Kids are receiving more CT scans than ever, but is radiation risk worth it?

There has been a steep increase in the number of CT scans given to children in emergency rooms across the U.S., mostly for "kids presenting with belly ache," but the appendicitis rate hasn't budged. Findings published today in the journal Pediatrics detail the spike in use of x-ray-based scans, which are associated with concerns over cancer risks down the road. Study lead Dr. Jahan Fahimi, quoted in Reuters: "For every six or seven kids that go to the ER for belly ache, one is going to get a CT scan."


  1. I worked for about a decade for a large medical specialty association and the radiologist lobby spent a great deal of time encroaching on diagnosis. It came down to specialists with years of training duking it out with technicians. Who would you rather have interpreting your scans for you?

  2. Given it’s the US and the profit motive is rampant. Surely the story is: CT scans are profitable, especially when not needed (health risks < profit motive)

    Don't delude yourself this is in your best interests.. you'll get the most profitable treatment for the doctors, even if it's the worst possible treatment for you*….

    *Sorry to politicize this, but it does need to be pointed out why privatisation is the worst possible solution ever invented…

    1. There’s another aspect: nobody ever sued a doctor for ordering a CT scan.  But if he just palpitates the abdomen and sends the kid home, who then dies with a burst appendix…

      1. Nobody does that nowadays in the USA. That’s 1982 you’re thinking of. It’s a different perspective. Now, they do diagnostics and instead of trusting their experience and trained judgment, they just order an image to make sure. This lead to all kinds of unintended consequences.

        1. You’re right, I’m showing my age.  I am a traveler from a past century, when doctors strove to do no harm.

      2. Yeah, American litigiousness knows no bounds. But just wait another 20-40 years when people start coming down with radiation exposure related cancers. Then the lawyer mills will really start turning.

        Male breast cancer is pretty rare, but radiation exposure increases the odds for it second to heredity.

        It seems to me that ultrasound would be a viable alternative to CT scans.

        And personally I am totally comfortable with abdominal palpation, as it’s statistical success at diagnosis of appendicitis is also quite good. I’d only want a CT if there’s a valid medical reason.

        1. There’s not going to be a smoking gun that says this CT was the one that caused the cancer.  It may have upped the prevalence, but each study is too little of a statistical nudge for a case to be ever made for suing someone. 

      3. How often does that even happen though? CT scans are becoming their own form of lazy diagnosis because the physicians don’t have time to spend on patients that they should. It’s a conveyor belt of sick people and they have to keep the line moving.

        1. I’m pretty sure that it’s liability driven and driven by the fact that the ER doctors don’t know the patients. If I had gone to my regular doctor with biliary colic instead of to the ER, he would have correctly diagnosed it in ten seconds. And because he knows me, he could be confident in providing the diagnosis without doing multiple tests to cover his ass.

          Every patient that an ER doc sees is a stranger and often an hysterical stranger. It creates an atmosphere.

    2. It’s disingenuous (at best) to suggest that ER doctors have any change in pay based on how many CT scans they order.

      1. Why not? Getting extra pay for the most profitable outcome is the only solution for a privatised system… If they *don’t benefit from the result* a socialised system is best.
        If you want a socialised minimal cost system, the profit motive (greatly) needs to be removed entirely as it’s completely incompatible…

        So choose… best profit or best results, but you can’t have both.

        Any person with any functional morals would choose results IMHO…

        1. I think institutionally they may encourage use of imaging, but it’s doubtful that many ER docs get money back for doing so.  As for doctors who own their own x-ray or MRI or CT machine, yeah, I could see them overprescribing studies that happen to be conveniently located down the hall…

  3. Classic overdiagnosis. Don’t pity the child who gets a CT. Pity the children who get CTs and die from complications of treatment of diseases they never actually had.

  4. It seems a classic CYA on the part of the hospital and parents, with a side of low short-term risk versus very low (but very hard to quantify) long-term risk. The fine line of appropriate diagnostics gets blurry when it comes to children. It’s hard enough for adults to describe their symptoms accurately and thoroughly enough; it’s even more difficult for children. Mix in worried parents and you get a lot of unnecessary scans and diagnostic work.

