Concerns About Repeated CT Scans in Young Children: Risks and Recommendations

A one-year and four-month-old child underwent four consecutive head CT scans?

Hello, my son is currently one year and four months old.
He slipped and hit the back of his head in the hotel bathroom.
An hour later, he vomited twice, and we immediately took him to the emergency room.
The emergency physician said that because he is still very young, there are concerns about potential brain injury, so they recommended monitoring him for now.
However, a few days later, he still experienced vomiting, lethargy, and low energy, so we went to a second emergency room (different hospital).
The doctor there said that while it didn't appear to be a brain hemorrhage, it would be prudent to perform a CT scan just in case.
Unfortunately, my son was very restless; even when he fell asleep in my arms, he would wake up as soon as I tried to lay him down.
Despite trying to stabilize his jaw, we were unable to get a successful scan after four attempts.
After discussing with the doctor, we concluded that he likely has a concussion, and we decided to monitor him.
I would like to ask if the fact that my son, at just one year and four months old, underwent four unsuccessful CT scans increases the risk of future brain cancer, leukemia, or other brain disorders, and what that risk might be.
Additionally, I have heard that "the younger the child, the higher the sensitivity to radiation, and therefore the higher the risk of disease." Is this true? I tried to use the National Health Insurance app to check the radiation dose he received that night, but it seems the hospital did not upload it due to the imaging failures.
I have been feeling very guilty about his injury and anxious about the potential radiation threat to his future health.
Thank you, Dr.
Wang, for taking the time to respond amidst your busy schedule.

Ao hui jiao lv de mu qin, 30~39 year old female. Ask Date: 2024/01/23

Dr. Wang Yifen reply Radiology

Hello, performing imaging examinations on young children who are restless and unable to cooperate poses a significant challenge for the personnel conducting the tests.
The radiation dose for an adult undergoing a single head computed tomography (CT) scan is approximately 2 millisieverts (mSv).
According to calculations from the American College of Radiology, the additional cancer risk from undergoing four head CT scans is about 0.092312%.
The International Commission on Radiological Protection (ICRP) report 103 states that doses below 100 mSv (whether from a single scan or multiple scans) do not cause clinically significant functional impairment.

Children, due to their developing organs and longer life expectancy, have an increased cumulative risk.
It is advisable to document the child's history of X-ray radiation exposure and discuss the necessity of the examination with the physician prior to undergoing X-ray tests.
If the child cannot cooperate, consideration may be given to administering sedatives, ensuring that the benefits of the examination outweigh the risks before proceeding with the X-ray.

Background radiation exists in nature, with the global average background radiation dose being 2.4 mSv per person per year.
It is crucial not to avoid examinations out of fear of radiation, as this could lead to missed opportunities for disease treatment.
Please take this into consideration, and I wish you safety and health.

Reply Date: 2024/01/23

More Info

When it comes to the concerns surrounding repeated CT scans in young children, particularly in the context of your one-year-four-month-old son who experienced a head injury, it is essential to understand both the risks associated with radiation exposure and the medical rationale behind the use of CT imaging.

Firstly, it is well-established that children are more sensitive to radiation than adults. This increased sensitivity is due to their developing tissues and organs, which are more susceptible to the potential harmful effects of ionizing radiation. Consequently, the lifetime risk of developing cancer from radiation exposure is higher in children than in adults. However, the actual risk associated with a single CT scan is relatively low. For instance, a typical head CT scan exposes a patient to about 1-2 mSv of radiation, which is comparable to the natural background radiation a person receives over a few days.

Regarding your concern about the cumulative effect of multiple CT scans, it is important to note that while repeated exposure does increase the risk, the increase is not linear. The risk of developing cancer from radiation exposure is generally estimated to be about 1 in 10,000 for a single scan, and while this risk does accumulate with additional scans, it is still relatively low. For example, if your child received four scans, the cumulative risk might increase, but it would still be within a manageable range. The exact increase in risk can vary based on several factors, including the child's age, the specific areas scanned, and the total radiation dose received.

In your case, the decision to perform a CT scan was likely made with the intent to rule out any serious injuries, such as intracranial bleeding, especially given the symptoms of vomiting and lethargy. The medical team must weigh the potential risks of radiation exposure against the immediate need for accurate diagnosis and treatment. In many cases, the benefits of obtaining critical diagnostic information outweigh the risks associated with radiation exposure.

As for your concerns about future health implications, while there is a theoretical risk of developing conditions like brain tumors or leukemia due to radiation exposure, the actual incidence remains low. Current research does not provide definitive evidence linking a specific number of CT scans in young children to a significant increase in these diseases.

It is also worth noting that the observation period recommended by the first emergency physician was a prudent approach, as many head injuries in young children can resolve without the need for imaging. The decision to proceed with a CT scan after observing persistent symptoms was likely made to ensure your child's safety and well-being.

In conclusion, while it is natural to feel anxious about the potential long-term effects of radiation exposure from CT scans, it is important to remember that the medical community is aware of these risks and strives to minimize them. If you have ongoing concerns, consider discussing them with your child's pediatrician, who can provide personalized advice and reassurance based on your child's specific situation. Additionally, maintaining a record of any imaging studies your child undergoes can help healthcare providers make informed decisions in the future.

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