Reducing radiation dose for the pint-sized set

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CHICAGO—Several items keep radiology administrators awake at night. Chances are radiation dose appears high on the list. Many radiology departments and imaging centers wrangle with the double-edged sword of multidetector CT. On one hand, CT provides better visualization of the head, neck, abdomen, thorax and skeletal system. Better visualization has fueled a dramatic upswing in CT utilization among both pediatric and adult patients. Increased utilization, in turn, correlates with increased risk of radiation-induced cancer.

According to the Alliance for Radiation Safety in Pediatric Imaging, a child undergoing a single CT of the abdomen and pelvis increases his or her lifetime cancer risk by 1 in 1,000. And the risk is cumulative; each subsequent CT scan increases risk accordingly. “Although the overall chance of a radiation-induced cancer remains fairly small, the population effects are significant especially for younger patients,” said Steven Horii, MD, professor of radiology, clinical medical director informatics group, Hospital of the University of Pennsylvania (Philadelphia). Horii highlighted multiple paths to dose reduction during a Tuesday morning refresher course at the 94th annual meeting of the Radiological Society of North America (RSNA).

Methods for dose reduction include design and education. Hospitals and imaging centers can gain an edge in safety by focusing on both especially in pediatric CT studies. In 2007, the Alliance for Radiation Safety in Pediatric Imaging launched an “image gently” initiative, a series of protocols to reduce dose for children and young adults. Pediatric radiation dose is a concern for all types of facilities as most pediatric scans are not performed at pediatric hospitals, said Lynne Fairobent, legislative and regulatory affairs manager with American Association of Physicists in Medicine. “Facilities can implement a three-pronged strategy to achieve minimal pediatric dose,” explained Horii.

  • Increase awareness among technologists of CT radiation dose
  • Implement decision support for pediatric CT studies
  • Develop low-dose protocols when CT is needed

Physicists, vendors and radiologists are focusing on additional steps to insure minimum pediatric dose, continued Fairobent. These include improved dose displays on CT panels, so technologists are aware of the dose associated with each scan, pre-set protocols to streamline the shift from adult to pediatric protocols (and dose) and a stronger focus on radiation dose awareness in vendor applications training programs.

The “Image Gently” initiative continues to garner support among the radiology community, said Fairobent. The Alliance plans to expand its educational campaign to CR/DR, interventional radiology, nuclear medicine and fluoroscopy in the next two years.