Imaging-Associated Radiation Trends in a Puerto Rican Pediatric Surgical Population: Is Over-Radiation an Issue in Our Emergency Departments?

The increased use of CT scans has raised concerns regarding the risks of early radiation exposure in the Puerto Rico pediatric population. Available literature sustains that repeated exposure to imaging-related radiation in the pediatric population is associated with a 3-fold increase in the risk of developing pediatric hematogenous and central nervous system malignancies. It is for this reason that an international effort known as the Image Gently Campaign was created, mostly based on the "As Low As Reasonably Achievable" (ALARA) principle described by the Center for Disease Control. With this in mind, our aim was to identify whether there are any discrepancies in imaging tendencies outside our pediatric academic center in Puerto Rico and to determine whether our patients are at increased risk of over-radiation. There were 181 patients; five were excluded because of incomplete data. Our results show that children with appendicitis who are evaluated at nontertiary centers are more likely to have a CT scan performed (93%, OR: 4.054; 95% confidence interval: 2.6-6.4), as opposed to a nonradiating imaging study. In the Pediatric University Hospital, a CT scan was performed as the initial study in 23 per cent of the patients (OR: 0.09; 95% confidence interval: 0.05-0.18), favoring ultrasound as the diagnostic modality of choice. Our concern is that if this trend does not change, our pediatric population might have an increased risk of developing associated malignancies. We believe a local effort toward educational strategies should be implemented to prevent radiation overexposure in our pediatric patients.