Posted: 4/3/2012 2:00:43 PM EDT
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My four-month-old son had a check-up yesterday and his head didn't measure correct. The nurse practicioner who saw him recommened a CT scan. I called today asking for a second opinion about a safer, less invasive method like an ultrasound, but was told that a CT is the best way to find skull abnormalities and an ultrasound is only as good as the person operating it.
I know there are some smart people here so I thought I'd check. Is a CT scan risky for infants? I understand the risk : benefit ratio, but I'd still like to know. Those who know my family, please don't spread the word; we're not telling anyone. 
ETA: Head measured too small. First occurrence. ETA2: Another concern I just found out was also about the shape. Apparently, it measured oval from front to back, instead of being round. I don't see this, but I trust they know what they're talking about. Update: 4/4 - Scheduled an appointment with our doctor for a second opinon on 4/16. 4/16 - Consulted with pediatrician. He's worried about craniosynostosis; specifically the posterior sagittal suture. Checking with neurologist if they will accept my son reasonably soon without a CT scan. 4/26 - Pediatrician does not see anything abnormal in the CT scan output.
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the ct scan can give more of a 3-d image, they're making sure the soft spots are not closing too early, if they are that is a big problem
then again without knowing if too small/too large, really can't say my son had one at two months, he's 7 now and no apparent ill effects |
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I would think an MRI would be even better imagery, and there's no ionizing radiation at all. I just fix computers though. MRI is great and no radiation. movement really fucks with MRI images. CT less so. So kids getting MRI usually get sedation or general anesthesia. Also. The new high sped spiral CTs can bang out a head real quick. |
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I would think an MRI would be even better imagery, and there's no ionizing radiation at all. I just fix computers though. Kid probably can't say still enough for the MRI. Sounds like they're looking for skull plate abnormalities (premature fusion, etc.)....not my field (I'm a Foot Dr). CT is a 'fancy' x-ray machine (takes lots of little x-rays, computer puts them together into a comprehensive image). Cut and paste from a website describing the dosages (vs. normal background radiation). Table I. - Radiation Dose Comparison
Diagnostic Procedure Typical Effective Dose (mSv) 1st Number Number of Chest X rays (PA film) for Equivalent Effective Dose 2nd number Time Period for Equivalent Effective Dose from Natural Background Radiation 3rd Number Chest x ray (PA film) 0.02 1 2.4 days Skull x ray 0.1 5 12 days Lumbar spine 1.5 75 182 days CT head 2 100 243 days CT abdomen 8 400 2.7 years Edited, cleaned up the table a bit... |
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I texted the wife again describing your situation
Her Response : IDK it's just a lot of radiation to give to anyone. What will this change? Is this just for their info or what? talk to pediatrician about their concerns for CT etc. It's something I personally would look deeper into before doing it. |
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I would think an MRI would be even better imagery, and there's no ionizing radiation at all. I just fix computers though. Kid probably can't say still enough for the MRI. Sounds like they're looking for skull plate abnormalities (premature fusion, etc.)....not my field (I'm a Foot Dr). CT is a 'fancy' x-ray machine (takes lots of little x-rays, computer puts them together into a comprehensive image). Cut and paste from a website describing the dosages (vs. normal background radiation). Table I. - Radiation Dose Comparison
Diagnostic Procedure Typical Effective Dose (mSv)1 Number of Chest X rays (PA film) for Equivalent Effective Dose2 Time Period for Equivalent Effective Dose from Natural Background Radiation3 Chest x ray (PA film) 0.02 1 2.4 days Skull x ray 0.1 5 12 days Lumbar spine 1.5 75 182 days CT head 2 100 243 days CT abdomen 8 400 2.7 years Good post. Thats why I wouldn't worry about the occasional X-ray study. Serial studies is another matter. |
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A CAT scan is not invasive. Words mean things. Also, if a kid's head "doesn't measure correct." that is cause for concern. Have it done and find out what the hell is going on in there while it still may make a difference. This, but get a second opinion first. |
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Ideally, evaluation of possible macrocephaly in an infant should be done by a pediatric neurosurgeon or pediatric neurologist. The choice of imaging modality is, in my opinion best left up to them.
