1. Approximately half (47%) of parents surveyed were aware that ionizing radiation from head computed tomography (CT) scans could increase their child’s risk of cancer, although 63% underestimated the risk.
2. Almost all (90%) parents wanted to be informed of potential risks of ionizing radiation from diagnostic tests before proceeding with testing.
Evidence Rating Level: 2 (Good)
Study Rundown: Children have been found to be more radiosensitive than adults, particularly to computed tomography (CT), which involves higher radiation doses than other methods of imaging and has been associated with a 1 in 10,000 increased risk of leukemia and brain tumors. Increased CT use for pediatric diagnoses may be attributed to parental desire for rapid results without a complete understanding of possible risks. To investigate parental knowledge of CT-related malignancy risk, researchers completed a prospective, cross-sectional study. Results from this study indicate that ~50% of parents surveyed were aware of head CT radiation increasing a child’s risk of cancer. After receiving information about potential risks, parental willingness to proceed with CT testing decreased by 30%; however, most were willing to proceed after discussing the testing with a physician. Approximately 90% of parents wanted to be informed of potential risks before ionizing diagnostic testing was initiated. Limitations of this study include possible self-report bias. Physicians should understand that parents increasing concerns regarding imaging radiation risk and should be prepared to initiate discussions regarding these concerns.
Study Author, Dr. Kathy Boutis, MD, FRCPC, MSc, talks to 2 Minute Medicine: Staff Emergency Physician; Senior Associate Scientist, Research Institute; The Hospital for Sick Children; Associate Professor, University of Toronto, Toronto, Ontario, Canada.
“[One major finding was that] parents would like more information. Almost all parents – over 90% – said that they would like more information and to be informed about potential risks – even if small. This is something which the medical community as a whole should be aware of and move to address. The central issue is, as always in medicine, of balancing the benefits from a test or treatment, against any potential risks it may carry. CT scans can provide doctors with a large amount of very important information which helps them decide how best to treat patients, especially in the emergency room setting. However, there is growing evidence that there is likely a small risk associated with the radiation used in medical imaging such as CT, and because of this, we have to carefully balance risk and benefit whenever we consider using such imaging, especially in children who are at higher risk.”
In-Depth [prospective cross-sectional study]: A total of 742 parents of children presenting to a Canadian, pediatric emergency department with head trauma were surveyed. The median age of children included was 4.4 years; 97% were diagnosed with a minor head injury/concussion and 12% had a history of a previous CT scan. Of parents surveyed, 46.8% were aware of the increased lifetime malignancy risk after having a head CT, although 62.9% underestimated the current best risk estimate. 51.1% of parents underestimated CT radiation dose, while 32.8% overestimated the radiation dose. Furthermore, 90.4% of parents indicated, at the survey initiation, that they were very willing/willing to proceed with a head CT if recommended by the emergency physician; this dropped significantly to 69.7% after risk information was provided (p < .0001). 35.3% would not have any further thoughts about recommended CT if the doctor thought it was important, while 41% wanted further discussion with a physician and 5.6% would refuse it altogether. 90.7% of parents indicated a preference to be informed about potential malignancy risk of diagnostic tests involving ionizing radiation before testing was initiated.
By Cordelia Y. Ross and Leah H. Carr
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