RSNA: Rads offer techniques to lower dose for pediatric imaging

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CHICAGO--Because infants are 10 times more radiosensitive than adults, radiologists must avidly attempt to reduce the amount of radiation exposure during pediatric imaging procedures, and researchers have found that using a screen capture can reduce dose significantly, according to a presentation this morning at the 96th annual scientific meeting of the Radiological Society of North America (RSNA).

The 128-bed Medical University of South Carolina (MUSC) in Charleston, S.C., performs an estimated 35,000 to 40,000 imaging exams annually and uses a team-based approach to care by integrating a radiological assistant (RA) into their pediatric imaging team and focuses on reducing radiation exposure in their pediatric patient population.

“Children are not just small adults they have entirely different disease processes, the differential diagnosis varies with age with the patients, so a patient’s history is very important, offered Jeanne G. Hill, MD, associate professor of radiology and pediatrics and director of pediatric radiology at MUSC.

To facilitate better care in the pediatric department, the addition of an RA to a pediatric imaging team helps to streamline patient imaging by minimizing a radiologists time commitment and consult with clinicians to ensure that the appropriate imaging tests are being performed on the proper patients, said Cephus E. Simmons, Sr., RRA, instructor in the department of radiology and an RA at MUSC.

Because the effects of radiation are “lifelong and cumulative,” Hill said. “Children are at the greatest risk.” The lifetime risk of radiation in the first 10 years of life is much higher than in adulthood.

Also, because radiologists and RA’s have the ability to control the amount of radiation dose emitted during fluoroscopy procedures, utilizing a screen capture can help to significantly reduce the risk of radiation dose, said Simmons.

“You can think of radiation as medicine,” said Hill. “When indicated, it can diagnose an illness and be clinically valuable, but if it’s not clinically indicated, you really shouldn’t be doing it.”

She said that overexposure can cause many complications including radiation burn and also produce a severe reaction, such as the development of cancer. “Therefore, no dose of radiation can be considered safe,” Hill said.

Hill alsoo suggested that when working with the pediatric population, care givers must “image gently” to ensure that you are utilizing the smallest amount of radiation possible.

Hill and Simmons offered the following techniques to lower dose:

  • Decreasing pulse rate: When treating the pediatric population it is often difficult to keep patient still. Simmons offered that you need to capture the image efficiently and quickly, adding that “fluoroscopy can get a nice picture right away if you use a screen capture."
  • Increasing collimation: Make sure that when you do collimate you only collimate only to what you are looking for, said Simmons.
  • Minimize magnification: Use the lowest possible magnification necessary, while still being able to evaluate and diagnose patient problems.
  • Utilize screen capture: Taking a picture versus an image can decrease dose significantly and almost entirely.
  • Minimize fluoroscopy time: A continuous fluoroscopy does not need to be performed. Simmons said that you should attempt to eliminate and reduce the amount of lead when performing imaging exams.

Hill concluded that if a test is not clinically indicated, you should aim to suggest a different technique to imaging and care and always be attempting to minimize radiation risk.