Cranial ultrasound can be done quickly and easily, but is less sensitive to small fluid collections and the posterior fossa is not as well evaluated. Head CT is quick and pretty sensitive, but utilizes ionizing radiation. MRI is probably the best overall choice, and no ionizing radiation is involved, but takes longer and sedation will probably be required. Of note, if ultrasound or CT are initially done, and are abnormal, an MR will almost certainly be done also. Edited to add: Of course, the anterior fontanelle has to still be open for ultrasound to be possible; chances are good that it is in your child. |
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I was taught a CT is the equivalent of 200 chest x-rays. It is a fair amount of radiation.
Now that being said it is the best test to evaluate bony anatomy. If I were in your shoes I'd request a eval by developmental Pediatrician to see what they recommend (CT vs MRI). Not bashing NPs - I know alot of great ones. |
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Ideally, evaluation of possible macrocephaly in an infant should be done by a pediatric neurosurgeon or pediatric neurologist. The choice of imaging modality is, in my opinion best left up to them. Cranial ultrasound can be done quickly and easily, but is less sensitive to small fluid collections and the posterior fossa is not as well evaluated. Head CT is quick and pretty sensitive, but utilizes ionizing radiation. MRI is probably the best overall choice, and no ionizing radiation is involved, but takes longer and sedation will probably be required. Of note, if ultrasound or CT are initially done, and are abnormal, an MR will almost certainly be done also. Edited to add: Of course, the anterior fontanelle has to still be open for ultrasound to be possible; chances are good that it is in your child. This guys name and picture lead me to believe you should trust him. |
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Is a CT scan risky for infants? Just curious: Is it too big or too small? A single CT scan is really not the end of the world if you're trying to determine whether: 1) It is too big because of hydrocephalus. 2) It is too small because of premature closure of the sutures. Either condition will be easily picked up on CT scan and needs to be addressed. They may still do an MRI under sedation but a CT scan is much faster and doesn't expose the baby to the risks of sedation. |
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My daughter was born with persistent pulmonary hypertension, she had a hemorrhage in the brain at 1 day old, She had over 60 CT scans the first year of her life, trust me theres no ill effects tot he CT from what I saw, getting them to stray still is the problem |
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I was taught a CT is the equivalent of 200 chest x-rays. It is a fair amount of radiation. Now that being said it is the best test to evaluate bony anatomy. If I were in your shoes I'd request a eval by developmental Pediatrician to see what they recommend (CT vs MRI). Not bashing NPs - I know alot of great ones. Correct. If there is evidence of abnormal head shape, not just enlargement, then CT will be needed to evaluate the sutures. |
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All this is already pretty much on here but the Ultrasound Technician at my wife's ER got back to me....
Ultrasound Tech Statement: IF the fontenail isn't closed yet then the bones in her skull may not have calcified yet and Ultrasound is possible. If not she may request a MRI which is no radiation and more expensive. They will probably have to sedate her/him because it takes 45-60 minutes and you have to lay still. If no other options she would go ahead with CT. She recently had a baby and said they are probably worried about fluid on the brain if the head is too big. can cause problems so worth the CT scan. Did she have an ultrasound when she was pregnant? |
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Regarding concerns about radiation:
In my opinion, medical imaging is overutilized. I am concerned that, over time, background cancer rates for the population, especially in the US, will rise a small but detectable amount due to exposure to radiation. Having said that, I would never hesitate to recommend or perform a test or procedure that involves radiation for a patient that actually has a valid indication for the study. That includes my wife and children. |
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Head too big or head too small? Is there a trend or a single abnormal measurement?
