CT for follow-up?

Question

Our doctor at the outpatient clinic recommended doing an annual CT for CF follow-up with our one-year-old daughter. Is that exaggerated? What about benefits and significance compared to radiation exposure? Is radiation exposure much higher than with X-ray?

Thanks in advance.

Answer

Hello,

several studies have shown that a CT scan is capable of detecting early alterations of the respiratory tracts in case of a CF-related lung disease, often before any clinical symptoms are visible. Also, the changes in tissue that a CT scan shows occur earlier in the life of a CF patient than it has been assumed so far. If transformations are diagnosed, treatment can be started early and the progression of the disease can be positively influenced. In the long run, these changes can be detected exactly in a CT; therefore a CT scan is very helpful and definitely superior to X-ray in assessing the progression of the lung. CT is therefore the best imaging examination method in the first few years of the patient’s life. A lung function test can usually only be done reliably from the age of 5, and other ways to measure lung function under that age are not available everywhere.

Preferably, the CT scan should always be done under similar circumstances and, at your daughter’s age, will certainly have to happen under sedation/short-term anesthesia.

Particularly with children under the age of 10, radiation exposure during a regular CT scan is many times higher than exposure through X-ray. In my opinion, it can therefore not be justified with intervals of one or one-and-a-half years, not even if the average information content is much higher compared to X-ray.

A further option is to carry out a CT scan following a low-dosage protocol; here, radiation exposure is decidedly lower and nearly corresponds with a conventional X-ray. In my opinion, such a low-dosage CT scan every one to one-and-a-half years is definitely justifiable if at the same time one foregoes the conventional X-rays for follow-up.

Kind regards,

Dr. H. Ellemunter

29.10.2009