Computed tomography of a 2-year-old child. CT scan for a child: indications for examination

Magnetic resonance imaging (MRI) is considered a safe, highly accurate, informative method of diagnostic research. This is the method of choice for identifying diseases of the central nervous system in the early stages of development, especially in children, and a clarifying method for assessing pathological changes in other areas. The test can be performed at any age, including in utero (the test is safe for the fetus).

At the Perinatal Medical Center and Clinical Hospital Lapino “Mother and Child,” MRI is performed using modern expert equipment from leading manufacturers that meets international standards of safety and effectiveness. The availability of MR-compatible vital activity monitors and anesthesia-respiratory apparatus allows for studies to be carried out under anesthesia.

The most important advantages of the procedure are:

• non-invasive;
• absence of ionizing radiation and x-ray load on the child’s body;
• high clarity display of almost all organs and tissues of the body;
• image of the vascular system without the use of contrast;
• the ability to use various types of anesthesia support;
• cozy and “friendly” atmosphere in the offices, through the use of the Ambient Lightning dynamic lighting system (Philips)
• the ability to be in the tomograph with the mother (open-type tomograph Philips Panorama HFO0)

Indications

MRI is used to diagnose pathological changes in various organs and systems of the body:

• developmental disorders;
• developmental defects;
• tumor processes;
• inflammatory processes;
• traumatic injuries.

MRI "in a dream"

For the most effective MRI (especially of the brain), complete immobility of the patient is necessary. The best way out in this situation is considered to be short-term sleep or sedation. In children under one year of age, it is possible to conduct research in a state of physiological sleep. The decision to use anesthesia is made only by a doctor according to strict indications:

• hyperactivity of a child with central nervous system features;
• fear of confined spaces;
• children with post-traumatic forced positioning of the body (MRI of joints, spine);
• episyndrome, mental disorders.

Contraindications

Despite all the accuracy and safety of the technique, MRI also has limitations.

Absolute contraindications(research is prohibited):

• artificial pacemaker;
• pacemaker lead wires and ECG cables;
• other electronic implants;
• periorbital metal foreign bodies;
• intracranial metal hemostatic clips in the early postoperative period.

Relative contraindications(research is possible under certain conditions):

• first trimester of pregnancy;
• serious condition of the patient;
• various medical devices (heart valves, stents, filters);
• claustrophobia.

Preparing for an MRI

There is no special preparation for the procedure. MRI with anesthesia is performed on an empty stomach (last meal of solid food 6 hours before diagnosis, liquid food 4 hours, water 2 hours before anesthesia). Before the procedure, all metal objects are removed.

How is an MRI done?

The study is carried out in a special room. The child is in a supine position on the tomograph table, which is located in the tomograph tunnel. Sensors in the wall of the device collect information and transmit it to the computer. The examination is accompanied by the noise of the operating tomograph, to reduce which special headphones are used, in which you can also listen to music and the doctor’s commands. The doctor receives an image of the area being examined for detailed examination. Conversational communication is maintained with the child throughout the procedure (with the exception of anesthesia). After its completion, the child and his parents can go home immediately (with the exception of certain types of anesthesia). Depending on the type of anesthesia, the child may need to stay in the ward to be monitored by doctors.

MRI results, in most cases, are prepared within an hour and are issued in the form of a study protocol, X-ray film and a recorded study on electronic media. The cost of MRI depends on the scope of the study performed and the use of anesthesia.

The medical centers of the Mother and Child Group of Companies have highly qualified doctors, candidates and doctors of science. The clinics have all the conditions for receiving qualified advice and necessary medical care.

Computed tomography today is considered one of the most informative examination methods. This study makes it possible to diagnose many diseases at an early stage of development in both newborn babies and older children. How harmful is it? It is very important to take into account all the nuances when prescribing a CT scan for a small child - X-ray radiation used during the examination has a detrimental effect on the young body. It is known that in childhood the body’s sensitivity to radiation is 5 times higher than in adults, so there must be clear indications for prescribing a CT scan.

Girl on CT scan

Specifics of computed tomography in childhood

The procedure for examining small children differs from scanning an adult. A one-year-old child is especially mobile, and it is completely impossible to explain to a newborn baby that it is necessary to lie still for a long time, so in most cases the scan is done under anesthesia.

Carrying out a CT scan must be justified - if possible, it is worth conducting the examination using other, less harmful methods. For example, magnetic resonance imaging is carried out using electromagnetic radiation and harmful x-rays are not used in this case. When prescribing computed tomography for young children, it should be understood that the benefits obtained as a result of the scan should be many times greater than the harm from it - late diagnosis of serious pathologies entails much more significant harm.