This is way outside my area of expertise, (I am an ER MD) but I see kids with head trauma routinely in the ER and I do everything I can to avoid doing a CT. You would not CT my kids head without a pretty good indication. I am well on the conservative side of this, but there is increasing data that we do too many CTs especially on young people. Not knocking on your health care provider, but it is easy to order a test because you see something "abnormal". The questions to ask are: It is truly abnomal? What is the best test to evaluate it? and What are you going to do with the results? Here is some info from a medical subscription service called "Uptodate" on evaluation of macrocephaly from an imaging standpoint. A lot of it won't make sense to you, but it basically says what "xraydoc" said, "find out who the specialist is who is going to address the problem, and ask what test they want." Tell them you are concerned about radiation. Neuroimaging — Neuroimaging should be obtained in children in whom an expanding lesion is suspected [43]. Among other children, neuroimaging is most helpful (in terms of determining an etiology) for those who have developmental delay but lack features suggestive of a particular syndrome [44]. Among children who have features suggestive of a particular syndrome, other laboratory tests (eg, genetic tests) are more helpful in confirming the diagnosis. (See 'Other tests' below.) Overview — Radiologic evaluation of macrocephaly may involve plain radiographs, ultrasonography, CT, or MRI of the head. The optimal imaging strategy permits the detection of significant intracranial pathology and minimizes the potential hazards of radiation and/or sedation [45]. (See "Approach to neuroimaging in children".) The approach to imaging in children with macrocephaly depends upon the age of onset and associated symptoms. Normal infants may experience genetic shifting in OFC percentiles. Thus, a slow shift across one or two major percentile lines (eg, 10th, 25th, 50th, 75th, 90th) in a developmentally normal child warrants careful clinical observation. If the child's OFC remains within the predicted ranges based on Weaver curves, imaging is not necessary. However, if a child has a dramatic increase in OFC across several major percentile lines or exhibits worrisome neurologic or developmental symptoms, neuroimaging should be undertaken. The timing of closure of the anterior fontanelle is an important factor when considering clinical observation versus imaging. Head ultrasonography, which is noninvasive and does not require sedation, can only be performed in infants with an open fontanelle. Once the anterior fontanelle closes, neuroimaging options include head CT or MRI, each of which may require sedation. Plain radiographs — Plain radiographs may provide evidence of primary skeletal dysplasia or increased ICP. Findings associated with increased ICP include widening of sutures, prominent convolutional markings on the inner table of the skull ("beaten silver skull"), and erosion of the sella turcica [16]. Ultrasonography — Head ultrasonography is a reasonable initial study in infants with macrocephaly, normal neurodevelopmental examination, no evidence of increased ICP, and an open anterior fontanelle [45]. It may identify ventricular or subarachnoid space enlargement. If head ultrasonography is normal, the infant's OFC and neurodevelopmental status should be monitored closely. (See 'Management' below.) MRI and CT — Infants with neurologic abnormalities, progressively enlarging OFC, or increased ICP and a closed anterior fontanelle should be evaluated with MRI or CT. The choice between these studies depends upon a number of factors, including the suspected etiology, acuity of symptoms, need for sedation, and availability. The lack of radiation exposure is a major advantage of MRI over CT. Consultation with a pediatric neurologist and/or neuroradiologist can be helpful in determining the best study for a particular child. (See "Approach to neuroimaging in children".) •MRI — MRI can delineate the size and position of the ventricles; determine the width of the subarachnoid space; distinguish communicating from noncommunicating hydrocephalus; and identify white matter changes, mass lesions, vascular malformations, subdural fluid collections, and porencephalic cysts [30,44]. MRI with contrast or angiography may be performed to evaluate porencephalic cysts [30,44]. MRI with contrast or angiography may be performed to evaluate vascular abnormalities. •CT — CT is used primarily in the acute setting for the evaluation of obstructive hydrocephalus. CT also may be used to identify intracranial calcification (which may be present in basal cell nevus syndrome, infection, hypoparathyroidism, or parasitic cysts) [30]. In addition, CT can identify tubers in tuberous sclerosis complex or asymmetry of the cerebral hemispheres in children with linear sebaceous nevus syndrome. |
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Internet:
Can a CT scan be harmful to a baby that is 6 months old? - Yahoo ... Resolved · Last updated: Mar 10, 2010 · 5 posts · First post: Mar 10, 2010 · 4 total answers Mar 10, 2010 · OK my doctor prescribed a CT Scan for my 6 month ... Lots of babies have had CT scans, in hospitals and stuff. ... if he happens to have CS, then it will be bad ... answers.yahoo.com/question/index?qid=20100309222300AAEn9hWSide Effects of CT Scan for 7 Month Infant - Radiation and ...Jun 11, 2008How dangerous is head ct scan for 2 months old baby? - Yahoo! AnswersJun 26, 2010CT scan - MayoClinic.com - Mayo Clinic CT scan — Overview covers definition, risks, results of this imaging procedure. www.mayoclinic.com/health/ct-scan/MY00309CT Scan for 2.5 yr old with chronic sinusitis - Toddlers - BabyCenter CT Scan for 2.5 yr old with chronic sinusitis: I'll try ... Toddlers ... seeking a second opinion might not be a bad idea. community.babycenter.com/post/a10022475/ct_scan_for_2.5_yr_old...CT scans risk to babies and toddlers - www.theage.com.au ... been advised to resist using brain scans on babies ... CT scans risk to babies and toddlers ... They may get a scan when clinically it's not ... www.theage.com.au/articles/2004/01/02/1072908911350.html?from=storyrhs |
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You need clarification from the Doctor. What exactly is wrong? If hydrocephalus is suspected a simple head ultrasound might do. If it is a true skull/calvarium abnormality suspected then plain radiographs might suffice, if not then CT scan. MRI is a bit more involved as mentioned above (needs sedation) and would be necessary for congenital brain malformations, developmental abnormalities and brain tumors. If you end up with the CT make sure you go to a place with pediatric experience (dose control) and with 3D reconstruction capabilities.
