Outpatient Radiographic Exposure in the First Five Years of Life

Young children receive a variety of diagnostic radiographs over time. In some cases the exposure to radiation may be unwarranted because the films may yield confusing results, or may also need to be repeated because of poor technical quality. Even when the results are clearly negative, the subsequent treatment may proceed as if the film had been positive because of the child's clinical condition. The cumulative effect of such low-dose radiation on infants and children over time is unknown. The number and types of outpatient radiographs received by a cohort of poor children from a hospital-based continuity clinic during their first 5 years of life were reviewed. Also noted were the reason for obtaining the film, whether it was positive for that reason or another, whether the child had a chronic condition that prompted the use of radiograph, and the child's sex, race, and age when the film was obtained. Of the 218 children, 132 (60.6%) received 349 sets of films in their first 5 years. There was no difference in the number of films by race or sex. Chest and posttrauma bone or joint films accounted for 315 sets of films or 90.3% of the total. Overall, 25.8% of the 267 chest films were positive; this varied by age. Only 15% of the chest films were positive in the first year compared with 29 to 49% in the second through fifth years (p < 0.001). Cough was the respiratory symptom most reliably associated with a positive chest film, both for the cohort (p < 0.0001) and for children in the first year of life (p < 0.01). Of the 132 children who had received a radiograph, 77 (58.3%) had some type of chronic condition, but only 33.5% of their films were directly related to those conditions. Of the children who received films, those with any chronic condition received more films in general (2.99 versus 2.10, p < 0.01) and chest films in particular (2.39 versus 1.44, p < 0.01) than did children without a chronic condition.