title: Trends in CT scan rates in children and pregnant women: teaching, private, public and nonprofit facilities.
abstract: BACKGROUND
  Radiation exposure from medical sources now equals or exceeds that from natural background sources, largely attributable to a 20-fold increase in CT use since 1980. Increasing exposure to children and fetuses is of most concern due to their heightened susceptibility. More recently, CT use may be leveling or decreasing, but it is unclear whether this change is widespread or varies by type of institution.
  
  
  OBJECTIVE
  We sought to characterize trends in CT utilization in California hospitals and emergency departments among children and pregnant women, looking at different types of facilities, such as teaching, private, public and nonprofit institutions.
  
  
  METHODS
  We examined frequency of CT examinations by year from 229 facilities reporting CT usage in routinely collected California statewide data for 2005-2012. We modeled trends overall and by facility type.
  
  
  RESULTS
  CT scans for pediatric and pregnant patient visits in the emergency department increased initially, then started to decline after 2008. Among hospital admissions, rates declined or leveled after 2005. In the emergency department, CT rates varied between types of facilities, with teaching hospitals reducing use sooner and more sharply than other types of facilities.
  
  
  CONCLUSIONS
  CT utilization in California among children and pregnant women has begun to level or decline. Still, population exposure remains at historically high levels, warranting consideration of potential public health implications. Further examination of reasons for trends among hospital types, particularly how teaching hospitals have reduced rates of CT utilization, may help identify strategies for CT reduction without compromising patient care.
authors: Environmental Health Investigations Branch, California Department of Public Health, 850 Marina Bay Parkway, Building P, 3rd Floor, Richmond, CA, 94804, USA, sumi.hoshiko@cdph.ca.gov.
authors: Sumi
authors: S
authors: Hoshiko
authors: Daniel
authors: D
authors: Smith
authors: Cathyn
authors: C
authors: Fan
authors: Carrie R
authors: CR
authors: Jones
authors: Sandra V
authors: SV
authors: McNeel
authors: Ronald A
authors: RA
authors: Cohen
mesh_terms: D000293:Adolescent; D002140:California / Q000453:epidemiology; D002648:Child; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D016304:Hospitals, Private / Q000706:statistics & numerical data* / Q000639:trends; D006779:Hospitals, Public / Q000706:statistics & numerical data* / Q000639:trends; D006784:Hospitals, Teaching / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009939:Organizations, Nonprofit / Q000706:statistics & numerical data* / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data* / Q000639:trends