Reducing unwarranted radiation exposure to children and young people from CT scans

In Australia, many computed tomography (CT) scans are performed on children and young people each year. CT is a valuable diagnostic tool, especially in emergency situations. However, CTs use higher doses of radiation than other types of medical imaging tests, and their use in childhood or adolescence has been linked to a slight increase in developing cancer later in life.1

Children and young people may also undergo a cone beam computed tomography (CBCT) scan as part of their oral health care. CBCT scans can provide dentists, orthodontists and surgeons with important information to help them with decisions regarding oral health care. While typical radiation doses in cone beam CT are much lower than those used in medical CT, use of radiation in oral health care should also be kept as low as possible.

Information for parents

If your child has had a CT or a CBCT scan, or may need one in the future, do not be alarmed. Talk to your child’s doctor or dentist about the benefits and risks of the test. You may want to ask:

• how the test will improve your child’s health care
• whether there are alternative imaging options, and
• if a CT scan is necessary, how the radiation dose will be kept as low as possible for your child.

Always let the doctor or dentist know about any other scans your child has had and take any previous scans with you to appointments.
If your child is referred for a CT or CBCT scan, it is important for you to remember that a scan which is warranted, will almost always result in more benefit than harm to most patients.

The Australian Commission on Safety and Quality in Health Care (the Commission) has partnered with the Association for the Wellbeing of Children in Healthcare and NPS MedicineWise to develop a brochure that answers questions that you may have if your child needs a CT scan.  A companion poster has also been developed by these organisations for display in doctors’ practices, medical imaging services and early child health services.

In partnership with the Australian Dental Association and other dental organisations, a brochure for parents and carers and a companion poster on CBCT have also been produced.

Support for health professionals

To support doctors requesting CT scans, the Commission has also partnered with the Australian Radiation Protection and Nuclear Safety Agency to update a fact sheet providing information on CT scans for children, including the typical radiation doses for various scans.  

To support all people involved in the CT patient journey, the Commission has partnered with Healthdirect Australia to establish a web page dedicated to hosting these and other resources on CT scanning for children and young people. Visit www.healthdirect.gov.au/ctscansforkids for access to the fact sheet, brochures, posters and videos and interactive tablet games to assist parents and carers to prepare a young child for a CT.

For more information about CT scans for children and young people, visit www.healthdirect.gov.au/ctscansforkids.

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 1 Mathews JD et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence:  data linkage study of 11 million Australians. BMJ.2013;346:2360

Dimity Herden
Senior Project Officer
Australian Commission on Safety and Quality in Health Care

G is for Grief and Grandma

“MG”, a dear friend of mine died recently. She had been fighting illness for over eight years and before thinking that is long enough, the health professionals who got to know her, regarded her as a miracle person. There were times of bounce back and return to health.

Even in the ill stages my friend was not known for sitting back, she took herself to and from treatment at different times for many years, was dynamic, stylish, generous and energetic. She had a spirit of compassion, acceptance of others and was also gifted with the ability to care. Her language of love included cooking fresh food from scratch, recipes came from the top of her head along with the dishes that just kept coming. MG always had a beautiful home and used her green thumbs to create a lush garden. Dance was a lifelong passion and included teaching seniors. Over recent years she cherished time with her grandchildren and cared for one grandson from nine months old for several days a week. With a sparkle in her eyes and a song in her voice, MG loved a lot and left many better off with her presence.

It was not easy for MG to be cared for in the last few months, having spent most of her life giving to others. Yet even at the end, in her fragile state, she reached out to her grandson and they began a little dance by the hospital bed.  Hearing about this caught my breath away.

“Yet even at the end, in her fragile state, she reached out to her grandson and they began a little dance by the hospital bed”

For much of his three years, this little boy had known Grandma was sick and also that she went to hospital. Recently, he watched nurses asking Grandma questions such as “what’s your name, birthdate and is this your medication?” Visiting Grandma in hospital meant he was an expert observer of Grandma’s care. It was a poignant moment for his mother, when she was about to take some medicine and her three-year old asked, “where’s your bracelet, what’s your name and birthdate?” With these words, I’m taken to a childish place.
This little boy’s parents had communicated about Grandma’s sickness and then her death. There are many children who are not given this opportunity, through circumstances and by parent or carer choice.

Children approaching a medical or surgical procedure are cared for by adults who are trained and experienced in pediatrics, they are “child-friendly”. However, children visiting sick adults in hospital are in an adult world with strange circumstances, sights and sounds.  I wonder what children who face this experience think? Parents and carers are there to guide, comfort and help make sense of what is happening.

My friend MG and her grandson, had a unique way of observing life and death. Amidst the grief felt by families, children observe many things. I've learned that a child’s approach to death may catch adults by surprise and for at least a moment, take our breath away.

Jillian Rattray

AWCH librarian
http://Library.awch.org.au
August 2015

Photograph: thank you to the children who created dancing grandmother, grandson and the special happy tree.

Little snails and tales, at lunch with hospital ward grandparents

At last an opportunity to try snails in Australia. When the time came to order I was absorbed listening to tales of hospital ward grandparents. With menu in hand and so many delicacies, I just pointed to the middle of the page, ahhh... duck liver pâté. All was not lost, at this gathering of over thirty hospital ward grandparent volunteers from over 6 hospitals across NSW, plates were scraped clean and for each of the three courses nobody appeared to regret their order.

“Grannies” who normally couldn't envisage making room for dessert, simply didn't have qualms when the time came. Once more, plates were left clean and all that remained were a few drips of sauce. Very little caramel was left on mine.

However, this was more than a delicious lunch at The Little Snail restaurant. It was an opportunity to celebrate National Volunteer Week 2015 and recognise the work of the AWCH Hospital Ward Grandparent volunteers to thank them for all they do to enhance the lives of sick children and their families in hospital. Volunteers spoke of times spent with shocked families in emergency waiting rooms, sharing toys and books with children and just being a supportive presence for parents. It was a proud moment when photos of a young boy were shared amongst volunteers who had cared for him over a number of years. They were on a journey with him and his family. This little boy with chubby cheeks and a winning smile had ‘graduated’ from hospital.

An informative guest speaker from Genetic Alliance Australia , Dianne, talked about their important work, giving listeners much food for thought. Genetic Alliance Australia supports families from the point of diagnosis and works towards making lives better for people living with rare diseases and genetic conditions. GAA is housed in the Garvan Institute of Medical Research building. This is where scientific advances are initiated and recent improvements in bringing early diagnosis to Australians has had a huge impact on people’s lives.

Lastly, in the spirit of fun, AWCH decided to give away some books that the ward grannies could read to their children. For a change the books were not about being sick. Instead the thought was to spark children's imagination and take them to another place. The books aimed at pre-schoolers and school children were, Don't let the pigeon ride the bus, Don’t let the pigeon stay up late, Tashi, Aussie bites : the bugalugs bum thief ….

I then highlighted a few recent books written to help parents cope with their child's medical and surgical procedures and hospitalisation. These too were snapped up. They were Help! my child's in hospital, by Becky Wauchope and Everybody stay calm, by Angela MacKenzie. I held tightly on to the one American book, it was harder to get Parenting children with health issues and special needs : love and logic essentials for raising happy, healthier kids -  people are invited to borrow this book.

Jillian Rattray

AWCH Librarian

http://library.awch.org.au

May 2015