The Food and Drug Administration last week issued new guidance urging healthcare providers to “child size” the radiation dose when conducting medical imaging exams on children.

“The level of ionizing radiation from X-ray imaging is generally very low, but can contribute to an increased risk of cancer,” states the FDA guidance. “Because children have longer expected lifetimes ahead of them for potential effects to appear and the risk for cancer is not fully understood, it’s important to use the lowest radiation dose necessary to provide a diagnostic exam.”

The regulatory agency recommends that providers optimize the radiation dose of medical imaging exams— including X-ray, CT and fluoroscopy—to deliver the lowest level of dose needed. Imaging exams should be performed on children only when it is determined the studies are necessary to answer a clinical question or guide treatment.

“Unnecessary radiation exposure during medical procedures should be avoided,” warns the FDA. “However, X-rays and CT scans should never be withheld from a child or adult who has a medical condition where the exam could provide important health care information that may aid in the diagnosis or treatment of a serious or even life-threatening illness.”

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While the FDA defines the pediatric population as birth through 21 years old, the agency contends that the optimization of image quality and radiation dose in X-ray imaging depends more on a patient’s size than their age and that smaller patients require less radiation to obtain a medically useful image.

“Technically, the patient’s body thickness (the distance an X-ray travels through the body to create the image) is the most important consideration when ‘child-sizing’ an image protocol,” according to the FDA’s guidance.

Ultimately, providers are responsible for ensuring there is justification for all X-ray imaging exams performed on pediatric patients, according to the agency. “They should also consider whether another type of imaging exam that does not expose the patient to ionizing radiation, such as ultrasound or magnetic resonance imaging, could be used to obtain the same result.”

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