Department of Orthopedic Surgery, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA.
J Trauma Acute Care Surg. 2012 Feb;72(2):403-9. doi: 10.1097/TA.0b013e31823a4bd7.
The trend of increasing cervical spine multidirectional computed tomography (MDCT) imaging of pediatric trauma patients is characteristic of the overall dramatic increase in computed tomography utilization in the United States. The purpose of this study is to compare the amount of radiation a pediatric trauma patient absorbs to the thyroid from plain radiographs and MDCT of the cervical spine and to express risk by calculation of theoretical thyroid cancer induction.
A retrospective evaluation of pediatric trauma patients admitted from October 1, 2004, to October 31, 2009, was performed at an academic, Level I trauma center. Inclusion criteria were Level I/II trauma patients, cervical spine imaging performed at our institution, and age <18 years. Absorbed thyroid radiation was calculated for patients receiving plain radiographs or MDCT. Thyroid cancer risk was calculated using the 2006 Biological Effects on Ionizing Radiation VII report.
Six hundred seventeen patients met inclusion criteria: 224 received cervical spine radiographs and 393 received cervical spine MDCT. The mean thyroid radiation absorbed from radiographs was 0.90 mGy for males and 0.96 mGy for females compared with 63.6 mGy (males) and 64.2 mGy (females) receiving MDCT (p < 0.001). The median excess relative risk of thyroid cancer induction from one cervical spine MDCT in males was 13.0% and females was 25.0%, compared with 0.24% (males) and 0.51% (females) for radiographs (p < 0.001).
The significant difference in radiation that MDCT delivers to the pediatric trauma patient when compared with plain radiographs should temper routine use of computed tomography in pediatric cervical spine clearance algorithms.
儿科创伤患者颈椎多排 CT（MDCT）成像趋势是美国 CT 使用率整体大幅增加的特征。本研究的目的是比较儿科创伤患者接受颈椎平片和 MDCT 检查时甲状腺吸收的辐射量，并通过计算理论甲状腺癌诱导来表示风险。
对 2004 年 10 月 1 日至 2009 年 10 月 31 日在学术性一级创伤中心收治的儿科创伤患者进行回顾性评估。纳入标准为一级/二级创伤患者、在我院进行颈椎影像学检查、年龄<18 岁。对接受平片或 MDCT 检查的患者计算甲状腺吸收的辐射量。使用 2006 年《电离辐射生物效应报告》VII 报告计算甲状腺癌风险。
617 例患者符合纳入标准：224 例接受颈椎平片检查，393 例接受颈椎 MDCT 检查。男性和女性从平片吸收的甲状腺辐射平均值分别为 0.90 mGy 和 0.96 mGy，而接受 MDCT 的男性和女性分别为 63.6 mGy 和 64.2 mGy（p<0.001）。从一次 MDCT 颈椎检查中男性甲状腺癌诱导的中位超额相对风险为 13.0%，女性为 25.0%，而平片检查的男性为 0.24%，女性为 0.51%（p<0.001）。
与平片相比，MDCT 对儿科创伤患者的辐射量差异显著，应调整儿科颈椎清除算法中 CT 的常规使用。
