This study was done to the review and documentation of brain CT investigations in King Abdulaziz University Hospital ( KAUH), Jeddah, Saudi Arabia in 2012 including CT findings for brain based on justifications for scan. The purpose of the study is to evaluate the situation of requesting CT brain versus the reporting findings. A retrospective study was carried out in the Department of Radiology, KAUH between 1 January and 31 December 2012 . There were 417 children scanned by CT for brain, their data were reviewed and analyzed from radiology records to form the sample of the study . The study revealed that high percentages of radiological findings for CT brain did not confirm the clinical diagnosis. The percentages of such cases which observed in the three departments of emergency, inpatient and outpatient were 68.4%, 53.6% and 49.4% respectively . This result shows that a percentage of children were given unnecessary exposure to radiation among those who received CT brain from the radiology department in KAUH. From the study, it is concluded that most brain CT done for children were not justification as well as there were more brain CT findings not confirmed the clinical diagnosis, although the brain CT may be significant in most of the cases. Hence, there is a big concern about the increasing requests for unnecessary brain CT. Therefore, the paediatricians should be more careful in requesting of brain CT unless it is indispensible.
The uses of computed tomography (CT) scan have seen increased in children in contemporary times. CT has brought significant changes in the diagnosis of diseases. Since the advert of CT into clinical practice in 1973 [
The King Abdul Aziz University Hospital (KAUH) is one such health institution and foundation where the health service and education is provided for patient, students, physician and trainees to obtain what they need. For literature searching, in the UK, in 2008, according to the latest multi-center survey, CT has grown in frequency from 5% to 11% compared with 10 years earlier. Despite this relatively low frequency of examinations, compared to radiography and fluoroscopy, CT is the growing and dominant contributor to the total collective effective dose from X-ray examinations being responsible for around 68% of the total collective dose, compared to 40% in 1998, while the percentage contribution from radiographic and fluoroscopic examinations has nearly halved [
American College of Radiology “ACR Appropriateness Criteria”, and the referral guidelines of The Royal College of Radiologists help the clinician (and radiologist) in deciding which imaging modality is the best for specific indications [
A recent study on June 6, 2012 showed radiation exposure from two or three head CT scans in childhood giving a cumulative dose of around 60 mGy can triple the risk of developing brain cancer, while five to 10 such scans (cumulative dose around 50 mGy) may triple the risk of developing leukemia, according to a major study published online June 7 in Lancet [
This is an exploration to understand the request form of the brain CT of children in the diagnostic radiology department, KAUH, Saudi Arabia. The purpose of this study is to evaluate the clinical diagnosis of brain CT and CT findings.
The current study is a retrospective was done after ethical approval was obtained of the Chairman of ethics and research committee in the KAUH.
CT brain reports of 417 brains CT in the diagnostic radiology department in the KAUH, between 1 January and 31 December 2012, were scanned and followed CT protocol taken through this study by the use of 128 Somatom CT machine as described in
Protocol | Brain sequence-child |
---|---|
Detector collimation | 12 × 1.2 mm |
KVp | 120 kv |
Effective mAs | Care dose |
Slice | 4 - 8 mm |
Rotation time | NA |
Scan time | NA |
Pitch | NA |
Delay | 2 Sec |
Feed | 14 mm |
Comments | Send to Picture Archiving and Communication System (PACS) Tomogram. AXIAL 4.8 mm Keinel H 40 Medium/window cerebrum. If trauma bony window H70 H VERY SHARP/Osteo. |
417 children formed the sample of the study, of which 222 were male and 195 female. The inclusion criterion for the study was to be a part of the diagnostic radiology department in the KAUH. The children were divided in 4 different age groups (less than 1, 1 - 5, 6 - 10, 11 - 15 years old). Frequency were used to describe the general and presenting characteristics in the children and among those who received brain CT scans, divided by three locations were include: first for Emergency, the second for Inpatient, and the third for Outpatient. Adjustment for multiple comparisons was performed. There were no other inclusion/exclusion criteria laid out for the study. The data obtained was validated for completeness and consistency and analysed quantitatively using the statistical package SPSS and Microsoft Excel.P value was considered to be significant if it was <0.05 and the results were gathered to look at the trends that emerged from the data with regard to the radiology electronic recording system. The results of the study are presented in the form of tables as included later in the study.
