Le recours à la tomodensitométrie (TDM) thoracique augmente en pédiatrie. L’objectif de notre travail était double : évaluer ses indications et son impact en pneumologie pédiatrique, et apprécier l’irradiation induite selon la sensibilisation des radiologues à la radioprotection.

Il s’est agi d’une observationnelle, prospective réalisée entre novembre 2009 et avril 2010. Tous les enfants, dont la TDM thoracique avait été présentée en réunion de radio-pneumologie pédiatrique du centre hospitalier régional universitaire (CHRU) de Lille, ont été inclus. Nous avons relevé les caractéristiques démographiques, les indications, l’irradiation (produit dose longueur [PDL] et dose efficace [DE]) et les résultats. Le PDL et la DE ont été comparés selon le lieu de réalisation (TDM double source ou 64 barrettes du CHRU, ou extérieur).

Cent trente-cinq patients ont été inclus (âge moyen 6,4ans). Les TDM diagnostiques (61 %), avaient eu un impact diagnostique pour 48 % et thérapeutique direct pour 24 %. Celles de suivi de maladies chroniques (39 %) avaient eu un impact diagnostique pour 38 % et thérapeutique pour 19 %. L’irradiation avait été significativement inférieure pour les TDM réalisées au CHRU, a fortiori avec la TDM 128 barrettes (DE double source : 0,61mSv±0,32 ; DE 64 barrettes : 1,24mSv±0,97 ; DE extérieurs : 2,56mSv±1,98).

La facilité d’accès aux TDM et leur qualité, y compris chez les jeunes enfants, ont augmenté leurs indications, ne dispensant pas de certaines précautions. Notre étude montre que la sensibilisation des radiologues aux risques pédiatriques, les progrès techniques et la collaboration avec les cliniciens réduisent l’irradiation induite.

New multidetector row computed tomography (CT) has made the imaging of younger children more feasible and extending CT indications to a wide range of pediatric respiratory diseases in the last few years. However, CT is a source of radiation exposure. The aim of this study was to evaluate the main indications and the contribution of chest CT in pediatric pulmonology as well as induced radiation.

This was an observational, prospective study. Children whose chest CTs were analyzed during multidisciplinary meetings (radiologist, pulmonary pediatrician) were included from November 2009 to April 2010. We collected demographic data, CT results, contribution of CT to diagnosis and management, and radiation doses (dose-length product [DLP] and effective dose). Radiation doses were compared according to the CT scans (Lille University Hospital with 128-slice dual-source CT or Lille University Hospital single-source 64-slice CT, or CT performed outside the university hospital).

One hundred thirty-five patients were included. The mean age was 6.4 years old. The main indications were analysis of bronchial disease (44%), infectious disease (16%), interstitial disease (14%), or a malformation (9%). The aim of CT was diagnosis (61%) or follow-up of previous lung diseases (39%). Diagnosis chest-CT directly contributed to diagnosis in 48% of cases and to treatment in 24%. Follow-up CT contributed to diagnosis in 38% and treatment in 19% of cases. DLP and effective doses were significantly lower for CT performed in the university hospital, especially with the 128-slice CT compared to the others (P<0.001). The effective doses were: 128-slice CT, 0.61mSv±0.32; 64-slice CT, 1.24mSv±0.97; outside university hospital, 2.56mSv±1.98.

This study confirms the role played by chest CT in children, which contributes to diagnosis and management of lung diseases. The main concern of CT application, especially in children, is the radiation burden. Children are more susceptible to the effects of radiation than adults and have a longer life expectancy to develop complications. Both radiologists and pediatricians should be aware of a potential risk and have to conjugate their efforts in reducing this risk. The wide range of radiation doses in this study for the same CT procedures underlines the extensive efforts still needed to limit radiation exposure in children.