The Clinical Impact of a Web-Based Image Repository on Radiation Exposure in Injured Children

J Am Coll Radiol. 2016 Nov;13(11):1397-1403. doi: 10.1016/j.jacr.2016.07.005. Epub 2016 Aug 28.


Purpose: The long-term cancer risks for children exposed to radiologic images can be two to three times higher than for adults because children are more sensitive to radiation and have a longer lifetime in which to accumulate exposure from CT scans. Injured children often undergo repeat CT imaging if they are transferred from non-pediatric hospitals to a Level I pediatric trauma center (PTC). This study determined the impact of a statewide web-based image repository (WBIR) on repeat imaging among transferred injured children.

Methods: All injured children who underwent CT imaging and were transferred to the PTC in 2010 (pre-WBIR) and 2013 (post-WBIR) were included. Patient-level factors studied included demographics, body region of scan, Injury Severity Score, and Emergency Department (ED) disposition. Change from pre to post on rate of repeat imaging was assessed.

Results: Two hundred fifty-four and 233 children, with a median age of 7.3 years, were transferred to the Children's Hospital in 2010 and 2013, respectively. Repeat imaging levels at the PTC were lower post-WBIR than pre-WBIR (20% versus 33%, odds ratio [OR] 0.54, P = .005). Images of the head decreased most significantly (60% versus 33%, OR 0.33). Images performed at Level II and III trauma centers were repeated less often after WBIR.

Conclusions: The WBIR significantly reduced repeat imaging among injured children transferred to a PTC, especially children transferred from Level II and Level III trauma centers, children with lower-acuity injuries, and children with initial scans of the head. Radiation savings are expected to be beneficial to children.

Keywords: Repeat CT; transferring hospitals; web-based image repository.

MeSH terms

  • Arkansas / epidemiology
  • Body Burden
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Demography
  • Female
  • Humans
  • Injury Severity Score
  • Internet*
  • Male
  • Neoplasms, Radiation-Induced / epidemiology
  • Patient Transfer
  • Radiation Dosage*
  • Radiation Exposure / adverse effects*
  • Radiation Exposure / statistics & numerical data*
  • Registries*
  • Retreatment
  • Risk Assessment
  • Tomography, X-Ray Computed*
  • Trauma Centers
  • Wounds and Injuries / diagnostic imaging*
  • Wounds and Injuries / epidemiology