  5. We don’t get paid for ordering scans. I can’t imagine a quicker way to create all kinds of horrible ethical and legal disasters. Most of us are paid by the hour, regardless of what we do our how busy we are (or aren’t.) 

    It takes me *much* longer to explain to mom & dad why I don’t think that its right thing to do the CT just now, be it for a concussion or abdominal pain. A lot of the time they’re irritated and insist on the scan regardless.

    The stance, “Understand that I’m not refusing, but I have to tell you, I wouldn’t scan my own child for this; I would keep a close eye on her and come back if she seems worse in any way or if she’s not getting better” doesn’t work nearly as often as you might think, even when you sit there and show them pictures of your own kids in the same age range. 

    Alas, its only about one family in five who says, “Wow, thanks for taking the time to explain your thinking. Now that I understand your concerns about chances of cancer on a population basis, I can see why you would recommend watchful waiting, particularly since my little one’s story and exam are somewhat equivocal.”

    The population who reads boingboing (and the subpopulation who reads comments) is not the population who calls my medical director and administration complaining that their child didn’t get the test that they wanted for her. 

    Whereas we are not pressured to do studies one way or the other, we are most certainly pressured to make people happy, and yes, for many of us there is a non-trivial chunk of our compensation attached to that. I don’t mind foregoing that part in favor of Doing the Right Thing, but a lot of my colleagues do.

    And when mom or dad assert that should I decline to scan their child for her concussion or tummy-ache then they will simply come back in a few hours, what then? “I refuse to be blackmailed” only gets a clinician so far, particularly in this setting.

  6. Is it wrong that I read the first sentence in the summary paragraph in Alan Alda’s voice?  As in, his voice as he sarcastically commented on stupidity in his character Hawkeye Pierce on M*A*S*H, not his presentation on Scientific American Frontiers…

    I literally wrapped up watching all eleven seasons of M*A*S*H today, finishing with the overlength “Goodbye, Farewell, and Amen”. We’ve been going through it for the better part of two years. I tend lately to think of a lot of medical foolishness with his voice I guess…

  7. So hilarious when a couple people are talking out their ass on an issue they overblow for their agenda.

    Geez last time I checked I never heard an MD ask me which CT exam he should order based on cost. Hate to destroy the fantasy but hospitals make money when people PAY their ER bills.

  8.  When I had appendicitis the doctor just looked at at me, poked me once, and once I’d stopped screaming told me to take myself to the hospital.  Why would you need a CT to diagnose that?

  9. My wife took a spill while pushing our children’s stroller.  The 3-month-old was up top in the carseat, while the 2-year-old was down below in the rumbleseat. The whole stroller went over and the baby hit his head on the sidewalk.

    Although he did not lose consciousness or vomit, I took him to the hospital because, hey, it’s a baby that fell three feet and hit his head on cement. I took him to one of the top children’s hospitals in the U.S. They checked on us constantly and monitored him. We asked for a CT scan to make sure he was okay. The doctor said she would order it, but did not believe it was necessary based on her observation. We pushed for it because, hey, it’s a baby that fell three feet and hit his head on the cement. We plan on being more conservative with such scans as our kids get older, but I’ve known people who have died after taking a blow to the head and then walked around for an hour or two.

    The doctor said that she would not choose to do a CT scan on her own child in this instance (we asked her that question), but said it was a reasonable request given the facts of the case.

    The CT scan revealed no problems, but I still stayed up all night watching him breathe.

  10. Something I have found while working in an ER: Most people are not happy until the Doctor has given them some sort of XRay or CT scan or something.

    No ER doc is getting any sort of kick back from ordering you a CT. It is at worst, a way for them to cover their own asses. Let’s face it, in our sue heavy culture, it isn’t a bad idea.

  11. Also to add: What the hell are you taking your kid to the ER when they only have a belly ache for anyway?

Comments are closed.