ALARA: is there a cause for alarm? Reducing radiation risks from computed tomography scanning in children

Abstract

Radiation exposure from computed tomography is associated with a small but significant increase in risk for fatal cancer over a child's lifetime. This review aims to heighten awareness and spearhead efforts to reduce unnecessary computed tomography scans in children. The use of pediatric computed tomography continues to grow despite evidence on known risks of computed tomography-related radiation and induction of fatal cancers in children. More than 60 million computed tomography scans are estimated to be performed annually in the USA, with 7 million in children. Pediatric radiologists apply the practice of ALARA ('as low as reasonably achievable') to reduce radiation exposure. Education and advocacy directed to the referring clinician reinforce these principles. Radiation exposure may be further reduced by developing clinical pathways limiting computed tomography scanning and encourage alternate, nonradiation imaging modalities, such as ultrasound and magnetic resonance imaging. Although individual risk estimates are small, widespread use of computed tomography in the population may implicate a future public health issue. Advocacy by pediatric healthcare providers to promote intelligent dose reduction based on the principles of ALARA and the judicious use of computed tomography scanning is essential to foster the safest possible care of children.