Image Gently
*Kale S.K*, Gupta V., Malhotra A., Chandramohan
The availability and intellectual acceptance of information does not always translate into appropriate action. This is particularly true regarding computed tomography (CT) radiation dose in children. It is estimated that since the 1980s when CT was beginning its ascendancy there has been up to 800% increase. CT scans in children provide great benefit in patient care when used appropriately. However, the practice of CT has been increasingly under scrutiny because of the association between cancer and low levels of childhood radiation such as in CT. While for most patients, benefits of CT greatly exceed the risks, this margin narrows when an excess of radiation is used .However, increased use requires a team approach to ensure that only indicated exams are performed and at the lowest and appropriate dose to the pediatric patient.
ALARA in Pediatric CT
ALARA recommends using all the measures to reduce the unwanted exposure and expose the child at adjusted doses. But apart from the technical parameters what all we can do is the need for the future. The Society for Pediatric Radiology, with an unrestricted grant from GE Medical Systems, organized a multidisciplinary international conference to discuss dose issues in pediatric CT (As Low as Reasonably Achievable, or ALARA, Concept in Pediatric CT—Intelligent Dose Reduction) in August 2001. There were over 100 attendees (participants and registrants) from the crucial disciplines (scientists, physicians, technologists, manufacturers, and representatives of government agencies) necessary to respond to the problem(s).
The transcription of this unique conference is published in its entirety in the April 2002 issue of Pediatric Radiology (link.springer.de/link/service/journals/00247/). Since many children undergo imaging examinations by non–pediatric radiologist.
Also to mention, the manufacturers sell their CT scanners on the basis of the “best picture,” albeit the highest-quality picture gives the greatest radiation dose. The incentive for industry to change must come from their customer base—the Doctors.
Rationale for formation of the Alliance
As a response to this public health issue, at international level various organizations and agencies have formed a multi-disciplinary group, The Alliance for Radiation Safety in Pediatric Imaging, to increase awareness and educate radiologists and radiology technologists on the need to “child-size” CT scan technique. The Alliance represents more than four lack health care professionals. Such an alliance is not only needed at national level but at the level of state and medical colleges also particularly in developing countries. Through a combined effort of all imaging healthcare workers from member organizations, educational and awareness campaign has the potential to improve patient care and safety by encouraging thoughtful CT practice tailored to children in the healthcare setting.
What Society can do for Radiologists?
Radiologists are passionate about care of their patients. Society members view themselves as advocates for children in imaging in all facets. Specific steps that can have a significant local impact include:
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Making a commitment to give a talk on radiation protection at pediatric grand rounds or for a regional interdisciplinary meeting as part of the campaign.
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Offering to give this talk to radiology residents. Many are used to the “adult way,” where CT radiation dose is considered less frequently.
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Displaying the poster in all clinics and emergency room that reminds Doctors to order the CT protocols only where required and look for other modalities if have choice.
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Discussing exam appropriateness with pediatricians and staying committed to individualized CT scan protocols. The risk to benefit ratio for performance of a CT exam must be considered. Repeat CT scanning in a brief time period might not be indicated and radiologists play a crucial role as radiologist-consultant.
Alternate imaging modalities might be discussed. Discussion of specific patients when appropriate provides an opportunity for educational interaction with the pediatrician, who has unique medical knowledge crucial to the care of the patient.
As noted by the National Council on Radiation Protection and Measurements, “any decision by a medical provider to expose a patient to ionizing radiation shall be justified”. This means that the expected benefits to the patient must exceed the overall risk.
The goal of all presentations and meetings should be a positive message, with new insights for referring physicians and increased understanding of the role that CT plays in the care of patients from the pediatrician’s, emergency room doctors and surgeon’s points of view. There is much to be learned from this dialogue. Our rewards for this effort will be to ensure safer use of our technology and better care of our most valuable asset—our children!
A. CT helps us save kids' lives!
B. But, when you image, radiation matters!
- Children are more sensitive to radiation
- What we do now lasts for their lifetime
C. So, when you image, image gently
- More is usually not better
- When CT is the right thing to do:
- Child-size the kV and mA
- One scan (single phase) is usually enough
- Scan only the indicated area
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Primary message of the “Image Gently” campaign
