CT Scan for 15 Month Old

[A.Jewell]

My DS will likely have to have a CT Scan with contrast fluid of his abdomen to check for abnormal intestinal development to see if surgery will help.  It is optional at this point, although highly recommended since he continues to get worse (back story here).  Obviously, we have some concerns about his safety.  Namely because he's already had abdominal x-rays as well as IV radioactive fluid in his veins for a Meckel's Scan--so I am worried about more radiation exposure.  Also, all of the tests he's had have yielded no results and I hate putting him through unnecessary, risky tests.  If you have any expertise or experience with this I would love your opinion.  Specifically, I am wondering:

- Is it really that much radiation?  Are there ways to minimize his exposure?  I'm having trouble finding studies that show what the chances of developing cancer might be in the future for exposure like this in children

- Should we go with sedation or take our chances that he will stay still (he's been sedated numerous other times for other procedures without complication)?  Do they strap them down?

- Is the contrast fluid harmful?

- Can we be in the room with him?  Do you have suggestions for helping him through the experience?

- What would you do?

Thank you in advance for any tips or opinions!

[Katie T]

If there is no other test with less radiation that they could do to get the results they need I think I would do it. 

My girl is going for a MRI on Tue and will be getting put under for the first time and I am nervous about that. 

Sorry I can't answer any of your other questions. I don't think the contrast is harmful and I don't think they strap them down if they are sedated but I am not 100% sure.

[melissa17s]

My ds has had both ctscan and mri sedated.  The ctscan was pretty fast, unlike a mri.   It is like a large donut and it slides over the bed. We were not allowed in the room.  He did not have contrast fluid with the ct, but they did use dyes with the mri.  I think barium shakes can be unpleasant and upset the tummy, but I do not think they have long term effects.  For the ct, I think the radiation is comparable to an xray.  I think the risk comes into play, if someone is having many procedures involving radiation. 

[moongazer]

These decisions are so hard to make.  It helps to have as much information as possible.  Here is a website that has tons of info about medical radiation and children.  It was recommended to us by my son's Interventional Radiologist.

www.imagegently.org

From that site, here is a comparison of CT scan vs. X ray.  If I am doing my math right, an abdominal CT scan is 600 times more radiation than a chest X ray:

We all are exposed to small amounts of radiation daily from soil, rocks, building

materials, air, water, and cosmic radiation. This is called naturally occurring

background radiation. The radiation used in X-rays and CT scans has been

compared to background radiation we are exposed to daily. This comparison may be

helpful in understanding relative radiation doses to the patient.

Radiation source Days background radiation

Background..............................................................1 day

Chest X-ray (single)..................................................1 day

Head CT....................................................................up to 8 months

Abdominal CT...........................................................up to 20 months

[mambera]

Hello, I'm forum-crashing a bit because I looked into this when someone recommended a CT for my then-four month old.  The imagegently site is great, and PP is correct that a CT is typically several hundred times the dose of a plain film (which btw a single plain film in a child would not concern me at all in terms of radiation dose). 

I wanted to also say that here is a paper that estimates the lifetime added risk from a 64-slice CT in a five year-old

http://www.ncbi.nlm.nih.gov/pubmed/20363573

They calculate the lifetime attributable risk of cancer from a single abdominal CT as 0.017%.

Here is another one that assumes a different CT technique.

http://www.ncbi.nlm.nih.gov/pubmed/20028922

They calculate a LAR for cancer from an abdominal scan in a 5 y/o ranging from 0.005% to 0.144%.

(PM me if you want the fulltexts.)

This is very small but not zero.  Risk increases with younger age of the child and with the number of additional scans he is subjected to.  I would think very hard about how many CT scans your child is likely to have in the future, and what information will be obtained from them.  If this is likely to be a one-time event and the information could be really helpful, that is a better scenario than if it is just a shot in the dark, or if he is likely to need many more CT scans in the future (meaning you would want to be very conservative each time you make this decision).

HTH

[APToddlerMama]

We researched this a while ago so my brain is a bit foggy, but, there is a CT made by General Electric that has something on it called Acer (I think that is how it is spelled).  It cuts the radiation by about 50%.  We ended up demanding to have our referral changed to a hospital that used this CT machine.  I don't like the idea of CTs, sedation, etc., but only you can decide if your child should have one done or not.  Sometimes the risks outweigh the benefits, and sometimes the benefits outweigh the risks.