At what age can a CT scan be performed?

Experts say that CT can be done even on a newborn if there are absolute indications for the study and other examination methods are not informative. In the first year of life, a child’s brain can be examined using ultrasound – neurosonography. Due to the open fontanel, ultrasonic waves make it possible to examine all the necessary brain structures. After closure of the fontanel, CT is used for examination. It is important to understand that in most cases, computed tomography is done for children to identify injuries and tumors, so the benefits of early diagnosis are much higher than the harm from radiation. There is no significant difference in CT scanning in newborns, one-year-old children, or children three to five years old.

In what cases does a doctor prescribe a computed tomography scan?

In most cases, computed tomography is performed on young children to diagnose brain diseases:

• During the newborn period, a CT scan of the brain is done to diagnose birth injuries, for example, depressed skull fractures or fractures along the sutures of the cranial bones. In addition, computer diagnostics can detect intracranial hemorrhages.
• In older children, after 1.5 years, the appointment of a CT scan is most often associated with head injuries resulting from the carelessness and neglect of parents. Using tomography, you can diagnose various traumatic brain injuries, hematomas, fractures of the bones of the vault and base of the skull - computed tomography is considered the most informative method in diagnosing bone tissue damage.
• Diagnosis of increased intracranial pressure.
• Detection of vascular anomalies, aneurysms, tumors and cysts of the brain.
• The appearance of the first signs of a mental disorder requires a computed tomography scan of the brain.

In addition to brain scanning, computed tomography is prescribed for diagnosis:

• Congenital anomalies of the respiratory system - CT is considered the method of choice due to better visualization of organs filled with air.
• Tumor diseases.
• Lesions of the musculoskeletal system.

To assess the condition of the abdominal organs in children, in most cases, a safer MRI is performed; CT is prescribed only if there are contraindications to magnetic resonance examination.

How to prepare your baby for the examination?

In some cases, performing a CT scan on a child is only possible under general anesthesia.

To obtain clear images during computed tomography, it is important to observe the basic requirement - immobility during the procedure. Children under the age of 5-6 years in most cases cannot fulfill this requirement due to age characteristics, so a CT scan is done under anesthesia, and preparation for the study comes down to preparation for general anesthesia:

• The last meal should be 4 hours before the test - a full stomach increases the possibility of aspiration of vomit. A newborn baby can be fed 3 hours before the procedure. The same applies to drinking - drinking before a CT scan is unacceptable.
• Older children need to be psychologically prepared for being in a confined space - it is important to explain the need for the procedure, explain that it does not hurt, and the mother will wait in the next room.
• Good nasal breathing should be ensured; for this you can drop vasoconstrictor drops into the child’s nose.
• Before the study, you need to find out about the list of necessary tests - in each clinic this list differs, in one they will only require a certificate from the pediatrician, in others ECG data and additional methods.
• If you plan to use a contrast agent, it is recommended to conduct an allergy test. This is especially true for allergic children.

Features of the CT procedure in children

CT scanning of a small child differs from the examination of an adult in that anesthesia is administered immediately before the procedure. Most often, the anesthesiologist administers light inhalation anesthesia, which does not require connection to a ventilator (artificial pulmonary ventilation) and ensures quick awakening.

It is recommended to swaddle a newborn baby. For children over one year old, the mother should wear comfortable clothes and take care that the baby does not get cold - for this you can take a light blanket with you. The child is placed on the couch and fixed in the desired position, depending on the area of ​​study. It is important to correctly calculate the radiation dosage and accurately set the X-ray tube stroke to eliminate unnecessary scanning areas. After fixation, the child is put into a state of anesthesia. Children 6-7 years old no longer require administration of drugs for anesthesia.

Older children can undergo a CT scan without anesthesia

The couch moves into the tomograph tunnel, where the scanning takes place. The anesthesiologist and specialist closely monitor the baby’s condition. After the machine stops operating, the anesthesia supply stops and the child wakes up.

It takes specialists some time to analyze the results obtained. All this time, the child will be under the supervision of a specialist until the effect of general anesthesia completely stops. The conclusion on the results of the examination is given to the parents, so they can return to the doctor who prescribed the CT scan.

Computed tomography is not a harmless procedure and, undoubtedly, carries a negative radiation load on the child’s body. But you should not refuse the procedure - undiagnosed diseases in time will cause much more harm to the baby, so it is important to do the necessary examination on time.

Today, magnetic resonance imaging is perhaps the safest, most modern and reliable research method. It is successfully used for diagnostics in all areas of medicine, for many known diseases. But when children get sick, parents are justifiably worried.

