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Bethany A. Karwoski, Kevin C. Chen, G. Emmett Lynskey, III, David Howard; Pediatric Orbital Imaging in the Emergency Setting. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1576.
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CT scanning exposes pediatric patients to ionizing radiation. Children have tissue that is more radiosensitive compared to adults and longer lives to develop possible problems from such radiation. Long-term studies have shown that low-dose radiation in childhood carries a small but significant increase in the lifetime risk for fatal cancer. When medically indicated, the benefits of CT outweigh individual risks. However, as increasing numbers of scans are performed, the potential for CT to become a public health concern also increases. Our study examines the use of CT for ophthalmic diagnosis among children in the emergency department of an urban trauma center.
We reviewed the logbook Ophthalmology residents use to record consultations for Pediatric Emergency Services at Bellevue Hospital Center, including all consultations for the period from May 2002 through October 2010 on patients 18 years of age and younger. We then searched the Bellevue Hospital Center PACS to determine whether or not patients seen in consultation by the Ophthalmology service underwent orbital imaging at the time of consultation, and noted the results of those imaging studies.
Overall, the Ophthalmology service saw 498 patients at the request of the Pediatric Emergency Room physicians, and 244 of these individuals were 18 years or younger at the time of consultation (range 10 days to 18 years). Of these cases, 53 had CT imaging of their orbits, face, and/or head. 33 cases (62% of patients imaged) had positive findings on imaging-- most commonly orbital fracture (18 cases), orbital cellulitis (4 cases), ruptured globe (3 cases), and orbital foreign body (3 cases). The remaining 20 cases (38% of patients imaged) had no significant findings on imaging studies.
The majority of patients having Ophthalmology consultation and orbital CT in our Pediatric Emergency Department have significant findings on imaging. Further study and identification of clinical features that will allow physicians to reduce the proportion of negative studies is an important step in improving management of radiation risk by clinicians. Imaging with alternative technology that does not use ionizing radiation (ie, MRI) may have a role for certain entities.
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