Building understanding of radiography, establishing quality programs and refining procedures are just a few of the suggestions for pediatric radiography providers from the newest initiative of the Image Gently campaign, called “Back to Basics,” detailed in the May issue of the American Journal of Roentgenology.

The initiative was developed by the digital radiography committee of Image Gently, and addresses methods of standardizing the approach to pediatric digital radiography, explained Bruce R. Whiting, PhD, of the University of Pittsburgh, and colleagues. The Image Gently campaign is designed to raise awareness about methods to reduce radiation dose in pediatric medical imaging exams, an effort supported by more than 40 organizations.

“Pediatric digital radiography, although an imaging modality that entails less ionizing radiation than CT, is commonly performed at both adult and pediatric facilities. Increased knowledge of this versatile and efficient technology will give radiologists and radiologic technologists a basis for standardizing an approach to imaging of pediatric patients, thereby reducing the tendency for excess radiation through exposure creep,” wrote the authors.

The 10 steps outlined in the article on “Back to Basics” that practices can take to better manage radiation exposure in pediatric digital radiography are:

• Understand the basics of digital radiography – Radiologists and technologists should understand the strengths and weaknesses of each detector to optimize exposure factors, according to Whiting and colleagues.
• Understand the challenge associated with digital imaging – Image acquisition varies by vendor and equipment type, while different detectors may require different techniques.
• Learn new exposure terminology standards – The International Electrotechnical Commission developed standardized terminology, including important terms such as target exposure index, exposure index and deviation index.
• Establish technique charts using a team approach – Technique charts should be created for common exams, and should be established by a team consisting of radiologists, radiologic technologists and medical physicists with input from the manufacturer, advised the authors.
• Measure body part thickness – Measuring body part thickness with calipers allows technologists to enter the correct exposure parameters for a given patient.
• Use grids only when solid body parts are thicker than 12 centimeters – Since grids double or triple the exposure factors needed to obtain an adequate image, they should be used sparingly in pediatrics.
• Collimate before the exposure – Rather than cropping an image after it has been taken, fields should be collimated to eliminate x-ray exposure to body parts not affecting clinical diagnosis.
• Display technique factors for each image at the interpreting workstation – Adding the tube voltage, current and other exposure indicators on displayed images allows radiologists to become more familiar with technical factors and allows for feedback when images are not acceptable.
• Accept noise level appropriate for the clinical question – While radiologists prefer images with little noise, the authors advised tailoring exposure to specific questions to avoid exposure creep.
• Develop a quality assurance program – Each institution should develop standards to assure diagnostic image quality at an appropriate dose. “It is likely that in the future there will be national standards of diagnostic reference levels to help radiology departments to compare their digital radiographic techniques,” wrote Whiting and colleagues.

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