Is this procedure safe for a child? At what age do children have MRIs? If you have a one-year-old baby, can you use the resonance method? If your child is 3 years old, 5 years old or 7 years old - how will he tolerate the study, will this affect his well-being? You will find answers to all these questions in this article.

In fact, it is impossible to mention in one article all the cases in which tomography is prescribed for children. This study is considered safer than traditional radiography (does not involve radiation exposure to a small patient).

Therefore, sometimes a doctor may recommend the procedure immediately, without preliminary X-ray diagnosis. This is especially true for very young children under 3 years of age or in case of serious pathology.

In addition, MRI is a more informative method than ultrasound and x-ray diagnostics. And usually such an examination is carried out after the initial diagnosis using the above methods. For example, tomography of brain tissue is always prescribed after making a preliminary diagnosis using ultrasound as a clarifying study.

• We list the five main diseases for which an MRI is indicated for a child:
• injuries, including the slightest suspicion of a concussion, are a reason to perform an MRI of the child’s head;
• deviations in the results of screening ultrasound of the heart, hip joint, brain;
• suspicion of tumors;
• foreign bodies in the digestive tract and respiratory tract;

infectious diseases and much more.

Contraindications for the study

Since the range of diagnostic procedures for children is noticeably narrowed due to their specific features, we can say that there are no contraindications for MRI. Indeed, the method is safe, non-invasive and quite affordable.

Young children under 5–7 years of age have to undergo the examination under general anesthesia, because During the procedure, the patient is required to remain completely still.

In general, the magnetic resonance diagnostic method does not require careful preparation. The main thing for the child and parents is to calm down before the test. The child needs to be encouraged to remain still, and explained that the procedure is painless and the family will be nearby at all times.

Although in general no preparation is required, there are a number of nuances that the doctor can warn you about before the test. For example, if a child is under five years old and is undergoing general anesthesia, then the tomography is performed strictly on an empty stomach. In other cases, a special diet is usually not prescribed.

What to expect during the procedure?

Before starting the study, the child’s parents are asked about his illness, well-being and the presence of allergic reactions.

After this, a contrast agent is administered intravenously if necessary.

If the patient is under three years old or for other reasons the child requires anesthesia, an anesthesiologist is invited, who must be nearby during the entire examination and monitor breathing, pulse and other vital functions.

The small patient is placed on a special table and secured with straps. During a brain tomography, a device with sensors that record nerve impulses will be placed on the child’s head. This will help reduce fear of an unknown procedure.

During the study, the magnetic tomography table is progressively placed inside a device that resembles a hollow pipe. In order not to irritate patients with the sounds of the tomograph, they wear earplugs or headphones. Typically, the study takes no more than an hour or up to an hour and a half when contrast is administered.

• What can parents do to simplify the procedure?
• The administration of a contrast agent is reminiscent of a regular injection or taking blood from a vein; you need to explain to the baby that it does not hurt.
• It is important to maintain contact with the child and distract him before and during the study.
• Modern tomographs sometimes have screens for watching cartoons: if the child is distracted and relaxed, this will help in the best way for an accurate diagnosis. If the examination does not involve general anesthesia, parents should opt for such a modern device.

It is extremely important to explain to your child, if possible, that he must remain still! Otherwise, you will have to redo everything again, and the procedure will be delayed.

Children are most often prescribed an MRI of the head. This is due, firstly, to the fact that the method is best suited for nervous tissue that has an active metabolism. In addition, today doctors try not to prescribe X-ray examinations for young children due to the influence of dangerous ionizing radiation on actively dividing cells. Magnetic resonance comes to the rescue.

Here are just some of the pathologies that this research method can identify:

• congenital malformations of the brain;
• brain cyst;
• hydrocephalus;
• brain injuries and concussions;
• pathologies of the cranial nerves: facial, ocular, auditory (congenital, traumatological, infectious);
• meningitis and meningoencephalitis;
• hormonal disorders - pituitary tumors;
• organic diseases of the cerebral cortex (epilepsy) and other structures of nerve cells (multiple sclerosis), etc.

Parents should understand that most tests performed on children do not diagnose any serious brain disorders. But a timely MRI scan of the head can help those children who really need help, and even save them.

This disease is most often observed in very young children. A cyst, as a rule, is not dangerous, however, when it enlarges, it creates increased pressure on neighboring areas of the brain, which can have a negative impact on the growth and development of the child

Conclusion

At the moment, there are no alternatives to magnetic resonance imaging in pediatric practice. This method is distinguished by safety, painlessness, accuracy and accessibility. All diseases must be diagnosed and treated at a very early stage, and a tomograph is an excellent help in this.

