Friday, December 28, 2012

Breast Cancer From Pediatric Trauma Imaging

Evaluations for significant pediatric blunt trauma tend to be rather rare.  However, one flip side to improved vehicular safety is that previously fatal accidents turn into diagnostic dilemmas with otherwise well-appearing children after horrific potential injury mechanisms.

This specific article tries to address the risk/benefit ratio for imaging the pediatric thoracic spine after trauma, with a focus on the lifetime excess attributable risk for breast cancer.  They used estimates of radiation to breast tissue from plain films and CT, and then applied the predictions from the BEIR VII report to determine EAR.  From all these various calculations, their worst-case scenario derived an excess of 79.6 cases of breast cancer per 10,000 CT scans in females aged less than 12 years.

Unfortunately, the proponents of CT imaging cite these studies and say we've done nothing but document theoretical risk (based on atomic bomb exposure) – while ignoring that the risk of missed injury is equally theoretical.  As usual, the prudent course of action is to perform additional testing only when explicitly indicated – the additional cases of breast cancer are not trivial, but neither are missed injuries.  The rate of additional breast cancer cases is certainly not so high that CTs should be skipped when clinically indicated.

"Theoretical Breast Cancer Induction Risk From Thoracic Spine CT in Female Pediatric Trauma Patients"
www.ncbi.nlm.nih.gov/pubmed/23184109

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