Pediatric Radiologists Thrust
                          Radiation Safety i...
more than 1,300 individuals have taken                                                                         Supporters ...
F.R.C.P.C., F.R.C.R., program coordina-     more people with subspecialties, and        is a pilot, but ultimately the res...
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Pediatric Radiation Safety


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RSNA News article about radiologists\' initiative to make medical imaging safer for children.

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Pediatric Radiation Safety

  1. 1. FEATURE HOT TOPIC Pediatric Radiologists Thrust Radiation Safety into Spotlight Photo by Jessica Tampas W HILE radiologists have long ogy. GE Healthcare been vigilant about radiation liked the idea, he said, dose, recent outreach by the and obtained permis- pediatric radiology subspecialty has sion from Broselow- inspired the strongest directives yet for Luten to use the same professional organizations and industry. color zones in their CT Adult patients generally trust that scanners. the benefits of CT scanning outweigh “The technologists the risks of their own radiation expo- really like the built-in sure, but parents tend to ask more protocols,” said Dr. questions about the increased risk to Frush. “There’s no their children, said Robert K. Zeman, magic here, really— M.D., professor and chair of radiol- just a way to build pro- Donald P. Frush, M.D. Robert K. Zeman, M.D. ogy and radiation oncology at George tocols directly into the Duke University Medical Center George Washington University Washington University Medical Center scanners so the appro- Medical Center in Washington. priate amount of radiation is given to Manufacturers Follow Suit “Many of us who practice adult kids of varying sizes.” Manufacturers are becoming acutely radiology had concerns about dose,” The idea that CT is a wonderful mindful of radiologists’ demand for Dr. Zeman said. “But it is our pediatric modality for specific problems—and conscientious imaging, said Drs. Goske radiology colleagues that have really if the exam is necessary, do it with and Frush. “All the major vendors now mobilized industry and our professional the lowest radiation dose possible—is include radiation dose safety issues in organizations to take action.” on the mind of all radiologists, said Marilyn Goske, M.D., Silverman Chair their marketing platforms,” said Dr. Pediatrics Well Positioned as Leader Frush. “Focus is turning to creating for Radiology Education at Cincinnati more efficient detector technology to Pediatric radiologists have naturally Children’s Hospital Medical Center increase image quality.” emerged as some of the key figures in and past chair of the board of trustees Added Dr. Goske, “Radiation dose radiation dose management, as many for the Society for Pediatric Radiol- has caught the attention of manufactur- are old hands at techniques to reduce ogy (SPR). As SPR past-president, Dr. ers not only because it’s the right thing their young patients’ Goske helped establish There’s no single dose in Image Gently, along with to do, but also because it sets them exposure. Donald P. any examination that’s Dr. Frush and a steer- apart from their competitors.” Frush, M.D., and his In addition to manufacturers, Dr. colleagues at Duke going to be appropriate ing committee from the Frush said that in recent years he has University Medical American Society of for all individuals. Radiologic Technologists, been pleased to see colleagues taking Center now use scan- an active interest in dose reduction. “I ners that incorporate the The best we can do is American Association of see that when we get studies from other Broselow-Luten pediat- Physicists in Medicine establish maximum and American College of institutions now, they’re tending to use ric color-coded system, and minimum dose.” Radiology. The pediatrics- much lower doses than they did seven which assigns one of or eight years ago,” he said. “Before nine dosage zones based focused campaign is Donald P. Frush, M.D. that, kids were scanned at the same set- on the height and weight gaining attention with tings as adults.” of the child. a simple message, said Dr. Goske: Since launching the Image Gently “They’re the same zones used for “When CT is the right thing to do, campaign, the Alliance for Radiation medications, fluids and equipment like child size the kVP and mA. One scan (single phase) is often enough, and scan Safety in Pediatric Imaging has assem- endotracheal tubes,” said Dr. Frush, bled 23 member organizations and chief of the division of pediatric radiol- only the indicated area.” 8 RSNA NEWS AUGUST 2008