ETA: I am a Radiologist |
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My daughter was born with persistent pulmonary hypertension, she had a hemorrhage in the brain at 1 day old, She had over 60 CT scans the first year of her life, trust me theres no ill effects tot he CT from what I saw, getting them to stray still is the problem Not to make you paranoid, but if that is true it is an unbelievable amount of radiation to an infant. You are not usually worried about short term effects, you are concerned about long term effects (cancer 10,20,30 years down the line). Everything you do in medicine has a risk and a benefit. The problem with CTs is that the benefit is "right now" and the risk is off in the future. Some docs don't even think about the risk of a CT. The number that is thrown around in ER literature is that for every 500-1000 CTs you do a person will die from cancer from one of your CTs. No one really knows if that number is true, and we will likely never have a study which gives us a reliable number, but that is something in the back of my head every time I order a CT. If I were you, I would make a list of the CTs she has had done and hand it to anyone who wants to Xray her in the future so they have some idea of how much radiation she has already been exposed to. |
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Was he in for a routine visit, or was it precipitated by an incident or symptoms? Routine visit. Another concern I just found out was also about the shape. Apparently, it measured oval from front to back, instead of being round. I don't see this, but I trust they know what they're talking about. |
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Ideally, evaluation of possible macrocephaly in an infant should be done by a pediatric neurosurgeon or pediatric neurologist. The choice of imaging modality is, in my opinion best left up to them.... This, absolutely. If there is a concern for microcephaly, you need to see a specialist and let them decide the imaging modality. Otherwise you are likely to find yourself going in for multiple studies. Kids can be sedated for MRI's to prevent movement and a lot of hospitals will have a protocol for that. With that, said, a CT in an infant isn't the end of the world. |
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It is true that one CT is not the end of the world. However, it is also true that a large percentage of CTs performed are not necessary, and carry with them a very small risk, especially in young children.
In my group there is a three fold range in the number of CTs ordered per patient (some docs CT 3 times as many patients as others). When you looked at missed diagnoses, we have folks on both ends of the spectrum who make lots of mistakes, and those who make few. Often a better clinician orders fewer CTs (my opinion). The more risk averse you are the more likely you are to order a CT to protect yourself. |
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Thank you, again, all.
I called the pediatrician's office today. Our doctor is out this week so his nurse consulted with another pediatrician. They are more worried about the bones (I believe synostosis is the word she used) and don't think that a referral to a pediatric neurologist is necessary, but the doctor would refer me if I wanted to. However, a pediatric neurologist might not be able to see my son for a month or so. For now, I scheduled an appointment with our doctor for a second opinon on 4/16. Nurse couldn't tell me how many standard deviations below the mean he measured. |
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get whatever second opinion. I pray that it is something that will resolve. I had a similar scare with my now 7 year old. Something appeared "off" they ordered a CT scan, it was positional, not a syntosis. He was up on my hip prior to delivery (scheduled c-section)
See what the doctor says, and pray. we're all here with you. |
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Just got back from the pediatrician. He had allowed more time than for a random appointment, which was nice. The good news is that the head growth rate is where it should be. The bad news is that while the forehead is nice and round, the back is sort of oval. The doctor is worried about craniosynostosis; specifically, the posterior sagittal suture. He recommended the CT scan as well and indicated that with general anesthesia required for MRI, the risks between a CT scan and an MRI for this age might balance each other. He also said that 80% of the time, he orders a CT scan before sending patients to the neurologist so the neurologist can assign the case a priority and see the child sooner if need be. However, he has no problem referring my son to the neurologist before the CT scan.
Right now, his lab nurse is checking with the neurologist's office to see how soon they can get us in without a CT scan. If the wait time is not reasonable, then we'll do a CT scan first. I appreciate everyone's help with this. |