The vast majority of pediatrics scanned with CT was male 222 (53.2%) while females were 195 (46.8%). Also study shows the the highest percentage was in the age of 1 - 5 years old (33.2%) (
Statistically significant differences were found for brain CT. This indicates that more than the half of the CT findings for brain not confirmed the reasons for exam. Thus, the results indicate that a significant variable in the decision to order CT brain for children in the diagnostic radiology department in KAUH. The most common clinical diagnosis (reason of exam) among 417 brains CT was 90 (21.58%) Trauma/Cerebrovascular Accident (CVA) for brain
The study indicated towards the trends of imaging of the brain by CT for children in the diagnostic radiology
Category | Number | Percentage % | |
---|---|---|---|
Gender | Male | 222 | 53.2 |
Female | 195 | 46.8 | |
Total | 417 | 100.0 | |
Age (Years) | Number | Percentage % | |
Under 1 | 85 | 20.3 | |
1 - 5 | 138 | 33.2 | |
6 - 10 | 98 | 23.5 | |
11 - 15 | 96 | 23.0 | |
Total | 417 | 100.0 |
P value | Total | Not confirmed number and percentage | Confirmed number and (Percentage) | Pediatrics location |
---|---|---|---|---|
0.005 | 155 | 106 (68.4) | 49 (31.6) | Emergency |
183 | 98 (53.6) | 85 (46.4) | Inpatient | |
79 | 39 (49.4) | 40 (50.6) | Outpatient | |
- | 417 | 243 | 174 | - |
Percentage | Frequency (number of patients) | Clinical diagnosis (reason for examination) | Percentage | Frequency (number of patients) | Clinical diagnosis (reason for examination) |
---|---|---|---|---|---|
0.48 | 2 | Myelomeningocele post repair | 21.58 | 90 | Trauma/CVA |
0.48 | 2 | Apnea | 14.63 | 61 | Convulsion/Seizure |
0.48 | 2 | Encephalopathy | 9.59 | 40 | Hydrocephalus |
0.48 | 2 | Sepsis/For more evaluation) | 9.35 | 39 | For follow up |
0.48 | 2 | Fever | 7.67 | 32 | Brain edema/insult |
0.24 | 1 | Willebrand disease | 4.80 | 20 | VP-Shunt |
0.24 | 1 | Post/pre Chemotherapy | 3.84 | 16 | Headache |
0.24 | 1 | Bony calvariumabnormality | 3.60 | 15 | Intracranial hemorrhage/hematoma |
0.24 | 1 | Mental Retardation aggression | 3.58 | 14 | Mass/Swelling |
0.24 | 1 | Dermoid cyst | 2.64 | 11 | Uprolling of eyes and loss of conscious |
0.24 | 1 | Post fenestration | 2.40 | 10 | Delay speech and response |
0.24 | 1 | Brain infarct | 1.68 | 7 | Limbs weakness |
0.24 | 1 | Intracranial pressure | 1.44 | 6 | Dyspnea and involuntary movement |
0.24 | 1 | Facial atrophy | 1.20 | 5 | Craniosynostosis |
0.24 | 1 | Due to birth asphyxia | 1.20 | 5 | Brain herniation |
0.24 | 1 | Disorientation | 1.20 | 5 | Meningitis |
0.24 | 1 | Metabolic disorder | 0.96 | 4 | Brain abscess |
0.24 | 1 | Encephalitis | 0.48 | 2 | Epileptics |
0.24 | 1 | Rigid neck | 0.48 | 2 | Facial palsy |
0.24 | 1 | Bony destruction for new surgery evaluation | 0.48 | 2 | Thrombi embolic |
0.24 | 1 | Hypoxic Ischemic | 0.48 | 2 | Aneurysm |
0.24 | 1 | Microcephaly | 0.48 | 2 | Facial asymmetry |
6.48 | 27 | (n = 417) 100% | 93.76 | 390 | Total |
department, KAUH. The results of the study can be seen as similar to what have been reported in similar studies by other researchers. Previous studies related to the derivation and validation of clinical decision rules have shown a 3% - 62% rate of CT scanning, [
Patients in these studies were primarily seen in academic and pediatric EDs with more significant mechanisms of injury [
As reported in this study 68.4% of brain CT findings did not confirm the clinical diagnosis in the emergency department. An earlier study led by Kuppermann and published by the Lancet in (2009) developed and validated a traumatic brain injury prediction rule to identify children at low risk for clinically important head injuries who probably do not require CT evaluation [
This study emphasizes that brain CT utilization must be associated with justification for scan in children. It is important that pediatricians should not order brain CT unless it is indispensable. It is no doubt true that health professionals work together to minimize the radiation dose to children. But it is recommended that it is very important for pediatricians, radiologist and x-ray technologist to put their minds on the three unique considerations in children: Children are considerably more sensitive to radiation than adults, as demonstrated in epidemiologic studies of exposed populations; children have a longer life expectancy than adults, resulting in a larger window of opportunity for expressing radiation damage and children may receive a higher radiation dose than necessary if CT settings are not adjusted for their smaller body size [
AwadElkhadir,MohamedGotb,DeemaHussein,MohamadSaka,SaddiqJastaniah, (2016) CT Brain in Children: Evaluation of the Clinical and Radiological Findings. Open Journal of Pediatrics,06,42-47. doi: 10.4236/ojped.2016.61008