Sometimes less is more. That may be the case with pediatric CT for surveillance of traumatic brain injury, which should be limited as much as possible due to the radiation it delivers to young patients. Other modalities like MRI should be considered instead for follow-up.
That’s according to a new Viewpoint article in JAMA Pediatrics that proposes a new surveillance protocol relying on rapid MRI scans rather than CT to follow kids who have experienced TBI.
The authors note that the head is the most frequently imaged body region in pediatric CT, with a 2025 study claiming…
- Cancer risk in scanned kids rose with higher radiation exposure.
- Just two head CT scans added up to a 1.8X higher risk of hematologic malignancy by age 21.
- 2-3 scans conferred a 2X higher brain cancer risk.
But regardless of how you interpret those statistics, few imaging specialists would dispute the need to keep pediatric CT radiation dose as low as reasonably achievable.
Instead of CT, the new imaging pathway proposed in JAMA Pediatrics recommends a rapid MRI protocol for surveillance imaging, as follows…
- Initial TBI diagnosis should continue to be made with index cranial CT to identify hemorrhage.
- Stable patients should be referred to MRI using motion-tolerant and blood-sensitive sequences like T2 with gradient-echo or susceptibility-weighted imaging.
- Such sequences can be performed without sedation in 5-7 minutes or less.
- For unstable patients, timely imaging – regardless of modality – and urgent neurosurgery consultation should be prioritized.
But there are barriers to wider use of MRI, such as the availability of MRI scanners and technologists, especially outside daytime hours.
- Nor do the authors recommend that children be transferred to other facilities solely to receive MRI scans.
But in cases where MRI is available, every effort should be made to provide a radiation-free option for tracking children with TBI.
The Takeaway
Radiology has demonstrated impressive progress in reducing overall CT radiation dose in the long term. The new article recommending an MRI-forward pathway for following children with TBI shows that additional progress can be made when it comes to our most vulnerable patients.