Developments in Pediatric Imaging: Best Practices in Dose, Comfort, and Safety

By Russell L. Cain, CRA, FAHRA

Gregg Cretella, Steven Don, MD, and Robert MacDougall, M.Sc certainly met their objectives in this morning’s Exhibitor Symposium. They began with a review of where we are with Image Gently®, and captured everyone’s full attention with the note that despite all the efforts of practitioners and vendors, the mean accumulated dose has doubled in pediatrics since the advent of direct digital x-ray, which constitutes the majority of imaging in pediatrics.

I thought “dose creep” was a thing of the past, but Dr. Don explained that this was not so. The challenge of understanding over and under exposure and the resistance of radiologists to interpret noisy images have led to increased repeat rates, increasing exposure, and a tendency to push the dose higher to eliminate noise. All of this has contributed to the upward trend of accumulated dose.

The presenters offered some solutions, supporting the argument for “back to basics” in reducing exposure during radiography. The concepts included using the tools most radiographers learned in school, even in the days of film and wet processing: collimating, shielding, knowledge, don’t use grids unless the body thickness is greater than 12 cm, etc. Technique now means EI (exposure index), DI (deviation index) and Target Exposure. These terms were explained fully and in understandable fashion. Technologists and radiologists should understand these terms and be on the same page with their utilization to reduce exposure and obtain quality images.

I gained further insights from the presenters’ discussion of ALARA, AAPM TG 252, and FDA requirements pertaining to the vendors’ responsibility. They ended with additional discussion that “age doesn’t equal thickness,” which means use calipers. There is also research in target EI (IRAK) for use of virtual tools to obtain measurement during positioning of the patient.

Russell L. Cain, CRA, FAHRA is the director of imaging services at Atlanta Medical Center in Atlanta, GA. He can be reached at azurscuba@aol.com.