Tracking plus feedback plus training add up to halved rad doses in kids

Layering brief radiologist training sessions atop feedback-enabled dose tracking, researchers at Children’s Hospital of Pittsburgh have shown that it’s possible to cut radiation exposure to pediatric patients almost in half.

Anish Ghodadra, MD, and Stefano Bartoletti, MD, collected data from 1,479 cases across three fluoroscopy procedures as read by nine radiologists.

Of the 1,479 cases, 530 procedures were performed after a 1-hour training session on radiation dose reduction methods. The other 945 were performed prior to the session.

For all three exam types performed in a six-month period—upper GIs, voiding cystourethrograms and barium enemas—the authors recorded a statistically significant decrease in the median normalized dose area product (DAP) between the pre- and post-training groups.

Moreover, the results showed a decrease in not only the median radiation dose but also in variability of dose between studies.

The median for pre-training and post-training normalized DAPs (μGy·m2 per minute) were 14.36 and 6.67 for the upper GIs; 13.00 and 7.16 for the voiding cystourethrograms; and 33.14 and 17.55 for the barium enemas.

In their discussion section, Ghodadra and Bartoletti posit that the excellent results owe to two main factors.

First, providing targeted training ensures that all radiologists are current with dose reduction techniques.

“Differences in equipment from site to site, or even among procedure suites, can cause difficulty in consistently implementing the various radiation dose reduction techniques,” they write. “For this reason, training should additionally focus on how to implement dose reduction techniques on all available fluoroscopy units.”

Second, recording and reporting of fluoroscopy procedure dose information provides increased awareness and continuous feedback to radiologists.

Although every radiologist is trained in the ALARA (as low as reasonably achievable) principles, “implementation during a busy clinical workday can be difficult, especially when dealing with complex disease and critically ill patients,” they write. “Thus, a routine dose reduction strategy should be devised prior to beginning a case; it could include ensuring that the grid is out, acquisition is set to pulsed and magnification is minimized.”

The study posted online Oct. 17 in JACR.