  2. 2. more than 1,300 individuals have taken Supporters of the pediatrics-focused Image the Image Gently Pledge. “The organi- Gently campaign are zations represent about half a million promoting a simple mes- radiology professionals,” Dr. Goske sage: When CT is the right said. “We have now gone international, thing to do, child size the with member organizations not only in peak kilovoltage (kVP) and milliamperes (mA). the U.S. but beyond our borders.” (For Remember that one scan more information about the Image Gen- (single phase) is often tly campaign, see Dr. Goske’s My Turn enough and scan only column on Page 4.) the indicated area. More ACR facility accreditation and other information about Image Gently is available at www. similar programs provide an incentive imagegently.org. for dose reduction, and industry and regulatory agencies are also taking note, said Dr. Frush. He added that the U.S. Food and Drug Administration (FDA) and the National Imagery and Mapping eral Hospital and chair of the American solely around reducing mAs. Agency (NIMA) are calling for more College of Radiology (ACR) board of “Radiology practices should closely consistent dose estimates, recording and trustees, “How low one can go is partly look at their CT protocols and consider archiving estimates. “The Alliance’s up to the person who must interpret using automatic dose reduction on all Vendor Summit will try to come to the images. We will not have uniform exams, more aggressively on exams terms with how to do this,” he said. agreement.” that are unlikely to harbor subtle low contrast lesions,” Dr. Zeman continued. Vendor Summit Seen as Pivotal Individuals Must Seize Dose Reduction “A weight-based patient dose nomo- Opportunities The Image Gently Vendor Summit, gram is another effective tool for limit- scheduled for Aug. 20 at Cincinnati Ultimately the radiologist must decide ing dose. Practices should not automati- Children’s Hospital, will include repre- in his or her own practice what consti- cally use the thinnest sections allowed sentatives of major CT manufacturers, tutes a diagnostic quality exam, said on a particular scanner, but rather use Image Gently organizations, the FDA Dr. Zeman. “There is, however, consid- slightly thicker sections which will and the Medical Imaging and Technol- erable ‘low hanging fruit,’ in terms of decrease image noise and allow for ogy Alliance, a division of the National opportunities to reduce dose,” he said. lower doses. Using pitches of greater Electrical Manufacturers Association. “Those opportunities do not revolve Continued on Page 11 The goal of the summit is to encourage Learn More manufacturers to develop products with For more information about the Image Gently campaign and the Aug. 20 vendor summit, ■ radiation dose in mind and also incor- contact Jennifer Boylan, executive director of the Society for Pediatric Radiology, at jboy- porate the campaign’s message into lan@acr.org. their training programs and installation ■ Resources are available online for radiologists seeking radiation dose guidelines: procedures. • American College of Radiology—the White Paper on Radiation Dose in Medicine is avail- able at www.acr.org. Click Radiation Safety under Hot Topics. Radiologists warn, however, against • Image Gently Campaign—imagegently.org offers downloadable tools including a pediatric expecting uniform standards for all CT protocol guide and worksheet. dosage protocols—neither the equip- • RadiologyInfo.org—the RSNA-ACR public information Web site provides simple, patient- ment nor the operating guidelines will oriented language about radiation safety. give radiologists a magic number. “There’s not going to be a single way ❚ that all the scanners work—it’s just not Radiation Dose at RSNA 2008 the nature of entrepreneurship,” said “Contemporary Topics—Radiation Safety in CT” is the focus of the Dr. Frush. “And there’s no single dose Friday Imaging Symposium to be held during RSNA 2008. Moder- in any examination that’s going to be ated by Lane F. Donnelly, M.D., this session will present epidemiologic appropriate for all individuals. The best evidence related to cancer risk and radiation dose. Also discussed will we can do is establish maximum and be current and future clinical and educational tools that can be used to minimum dose.” minimize radiation dose from CT in children. Register for RSNA 2008 Added James H. Thrall, M.D., radi- at RSNA2008.RSNA.org. ologist-in-chief at Massachusetts Gen- 9 RSNANEWS.ORG RSNA NEWS
