CT Versus Plain Radiographs for Evaluation of C-Spine Injury in Young Children: Do Benefits Outweigh Risks?

Pediatr Radiol. 2008 Jun;38(6):635-44. doi: 10.1007/s00247-007-0728-2. Epub 2008 Mar 27.


Background: Various reports support the use of cervical spine (c-spine) CT over conventional radiography in screening of c-spine injury. Interest now exists in diagnostic radiation-induced morbidity.

Objective: To estimate excess relative risk for developing cancer from c-spine high-resolution CT radiation exposure.

Materials and methods: We conducted a retrospective review of children evaluated for c-spine injury using CT. The study population was divided into three age groups, 0-4 years (group 1), 5-8 years (group 2), and older than 8 years (group 3). Anthropomorphic 1-year-old and 5-year-old phantoms were used to measure radiation at the thyroid during radiography and CT. Excess relative risk for thyroid cancer was estimated using these measurements.

Results: A total of 557 patients were evaluated with CT. The radiographic method most commonly used was head CT/c-spine CT in 363 (65%). Only 179 children (32%) had any type of prior radiography. The use of c-spine CT exposes the thyroid to 90-200 times more radiation than multiple conventional radiographs. The mean excess relative risk for thyroid cancer after CT was 2.0 for group 1 and 0.6 for group 2. There were no comparison data for group 3.

Conclusion: C-spine CT is associated with a significant exposure to ionizing radiation and increases excess relative risk for thyroid cancer in young children.

Publication types

  • Comparative Study

MeSH terms

  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / injuries
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Phantoms, Imaging
  • Radiation Injuries / prevention & control*
  • Retrospective Studies
  • Risk Assessment / statistics & numerical data
  • Severity of Illness Index
  • Spinal Injuries / diagnosis*
  • Thyroid Neoplasms / prevention & control*
  • Tomography, X-Ray Computed / adverse effects*