Pediatric Ophthalmic Computed Tomographic Scanning and Associated Cancer Risk

Purpose: To review pediatric neuroimaging studies of the head and orbit and the radiation-induced cancer risk associated with computed tomography in light of recent attention to pediatric radioimaging by the US Food and Drug Administration, the National Cancer Institute, pediatricians, and radiologists. Design: Perspective. Methods: Literature review. setting: Institutional. patient population: Pediatric ophthalmic patients requiring neuroimaging studies. intervention/procedure: Review of the current literature. main outcome measures: After review of the current literature and discussion of the related issues, recommendations are made for pediatric neuroimaging studies of the head and orbit. Results: Computed tomography (CT) of the head and orbit may be performed in children with the appropriate indications as long as the radiation exposure is minimized. Conclusions: Information obtained from CT scans of the head and orbit may determine or affect management in the pediatric ophthalmic population. Because of the concern of cancer induced by radiation exposure in children, neuroimaging modalities without radiation exposure, such as magnetic resonance imaging or ultrasound, may be considered. However, when CT is indicated, it is reasonable and acceptable to perform CT of the head and orbit while minimizing the radiation exposure, thereby adhering to the "ALARA" (as low as reasonably achievable) policy recommended by the US Food and Drug Administration. Further studies of the actual radiation dose delivered during pediatric CT of the head and orbit and the true incidence of radiation-induced cancers after scans are warranted.