 3 and 4 TCs in 2012, similar to variation observed in 2008-2009 among level 4 TCs. Mean organ dose was significantly lower in 2012 for eye lens and brain, but higher for thyroid than in 2008-2009 (P < .05).
  
  
  CONCLUSIONS
  Although most Washington State TCs employ dose reduction protocols for pediatric head CTs, and some measures were lower in 2012, variation in protocols use and estimated dose continues to exist. More complete responses in 2012 suggest improved understanding of the importance of pediatric dose reduction efforts. Education and institutional protocols are necessary to reduce pediatric radiation dose from head CTs.
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington. Electronic address: janessa@uw.edu.
authors.forename: Janessa M
authors.initials: JM
authors.lastname: Graves
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Radiology, School of Medicine, University of Washington, Seattle, Washington.
authors.forename: Kalpana M
authors.initials: KM
authors.lastname: Kanal
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.affiliation: Department of Radiology, School of Medicine, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost and Outcomes Research Center, School of Public Health, University of Washington, Seattle, Washington; Department of Neurological Surgery, School of Medicine, University of Washington, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Jarvik
authors.affiliation: Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
mesh_terms: D002648:Child; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D011829:Radiation Dosage; D011835:Radiation Protection / Q000592:standards / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D014861:Washington / Q000453:epidemiology
keywords: CT imaging protocols; Washington State; pediatric head CT; radiation dose; trauma center