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Brancato Sandra (Pediatrician)
As La Revue du Praticien reported at the end of January, the number of imaging procedures carried out in pediatrics is increasing in France. However, children are a population that is particularly sensitive to ionizing radiation which induces a low but present risk of cancer. Should we change our medical habits?
Even more than in adults, radiation from X-rays and scanners is harmful to children, and exposes them to a low but quantified risk of cancer. The Practitioner’s Review echoed this one last time last January in a dedicated publication.
Procedures still widely prescribed in France
The frequency of these acts is not necessarily decreasing in France. Thus, the Institute for Radiation Protection and Nuclear Safety showed in its latest report that around 604 diagnostic procedures per 1,000 children aged 0 to 15 were carried out in 2015. The proportion of children having benefited from at least one procedure diagnostic (i.e. “exposed” children) was 31%. The most frequent procedures in children overwhelmingly concerned conventional and dental radiology (around 56% and 41%, respectively). But 1.1% of children under 16 also had at least one CT scan per year. Proving that the practice is easily advocated.
Children more sensitive to radiation than adults
However, these acts remain worrying for the present and future health of children. “In the event of DNA breakage by ionizing radiation, poor repair of genetic material can lead to cellular mutation, which is the first step towards a process of carcinogenesis. indicates the publication.
Exposure to high doses of ionizing radiation, particularly in x-rays and scanners, is associated with an increased risk of second cancer. During a study conducted between 2001 and 2011 a significant increase in the risk of leukemia and brain tumor depending on the dose received was observed, particularly after several scans before the age of 15.
The justification of imaging procedures at the heart of the medical debate
According to the medical publication, the three main principles of radiation protection are justification, optimization and limitation. Principles explained to us by Sandra Brancato, pediatrician and member of Afpa, contacted by Doctissimo.
“To counter this risk which threatens the youngest patients, the real question which must be asked by every doctor is “what is the examination which will be the most useful for the diagnosis?” So of course, rays are very often necessary in cancers and extremely serious illnesses, but these pathologies nevertheless benefit from cutting-edge services and doctors who are aware of the advantages and disadvantages of potential risks and are committed to protecting children as best as possible. For the rest, it is necessary to distinguish the actions that are necessary and largely justified by the pathology. It is always the question of the balance which must prevail: an x-ray is X-rays. So if we irradiate the body of a child, it must be because we really need it to solve a problem. If this does not change anything in the treatment (in the context of a fracture of the little finger for example which will not be casted or operated on) then the examination is useless. This is what we do more and more in pediatrics, but this is not always applied in community medicine.
Imaging no longer has to be automatic (but it’s not always simple)
The fact remains that imagery remains a reflex that is too often demanded by parents and establishments. “There are still many parents who think that falls or stomach aches necessarily require an x-ray or a scanner and want to be reassured” she reveals. “The problem also is that in certain centers, and in emergency rooms, we always tend to send the child for an x-ray before even seeing the doctor. While there is also the option ofultrasoundnon-irradiating”. A drift which is due to the degraded operation of establishments.
What you also need to know is that an ultrasound requires the presence of a radiologist on site. Whereas an x-ray or a scanner, only that of a technician, who will send the image to the radiologist, remotely. It is then difficult to reduce the frequency of x-rays when radiologists are lacking at night and on public holidays.
“As a result, there are probably a large number of children who would not have had an X-ray if they had seen the surgeon or doctor first. But the way the centers currently operate means that they are so overbooked that the passage is faster this way. It’s very complicated when you’re working under capacity.”