268562 Computed tomography (CT scans) in California children and pregnant women: Is use still increasing?

Wednesday, October 31, 2012 : 8:30 AM - 8:50 AM

Sumi Hoshiko, MPH , Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA
Cathyn Fan, MPH , Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA
Sandra McNeel, DVM , Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA
Carrie Jones, MD, MPH , Division of Environmental and Occupational Disease Control, California Department of Public Health, Richmond, CA
Daniel Smith, DrPH , Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA
While exposure to ionizing radiation (IR) from medical sources, primarily computed tomography (CT), has risen over 700% in the 25 years ending 2006, recent trends are less clear. As IR from a pediatric CT scan is equivalent to that from 150 - 250 chest x-rays, and children are 2-10 times more sensitive to IR effects than adults, increasing exposures to children and pregnant women raise concern. Our objectives were to: 1) characterize CT trends in California hospitals and emergency departments (EDs), by demographic and utilization factors, for children and pregnant women from 2005 – 2010; 2) estimate scan doses and calculate lifetime attributable cancer risk per visit. Results showed hospital visits involving CT declined 21%. ED visits involving CT rose from 1.0% to 1.8% between 2005 and 2009, dropping slightly to 1.7% in 2010. Because these percentages differ from national estimates of around 5%, these preliminary results will be further reviewed. Over ¼ of hospital and 1/3 of ED patients received two or more scans per visit. Rates of CT use in hospitals were highest among infants <1 year, followed by adolescents aged 15-17. The CT rate among pregnant women nearly doubled, from 36 to 61 per 10,000 ED visits. Effective doses and lifetime attributable risk per visit, accounting for multiple scans, will be calculated. Depending on the procedure, doses may exceed annual natural background radiation. While the historical increase in CT use may be leveling, implications for individual and population health at these elevated levels of utilization merit further examination.

Learning Areas:
Epidemiology
Provision of health care to the public
Public health or related research

Learning Objectives:
1. Describe temporal trends in hospital and emergency department utilization of CT use among children over the past few decades and from 2005 – 2010. 2. Describe in relative terms the dose levels from typical CT procedures and CT-involved visits in children, compared with annual natural background and approximate equivalent numbers of x-rays.

Keywords: Radiation, Pediatrics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract Author on the content I am responsible for because I directed the research that is presented. I am an epidemiologist with the California Department of Public Health, Environmental Health Investigations Branch.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.