SPR: The state of Image Gently in the U.S.

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BOSTON--While the Image Gently campaign had some positive impact on reducing radiation dose for children, there are still residual problems that persist in U.S. pediatric imaging-- including who is performing the imaging--which were discussed during a panel on international perspectives of radiation protection for children at the SPR conference in Boston on Thursday.

Image Gently, an education, awareness and advocacy campaign to improve radiation protection for children, was established by the Society of Pediatric Radiology (SPR) to work quickly and aggressively with other organizations to ensure safe imaging to children, explained Marilyn J. Goske, MD, of Cincinnati Children’s Hospital Medical Center, who moderated the panel.

During the panel discussion, Donald Frush, MD, of Duke Medical Center in Durham, N.C., offered the U.S. perspective on pediatric imaging. Citing a current problem in the U.S. healthcare system, Frush explained that there are a number of individuals who conduct imaging exams aside from radiologists, including physician assistants, cardiologists, obstetricians and neurologists. 

“Almost anybody can do imaging. The complexion of who will be doing imaging will continue to change over the next few years, including CT exams,” said Frush, noting the newer, portable equipment that is facilitating the influx of imaging exams.

Speaking to the reasons that drive imaging, Frush said that marketing comes into play. “The idea is we need to have the best, the fastest and the newest CT scanner.” Frush also noted that uninformed imagers and non-radiologists can also overuse imaging studies, noting a widespread perspective of imaging exams being “the easiest thing to do. Why do an exam when a CT exam will show it?” he asked. “The use by non-imagers of CT exams drive what we do."

However, there are also elements that are currently driving physicians and patients away from imaging, with the media being a large player, said Frush. “There are a number of articles that have come out and as a result, many patients come in with preset ideas of what they want.”

Frush said that since 2001 radiation exposure has been a large concern. He  noted that 50 percent of all radiation exposure to the U.S. population is currently due to medical imagining, with half of this percentage coming from CT exams alone. “That’s pretty substantial,” stated Frush, noting that  the FDA regulates imaging equipment, but not radiation and exam techniques.

And Frush explained that “pediatrics in general has a pattern of following adult medicine,” noting that practices in areas such as cardiology and the emergency room “tend to trickle down to pediatrics.”

Despite the high amount of radiation, Frush explained that while “it is still front page news, attention by other physicians is growing and they are starting to take note.” He said that based on the establishment of the Image Gently campaign, “The practice of radiology has changed. Attention is being paid to this issue, and that is the justification of radiation protection, but we can only do so much.”

Closing on a positive note, Frush noted that imaging exams for children have seen a 3-7 percent annual decrease over the past couple of years, as opposed to the typical CT growth rate of 10 percent yearly in adult medicine. He noted that there is a debate among physicians of whether or not this fact is positive.

“This is the way it should be, and I think this is a good thing. We, as ambassadors for our patients, as well as efforts like [Image Gently] need to continue to go out and drive home the point that we have to do what’s right from the standpoint of safety,” Frush said.