The authors of the article sincerely wish you and your children never to get sick!

Computed tomography for children is a non-invasive diagnostic method that allows you to obtain a three-dimensional image in several layers of all tissues and bones. With the help of research, the doctor can detect various destructive processes, inflammation and tumors even in the early stages. The advantage of CT is the safety of the procedure. X-ray radiation during this examination is minimal. Nevertheless, computed tomography for children

In some cases, in emergency situations, when a child needs to undergo a CT scan to determine damage or inflammatory processes, for the most effective diagnosis, doctors may recommend CT scan for children with contrast.

Computed tomography with contrast

To visualize tissues and bones in a young body, as well as to determine the location of tumors, a procedure is performed with an iodine-based drug. Contrast is used by injection into a vein. The substance accumulates in tissues, which allows them to be seen more clearly in photographs.

Contrast-enhanced CT is particularly effective in identifying abnormalities in areas where there is extensive blood flow. This is possible due to the fact that the drug penetrates particularly organically into well-supplied organs and tissues. But before carrying out the procedure, the doctor is obliged to find out if the child has allergic reactions.

Tomography for children: is it harmful?

It is impossible to say for sure whether CT scanning is dangerous for children. The main thing is that such a procedure is carried out justifiably. The benefits of unfounded examinations are not always commensurate with the possible risks. This is explained by the fact that in a young organism the sensitivity to radiation is approximately 4-5 times higher than in adults.

Single CT scans are allowed for children. But during the examination, the current parameters of the X-ray tube in the tomograph must be adapted to the young body, which will reduce the dose load and the total radiation exposure during the examination. In this case, a CT scan may be performed.

The standard age limit for CT examination is 14 years.

Our equipment

• Philips Brilliance 64 - a breakthrough in medical technology;
• Expanding the boundaries of clinical application in the field of imaging of the heart, lungs, traumatology and pediatrics;
• The system supports scanning with a full gantry rotation in just 0.4 seconds;
• 40 mm coverage area per revolution with sub-millimeter isotropic accuracy;
• The CT doctors' workstation is equipped with a CAD module, which allows you to connect computer algorithms for image analysis and detection of hidden pathology;
• The best image reconstruction speed among devices of this class.

These children. A 2012 study concluded that the use of expensive CT technology in emergency departments to diagnose abdominal pain in pediatric patients increased sharply from 1998 to 2008.

Although the rate of CT scans prescribed to children for reasons such as isolated disease is declining, the authors of another study concluded that the rate is still prohibitively high—and many children undergo CT scans more than once. In response to these and many other studies, efforts have been made around the world to reduce exposure to CT scans, and to reduce the frequency of CT scans in general.

But are we reducing the frequency of CT scans too much? What are the risks of diagnosis without this study, what is the other side of the coin? Should we be concerned that decreasing use of this technology increases the risk of missing important diagnoses, or details of a diagnosis that can only be revealed by this diagnostic technique?

Alan S. Brody, MD, radiologist and chief of thoracic radiology at Cincinnati Children's Medical Center, answers these questions and more. Dr. Brody co-authored a recently published paper in which he says "the anti-CT pendulum has swung too far."

Journalist: When did concerns first arise about the misuse of X-rays in CT scans? Have there been any changes in the technology of radiological examinations since that time?

Dr. Brody: This issue first came to the attention of doctors and the public in 2001, following three scientific articles published in the American Journal of Roentgenology. The first article attempted to calculate the potential risks of developing malignant tumors due to radiation exposure when using CT technology in children.

The second article was devoted to ways to reduce the radiation dose in pediatric practice.

Today we have learned to use very reasonable doses, and have reduced the potential risks when performing CT scans by about 10 times. However, now 2 new dangers have appeared.

• First: this is the risk of refusing to conduct research in cases where it is absolutely necessary (due to an unreasonable fear of X-ray radiation).
• Second: the use of too low doses of radiation, which significantly reduces the quality of images and thereby interferes with making a correct diagnosis.

We need to understand how big the risks of having a CT scan really are. We must take into account that we are all exposed to some dose of radiation every day. We receive about 3 mSv of radiation per day - this is a dose comparable to that used when performing a CT scan on a child. Natural radiation comes to us from solar radiation, in the food we eat, and radiation from the earth's rocks.

Journalist: In your experience at Cincinnati Children's Hospital, have you noticed that doctors have become more wary of performing CT scans for fear of increasing the risk of cancer in their young patients later in life?

Dr. Brody: The frequency of CT use is decreasing, and this despite the fact that every year the indications for CT are only increasing. I think this is mainly due to doctors' concerns about excessive radiation exposure to patients.

