Pediatric Trauma Radiation Exposure Dilemma- Opportunities for Improvement with iCloud Radiology

Yana Puckett, MD, MPH Student; Jose Greenspon, MD, FACS

IntroductionThis study examined the inefficiencies of radiologic imaging transfers from one hospital to another during pediatric trauma transfers in an era of cloud based information sharing.

Effects of Hospital Radiation Exposure in Children

• Radiation exposure during CT of major concern in children.

• Over 7 million scans performed in children over last decade, mostly for trauma and appendicitis.

• Longitudinal, population-based study in Great Britain demonstrated an increased incidence of leukemia and brain cancer after repeated CT scans in children (*).

• Models extrapolated from radiation exposure from atomic bomb explosions- one fatal cancer per 1000 CT scans performed in young children estimated (*).

• Children have a longer life expectancy than adults, resulting in a larger window of opportunity for expressing radiation damage.

• Children may receive a higher radiation dose than necessary if CT settings are not adjusted for their smaller body size.

Methods• A retrospective review of all patients

transferred to a pediatric trauma center in in Saint Louis between 2008 and 2014 was performed. Data was divided by the type of trauma sustained, time spent at outside hospital before transfer.

• Imaging was reviewed to see if outside hospital obtained imaging, whether accompanied the patient, whether imaging was able to be uploaded onto computer for records, whether imaging had to be repeated, whether labs had to be repeated, whether imaging obtained at the outside hospital was done unnecessarily.

Results• We reviewed 521 charts. • Imaging was sent with the patient 87.7%

of the time. • Imaging was unable to be uploaded to

EMR 27.8% of the time. • CT imaging had to be repeated 1.2 % of

the time. • CT scan was done unnecessarily or not per

universal pediatric trauma guidelines 1.2% of the time.

Conclusion• Pediatric trauma transfer patients often

come to an accepting facility with films that require duplication or are not able to be uploaded to the electronic health records at receiving hospitals.

• This results in significant transfer delays, missing diagnostic information, loss of imaging, unnecessary irradiation to child, and increased cost to healthcare system.

• Cloud based radiology systems are widely available to be incorporated into hospital systems and can allow instant view of labs and imaging from another hospital eliminating unnecessary repeat imaging, delays in treatment, and decreasing healthcare costs dramatically.

* Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: A retrospective cohort study. Lancet 2012;380: 499–505.