title: Pediatric Emergency CT Scans at a Children's Hospital and at Community Hospitals: Radiation Technical Factors Are an Important Source of Radiation Exposure.
abstract: OBJECTIVE
  This article compares the technical factors-in particular, tube current and voltage-and the resultant exposure to radiation associated with CT examinations performed at a children's hospital and at more general community hospital emergency departments (EDs).
  
  
  METHODS
  CT scans obtained at community hospital EDs were retrospectively reviewed and compared with CT scans obtained at a children's hospital, to assess differences in kilovoltage, tube current, and volume CT dose index (CTDIvol) used. The number of scans obtained during the contrast-enhanced phase was also assessed. Parametric and nonparametric statistical analyses were used to test differences.
  
  
  RESULTS
  A total of 233 body CT examinations were performed at community hospitals, and 287 were performed at a children's hospital. At both types of hospital, the median patient age was 12 years (p = 0.66). Of the body CT scans obtained at community hospitals that focused on the care of adult patients, 194 of 233 (83%) used a tube voltage of 120 kVp, 29 of 233 (12%) used 100 kVp, and two of 233 (< 1%) used 80 kVp. Of the body CT scans obtained at the children's hospital, 121 of 287 (42%) used a tube voltage of 120 kVp, 129 of 287 (45%) used 100 kVp, and 36 of 287 (13%) used 80 kVp. The median tube current was also lower at the children's hospital (110 vs 125 mA) (p < 0.001). At the community hospitals, 11 of 233 studies were multiphasic, whereas at the children's hospital, there were no multiphasic studies. For all CT types, the median CTDIvol was 4.9 mGy (range, 2.5-8.2 mGy) at the children's hospital and 8.6 mGy (range, 6.0-14.4 mGy) at the community hospitals (p < 0.001).
  
  
  CONCLUSIONS
  The results of this study suggest that a large proportion of children who undergo CT at community hospitals receive relatively higher radiation doses than children who undergo CT at children's hospitals. This finding is related to the higher tube settings (in particular, kilovoltage) used at community hospitals.
authors.affiliation: 1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO 63110.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: 2 University of Arizona Medical Center, Tucson, AZ.
authors.forename: Clinton
authors.initials: C
authors.lastname: Jokerst
authors.affiliation: 1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO 63110.
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Siegel
authors.affiliation: 1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO 63110.
authors.forename: Charles
authors.initials: C
authors.lastname: Hildebolt
mesh_terms: D000293:Adolescent; D002648:Child; D003287:Contrast Media; D004630:Emergencies; D005260:Female; D006764:Hospitals, Community; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D011829:Radiation Dosage; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: CT; children's hospital; community hospitals; pediatrics; radiation