Imaging of children why they are different

omatalabi@gmail.com
2019
PAN AFRICAN CONGRESS OF
RADIOLOGY AND IMAGING
(PACORI)
ACCRA GHANA

DR OMOLOLA MOJISOLA
ATALABI FWACS, FMCR, MBA
PROFESSOR/ CONSULTANT RADIOLOGIST
DEPARTMENT OF RADIOLOGY,
COLLEGE OF MEDICINE UI/ UCH,
IBADAN
19/02/2019omatalabi@gmail.com

IMAGING OF CHILDREN: WHY THEY ARE
DIFFERENT
19/02/2019
omatalabi@gmail.com

DISCLOSURE: IAEA PART-
SPONSORSHIP

Proud and distinguished Roentgen. His discovery would later earn him the first Nobel prize in Physics.
This research was the - the fastest translational research
• Since his discovery, the use of
ionising radiation has
revolutionised medical treatment
• Dec. 1895 Roentgen submits
published in 3 days
• Jan 9, 1896 Vienna Press
• Jan 23, 1896 presented data
• By mid 1896, in practice including
fluoroscopy
Wilhelm C. Roentgen 1845-1923
19/02/2019 omatalabi@gmail.com

CHILDREN WERE THE FIRST CULPRITS…..
The first ever child that was x-
rayed had a 14-minute
exposure (with great sedation)
and was published in the
Archives of Skiagraphy in 1896

• IMAGING TESTS THAT USE RADIATION CAN ALSO BE PERCEIVED
AS A FORM OF MEDICATION
• TOO LITTLE RADIATION MAY GIVE POOR OR NON-DIAGNOSTIC
IMAGES
• WHILE TOO MUCH CAN HAVE CARCINOGENIC EFFECTS OR
RESULT IN CARCINOGENESIS
Diagnostic tests and therapeutic
medications are generally safe.

SOURCES OF RADIATION
• NATURAL
• MAN MADE (BY FAR, THE MOST SIGNIFICANT MAN-MADE SOURCE)
• DIAGNOSTIC X-RAYS
• NUCLEAR MEDICINE PROCEDURES (IODINE-131, CESIUM-137, AND OTHERS)

ELECTROMAGNETIC SPECTRUM
Because x rays has a
shorter wave length
and consequently a
larger photon
energy, they can
break chemical
bonds and cause
biological effects

ALICE STEWARTS OBITUARY IN NY TIMES 2002
New York Times 2002

AS WRITTEN IN THE ANNOUNCEMENT OF HER
OBITUARY BY CARMEL MCCOUBREY, IN THE NEW
YORK TIMES OF JULY 4, 2002
‘IT WAS AN INCREASINGLY COMMON PRACTICE IN THE 1950'S TO X-RAY THE
ABDOMENS OF PREGNANT WOMEN TO DETERMINE THE POSITION OF THEIR
BABIES, SAID DR. GAYLE GREENE OF SCRIPPS COLLEGE IN CLAREMONT, CALIF.,
WHO WROTE ''THE WOMAN WHO KNEW TOO MUCH: ALICE STEWART AND THE
SECRETS OF RADIATION.''
DR. STEWART, THEN A MEMBER OF THE SOCIAL MEDICINE DEPARTMENT AT
OXFORD, WAS SURPRISED TO DISCOVER WHEN SHE CONDUCTED A SURVEY THAT
CHILDREN OF MOTHERS WHO HAD HAD THIS X-RAY WERE ALMOST TWICE AS
LIKELY TO HAVE CANCER AS OTHER CHILDREN’.

WHAT CAN IONIZING RADIATION DO?
GENERAL EFFECTS
• CANCER
• GENETIC EFFECTS
• SKIN INJURIES
• CATARACTS
• INFERTILITY
• DEATH
• OTHER: SUCH AS CARDIOVASCULAR EFFECTS

SO HOW DOES RADIATION EFFECTS HUMAN
CELLS?
AN X-RAY CAN PASS THROUGH THE BODY OR BE
ABSORBED. ABSORPTION CAUSES RELEASE OF THE
X-RAYS OR PHOTON ENERGY. THE PHOTON
ENERGY EITHER INDIRECTLY (MOST OFTEN) OR
DIRECTLY CAUSES DAMAGE OF THE DNA.
1. THE INDIRECT MECHANISM OCCURS WHEN
THE ENERGY OF THE RECOIL ELECTRON
INTERACTS WITH WATER (H2O) TO
PRODUCE A HYDROXYL RADICAL (OH-),
WHICH THEN DAMAGES THE DNA.
2. THE DIRECT MECHANISM IS WHEN THE
ABSORBED ENERGY DIRECTLY DAMAGES THE
DNA.
Ref: E. Hall. Radiation Biology for Pediatric Radiolog
Ped Rad 2009, 39;S1:57