  3. 3. F.R.C.P.C., F.R.C.R., program coordina- more people with subspecialties, and is a pilot, but ultimately the residents tor Timona Obura, M.B.Ch.B., M.Med., for that reason we hoped this program felt that this program was very benefi- and a few other radiology faculty mem- would supplement their onsite learning cial,” he said. bers, uploaded the cases to a Web site by expanding their exposure to more While RSNA has over the years from which the residents could down- cases and more subspecialty radiology,” supported a lot of international educa- load the cases to their computers. said Dr. Brant. tion, he said, the e-mentoring program After three initial weekly sessions, Joyce Sande, M.D., one of residents creates a “real-time” opportunity for Dr. Brant talked to the residents live involved in the e-learning project, said supplementing education in developing online once a month for two hours, exposure to a “spectrum of pathology” countries, said Dr. Brant. using a commercial program that was one of the main reasons the pro- “A lot of faculty can participate and allowed him to share his desktop with gram was a success. “While we do see assist programs in developing countries the students. “We were able to discuss a lot of normal exams, which is still at a much lower cost,” he said. “We can the cases live and the delay was less of use, the experience we got from the therefore have a continuing relationship than a second, so that was not bad,” sessions built our confidence in terms that can really develop over the years.” said Dr. Brant. of conditions that we may face in the S.M. Faisal Mosharraf, M.B.B.S., While many government hospitals future,” Dr. Sande said. who supervised the e-mentoring ses- in Africa are very poor and lacking sions and facilitated discussion on the Program Prompts Discussion Among equipment, Dr. Brant noted that Aga Aga Khan end, praised the project as Residents Khan is fairly well-funded. “It has novel and innovative but said there is been there for a long time and in the Residents said the program benefited room from improvement. Residents past five years they have decided to them in other ways as well. “The way learned from the sessions, he said, make post-graduate education one of in which it was run encouraged us to however more must be done to encour- the functions of the hospital, with the discuss various cases together,” said age them to apply their new knowledge hopes that it leads to a medical school,” Dr. Sande. “In doing this, we were able to their day-to-day work. he said. “I think this hospital will be a to enhance each others’ strengths and “I think we have to further think good training ground for more radiolo- minimize weaknesses. This is espe- and bring some innovative ideas to gists to work in Kenya.” cially so because during the discussions make the project a complete success,” Dr. Brant added that Aga Khan has different points were raised by different said Dr. Mosharraf. most of the same equipment as he has residents such that at the end of a dis- Dr. Sande said she would recom- available at the University of Virginia, cussion, we all had made fullest use of mend the program to other residents. something very important to the pro- each case.” “It has helped in my studies by giv- gram. “They had top notch ultrasound, Dr. Brant, who traveled to see ing me guidelines on how to approach state-of-the-art MR and a multislice CT the residents in person again in mid- self-directed learning, and the time scanner,” said Dr. Brant. “Their big- June, said he believes that “everyone taken to explain the cases has give us gest deficiency was plain radiography, involved considers this program a great a strong foundation because it will be believe it or not.” venture,” but notes there initially might difficult to forget what was learned,” The University of Virginia’s radiol- have been some hesitation on the part she said. “When you understand why ogy department currently has three to of the Aga Khan residents. certain pathology occurs and why four times as many clinical faculty and “I think at first they thought they it appears as it does, the memory is ■ residents as Aga Khan. “We have many may be guinea pigs of a sort, since this grounded deeper.” Pediatric Radiologists Thrust Radiation Safety into Spotlight through the cast to see the hip is with a tly will be reaching out to parents,” Dr. Continued from Page 9 than one is a great way to reduce dose CT scan,” said Dr. Goske. “However, Goske continued. “But we must first while reducing scan times.” we only need to see gross anatomy, so remind radiologists, radiology technol- One of the simplest ways to cut we can bring the dose way down and ogists and physicists, and then referring dose, Drs. Zeman and Goske point out, do a very short spiral, maybe 3 centime- physicians.” remains the same—scanning only the ters. The referring doctor may order a Added Dr. Zeman, “We are not necessary area. “For example, if you scan of the pelvis, but we don’t need the currently positioned to be the gatekeep- have a child who has chronic hip dislo- whole pelvis. We just need a couple of ers of the entire referral process, but cation, has had surgery to reduce the hip centimeters through the hip joint. we can be the gatekeepers of patient ■ and is in a cast, the only way to look “The third phase of the Image Gen- dose.” 11 RSNANEWS.ORG RSNA NEWS