Journalist: And hasn’t the development of alternative diagnostic methods contributed to a decrease in the frequency of CT scans?

A positive example of a decrease in the frequency of CT scanning is the diagnosis of acute appendicitis in a child. Previously, in many cases, the first diagnostic method was CT. Currently, ultrasound has become the first method. Only if ultrasound does not give an accurate answer, the patient is referred to a CT scan. There are several high-quality studies that clearly show that such an algorithm is more correct [,]

MRI has also become more accessible. We were able to take scans faster, which reduced the need for sedation and reduced the amount of time the child spent in the magnet. Now we can obtain even more informative data than with CT in some cases - for example, with brain tomography.

So I think the decline in CT use is a result of both factors.

Journalist: How would you comment on the statement of the American Association of Physicists in Medicine (AAPM) regarding the use of CT technology in children?

Dr. Brody: The AAPM says the decision about medical imaging should be tailored to the situation. This means that CT should only be performed when its benefits outweigh the possible risks (see). If the decision to perform a CT scan is made, the radiologist must use the correct dose of radiation, that is, the dose should be no more and no less than that necessary to obtain high-quality images.

The AAPM Statement states that when talking to parents, information about CT scans should be presented in terms of proportions and risks, rather than just listing risks.

It should also be noted that the AAPM believes that the risks associated with medical imaging at effective doses below 50 mSv for a single procedure or 100 mSv for multiple procedures over a short period of time are too small to be detected and may simply not be present. The AAPM specifically stated that calculating the hypothetical risk of cancer incidence and mortality in patients exposed to such low doses of radiation is speculation and directly harms the patient because it increases the risk of unnecessary refusals of CT. such a practice should not be encouraged.

Journalist: Can you describe the calculation of the risks and benefits of CT scanning in childhood? How should it be carried out?

Dr. Brody: I see a problem in the very conversation about such children, because this conversation itself overly alarms parents. The very word “irradiation” scares parents. Doctors and families focus on the risks but neglect the benefits. My article, which you mentioned above, is precisely devoted to the fact that the risks of performing a CT scan are negligible in comparison with the huge potential benefits of performing it.

I often encounter parents for whom the issue of consent to CT scanning is frightening and painful, even in cases where its benefits are obvious. If there is any chance of a subsequent increase in cancer risk due to exposure to CT radiation, it is less than 1:4000. This means that a CT scan will not increase the risk of cancer in 99.975% of cases. Neither the family nor the doctor should hesitate for a second when the question arises of performing a CT scan, even if it will be useful in 1 in 100 cases of the child's diagnosis.

Take, for example, the case of differential diagnosis of appendicitis. Let's say we did an ultrasound and we're not sure if the baby has appendicitis. We believe that without a CT scan, the chances that the child has appendicitis are 25%. What risk from CT can justify refusing it in this situation?

After all, if we immediately take the child for surgery, there is a 75% chance that we will do it in vain. And if we choose a wait-and-see approach, we will get a significant increase in the risk of developing peritonitis, which will sharply increase the risk of complications, the volume of the operation and the number of days the child spends in the hospital. This, in turn, will increase the risk of adhesive disease in the near future of the child, as well as cases of acute intestinal obstruction.

Now compare the risks that we received in both cases after abandoning CT and the risks of CT itself. They can't be compared, and you don't need to be a doctor to understand that.

Moreover, each subsequent CT scan carries the same cancer risk as the first, and a CT scan cannot be canceled simply because it was recently performed for another reason. To understand this, imagine an analogy: We all know that traveling in a car carries some risk of death in a car accident. And the more you travel, the higher the risk. But this does not mean that the risk increases from trip to trip. After all, no one would say, “My son has traveled several thousand miles this year, so I think he should hold off on going to the family reunion this weekend.” So, if a CT scan is justified, the risk should not be overestimated just because it is not the first time it has been performed on this child.

Journalist: Are there any specific examples where MRI or ultrasound is a particularly poor substitute for CT?

Dr. Brody: CT is the best test for acute head trauma - much better than MRI. MRI is not nearly as good as CT in diagnosing lung diseases, although modern devices are becoming more sophisticated and this difference is slowly being smoothed out. There are many more similar examples.

Dr. Brody: I would like to encourage doctors to be as effective in their judgment as possible and to teach this to their patients, and to their patients' parents. When you say the famous saying that if a million children get a CT scan, 100 of them will get cancer, then don't forget to add that if a million children get a CT scan, half of them will avoid unnecessary surgery, and 100,000 of them will get the surgery done in the optimal way (because the surgeon, guided by the CT results, will be able to predict the course of the operation much better).