January 21, 2026
Pediatric Patients Exposed to Ionizing Radiation in Imaging at Higher Rates in Non-Children’s Hospitals than Children’s Hospitals
A new Harvey L. Neiman Health Policy Institute study, performed with the American College of Radiology’s (ACR) Pediatric Imaging Research (PIR) Committee, highlights differences in imaging use among children that raise safety concerns and opportunities to reduce radiation exposure. The study analyzed over 5.4 million outpatient hospital encounters for pediatric Medicaid patients and found significant differences in imaging utilization between children’s hospitals and non‑children’s hospitals. The findings, published today in the Journal of the American College of Radiology, showed that non-children’s hospitals rely more heavily on CT and radiography, which use ionizing radiation that can cause DNA damage, while children’s hospitals make greater use of safer imaging, including MRI and ultrasound.
Using 100% of 2018-2019 Medicaid outpatient hospital claims, the researchers found that non-children’s hospitals used CT at twice the rate of children’s hospitals (1.0% vs. 0.5% of encounters) and radiography at about 1.5 times the rate of children’s hospitals (11.8% vs. 7.5% of encounters), while children’s hospitals used MRI (0.9% vs. 0.5%) and ultrasound (2.5% vs. 1.7%) more frequently than non-children’s hospitals.
“The data show clear, measurable variation in imaging practices between children’s and non‑children’s hospitals,” said Casey Pelzl, lead author and Principal Economics and Health Services Researcher at HPI. “Even after accounting for factors like patient complexity and chief complaint, CT and radiography were used more often at non‑children’s hospitals.”
Limiting pediatric exposure to ionizing radiation is particularly important for children because they are at greater risk than adults of developing cancer after being exposed. The observed differences in imaging utilization at children’s hospitals and non-children’s hospitals raise important considerations for pediatric imaging safety and adherence to Image Gently®’s mission to limit radiation exposure for pediatric patients.
“Children are not just small adults, and the imaging used in their diagnoses should reflect children’s higher sensitivity to ionizing radiation,” said Dr. Sherwin Chan, Vice Chair of Radiology Research at Children’s Mercy Kansas City and co-chair of ACR’s Pediatric Imaging Research (PIR) Committee. “Forty-seven percent of the 5.4 million encounters in our study occurred in non-children’s hospitals, highlighting the need for broader adoption of pediatric‑appropriate imaging protocols in these settings.”
“The higher use of CT among pediatric patients at non-children’s hospitals has significant implications beyond the United States,” said Dr. Andrea Doria, Research Director, Senior Scientist, and Imaging Lead of Personalised Child Health at The Hospital for Sick Children in Toronto and co-chair of ACR’s PIR Committee. “These findings underscore the importance of pediatric‑specific protocols and the need for international collaboration to promote safer imaging practices.”
This study highlights the need for ongoing evaluation of pediatric imaging practices across all hospital types, particularly those that care for large volumes of children but may lack pediatric‑specific imaging infrastructure. In an effort to formalize a radiology professional’s commitment to radiation safety, responsible imaging, and ongoing quality improvement, the ACR has asked individuals, facilities, and associations to renew their pledges to Image Wisely and Image Gently in 2026, and ensure that children receive imaging according to the guidelines available through these initiatives.
To arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.
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About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on X or LinkedIn.