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Increasing Concern Regarding Computed Tomography Irradiation in Craniofacial Surgery

Domeshek, Leahthan F. B.S.E.; Mukundan, Srinivasan Jr M.D., Ph.D.; Yoshizumi, Terry Ph.D.; Marcus, Jeffrey R. M.D.

Plastic and Reconstructive Surgery: April 2009 - Volume 123 - Issue 4 - p 1313-1320
doi: 10.1097/PRS.0b013e31819e26d5
Pediatric/Craniofacial: Special Topic

Summary: The safety of medical radiation, particularly computed tomography, has recently received much attention in both the medical literature and the popular press. As knowledge regarding side effects of radiation exposure has increased, so have attempts to limit doses to patients through more selective use of scans and transitions to lower-dose protocols to conform to the As Low As Reasonably Achievable (ALARA) principle. This trend has been apparent across many fields within medicine, including craniofacial surgery. Craniofacial surgeons should be familiar with these issues to participate in the determination of practice standards and to address patient concerns. A number of authors have questioned the value and necessity of obtaining computed tomography scans for the management of single-suture craniosynostosis in light of known radiation risks. Although unnecessary exposure to radiation from computed tomography scans should be avoided, imaging provides useful–-often vital–-information to the treatment of craniosynostosis. Use of low-dose protocols, which have been shown to provide images of satisfactory quality for the evaluation of both suture patency and associated intracranial abnormalities, may be a favorable alternative. The authors discuss the issue of medical radiation and its risks. In the context of risks and benefits, the authors reviewed the current practice of imaging in craniofacial surgery with the intent to encourage dialogue between surgeons and radiologists to develop thoughtful practice standards.

Durham, N.C.

From the Interdisciplinary Craniofacial Imaging Laboratory and Department of Biomedical Engineering, Duke University; and Division of Plastic and Reconstructive Surgery and Department of Radiology, Duke University Medical Center.

Received for publication June 5, 2008; accepted October 14, 2008.

Disclosures: Funding for this project came internally from the departments of Plastic Surgery and Radiology at Duke University Medical Center. No extramural resources were utilized. The Interdisciplinary Craniofacial Laboratory at Duke University has received grant support from the General Electric Corporation. The authors have no other financial interest to disclose in relation to the content of this article.

Jeffrey R. Marcus, M.D., Duke Children’s Hospital, Duke University Medical Center Box 3974, Durham, N.C. 27710,

©2009American Society of Plastic Surgeons