ClÃnica Las Condes / vol. 24 n0 1 / enero 2013

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[REV. MED. CLIN. CONDES - 2013; 24(1) 15-20]Radiation Risks to Children fromMedical ImagingDonald P. Frush, MD, FACR, FAAP (1)1. Donald P. Frush, M.D. FACR, FAAP Professor of Radiology and Pediatrics Chief, Division of Pediatrics Radiology Faculty, Medical Physics ProgramDuke University Medical Center.Email: donald.frush@duke.eduKey words: Medical imaging, children, ionizing radiation,risk, radiation dose, nuclear imaging.INTRODUCCIÓNMedical imaging is extremely important value and role in the care ofthe ill or injured child. This includes diagnosis of emergent includinglife threatening conditions, as well as an aid in management, such asappropriate triage to promote efficient and judicious use of medicalresources. For example, CT and MR have been heralded as one ofthe most significant medical advancements in the past 30 years,based on a survey of medical practitioners (1). While much of thefollowing material will discuss the specific risks of ionizing radiationrelated to medical imaging, one must not lose sight that when usedappropriately, the benefits of medical imaging are far in excess of realand potential risks.Much of medical imaging depends on the use of x-rays, a type ofionizing radiation, for imaging formation. The general modalities thatuse x-rays consist of radiography, fluoroscopy (including angiography),computed tomography (CT) and nuclear imaging (also known as nuclearmedicine). Other modalities which do not use ionizing radiation whichare commonly used for medical imaging consist of sonography, andmagnetic resonance imaging. Radiation, in relatively high doses, hasknown biological effects. These effects include the induction of cancer.Almost without exception, diagnostic medical imaging uses low levelsof radiation and the types of biological effects and attendant risks ofcancer will be different (as discussed below). The topic of radiationrisk in medical imaging is also timely, especially in the United Stateswhere there has been increased public attention mostly throughmedia scrutiny reporting radiation doses from medical imaging andbiological effects. These reports included hair loss from perfusionimaging (a type of brain CT examination) (2), radiation dermatitis fromCT examination in a child (3), relatively high doses from radiography indental evaluation (4), and excessive radiation doses from improperlyperformed neonatal radiography (5). Because radiation related effectsespecially cancer may not be evident for years even decades, concernmay be long lasting. I have received communications from parentseven several years after imaging evaluation who are concerned aboutwhat they have heard about cancer risks and radiology in the media.Recently, the first scientific investigation associating pediatric CT withcancer was published in Lancet (6). Taken together, the importanceof medical imaging using ionizing radiation, and continued, and insome circumstances, escalating use of this imaging in both adults andchildren, and the persistent and often pervasive attention to the longlasting possibility of cancer from ionizing radiation in levels found withdiagnostic medical imaging necessitates a reasonable understandingof the risk aspect of the risk benefit ratio for diagnostic medicalimaging. This basic understanding applies to all medical practitioners,not just those with imaging expertise (i.e. radiologist). These healthcareproviders, such as pediatricians or emergency medicine physicians willbe potentially involved in discussions with colleagues about risksand benefits in patient management, as well as conversations withpatients about the potential risks and benefits.This topic of radiation risk and medical imaging applies to all ages.However, it is particularly important in children. Children are relativelyArtículo recibido: 21-09-2012Artículo aprobado para publicación: 03-12-201215
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ClÃ­nica Las Condes / vol. 24 n0 1 / enero 2013

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ClÃnica Las Condes / vol. 24 n0 1 / enero 2013