Consequences of DNA damage I

Consequences of DNA damage II

• THE SEVERITY OF STOCHASTIC EFFECTS
ON THE OTHER HAND IS INDEPENDENT OF
THE ABSORBED DOSE.
• UNDER CERTAIN EXPOSURE CONDITIONS,
THE EFFECTS MAY OR MAY NOT OCCUR.
• THERE IS NO THRESHOLD AND THE
PROBABILITY OF HAVING THE EFFECTS IS
PROPORTIONAL TO THE DOSE ABSORBED.
• CHARACTERISTICS OF STOCHASTIC
EFFECTS:
• SEVERITY IS INDEPENDENT OF ABSORBED
DOSE
• THRESHOLD DOES NOT EXIST
• PROBABILITY OF OCCURRENCE DEPENDS
ON ABSORBED DOSE
• BASED ON ANIMAL EXPERIMENTS IT
WAS DISCOVERED THAT THE
SEVERITY OF CERTAIN EFFECTS OF
RADIATION WILL INCREASE WITH
INCREASING DOSES.
• THERE EXISTS A CERTAIN LEVEL, THE
"THRESHOLD", BELOW WHICH THE
EFFECT WILL BE ABSENT. THIS KIND OF
EFFECT IS CALLED "DETERMINISTIC
EFFECTS". RADIOLOGIST AND OTHER
RADIATION WORKERS ARE THE MOST
AFFECTED. DAMAGE DEPENDS ON
ABSORBED DOSE
• THRESHOLD EXISTS
• EXAMPLE: CATARACT, ERYTHEMA,
Deterministic Effects
Characteristics of
Deterministic effects
Stochastic effects
Characteristics of stochastic eff

A good example of a stochastic effect is noted in shown below, that it is
random whether a cell gets hit by radiation and the effects of DNA damage
might not be seen for many generations. This explains the 20-40-year lag in
expression of radiation-induced cancer.

Radiation dose by Imaging Test

ATALABI, O.M., AKINLADE, B., ADEKANMI, A. J. AND SAMUEL, O
ENTRANCE SURFACE DOSE FROM PAEDIATRIC DIAGNOSTIC X-RAY
EXAMINATIONS IN A DEVELOPING WORLD SETTING: ARE WE ‘ALARA
PRINCIPLE’ COMPLIANT? BRITISH JOURNAL OF MEDICINE AND MEDICAL
RESEARCH VOL. 3. NO. 4: 2288-2298.
• WE LOOKED AT 253 PAEDIATRIC PATIENTS UNDERGOING VARIOUS
X-RAY EXAMINATIONS
• THE HOSPITAL HAS NO DEDICATED PAEDIATRIC X-RAY EQUIPMENT
/ STAFF
• THE STUDY SHOWED THAT PEDIATRIC PATIENTS ARE BEING OVER
EXPOSED TO RADIATION AS THEIR ESD IS WAY HIGHER THAN
INTERNATIONALLY ACCEPTED REFERENCE VALUES.
• X-RAY OPERATORS SOMETIMES USED EXPOSURE PARAMETERS AND
RADIOGRAPHIC TECHNIQUES THAT ARE NOT APPROPRIATE FOR

ESTIMATION OF THE RISK OF CANCER ASSOCIATED WITH
PEDIATRIC CRANIAL COMPUTED TOMOGRAPHY
O. M. ATALABI1, B. I. AKINLADE2* AND A. J. ADEKANMI1
BRITISH JOURNAL OF MEDICINE & MEDICAL RESEARCH
9(10): 1-7, 2015, ARTICLE NO.BJMMR.18079
ISSN: 2231-0614
• THIS STUDY SHOWED A HIGH RISK OF CANCER INCIDENCE AMONG PAEDIATRIC
PATIENTS REFERRED FOR CRANIAL CT EXAMINATION IN OUR HOSPITAL.
• THIS IS MAJORLY DUE TO LACK OF APPROPRIATE EXPOSURE PARAMETERS FOR
DIFFERENT PAEDIATRIC AGE GROUPS ON THE CT SCANNER AND NON-
AVAILABILITY OF TRAINED PAEDIATRIC CT OPERATOR.

DIFFERENT IMPACTS
CHILDREN VS ADULTS
• THERE HAS BEEN MANY RESEARCHES AND PUBLICATIONS ON WHY.
• THESE PUBLICATIONS ALL AGREE THAT RADIATION IS MORE LIKELY TO CAUSE
CANCER IN CHILDREN THAN IN ADULTS ALTHOUGH –
• "DOSES RECEIVED BY CHILDREN AND ADULTS FROM THE SAME SOURCE OF IONIZING
RADIATION CAN HAVE DIFFERING IMPACTS, AND THEREFORE, SHOULD BE
CONSIDERED SEPARATELY IN ORDER TO PREDICT RISK FOLLOWING EXPOSURE MORE
ACCURATELY FOR CHILDREN," WAS THE MAIN THRUST OF THE REPORT "
(PUBLICATION OF VOLUME II OF THE UNSCEAR 2013)
• REPORT: PUBLISHED ON 25 OCT 2013 FROM UN SCIENTIFIC COMMITTEE ON THE
EFFECTS OF ATOMIC RADIATION

It has been proven that
those who acquired
cancer were those
exposed at the younger
ages and that the new
born is 10-15 times
more sensitive to
radiation than older
adults. It also became
obvious that females
developed more cancers

SO WHY ARE CHILDREN MORE SUSCEPTIBLE
TO IONISING RADIATION
1. RADIO-SENSITIVITY
PROBABILITY OF A CELL, TISSUE, OR ORGAN SUFFERING AN EFFECT PER UNIT DOSE
WILL BE GREATER IF THE CELL:
• IS HIGHLY MITOTIC
• CHILDREN’S CELLS DIVIDE RAPIDLY AND ORGANS
• MAY BE LESS DIFFERENTIATED THAN AN ADULT, SO
• THEY ARE MORE RADIOSENSITIVE.
• *IS UNDIFFERENTIATED ( EXCEPTIONS, AS IN STEM CELLS)

SO WHY ARE CHILDREN MORE SUSCEPTIBLE TO
IONISING RADIATION…
• THEIR CELLS ARE ACTIVELY DIVIDING AND UNDERGOING MITOSIS AND ARE
THEREFORE PRONE TO DIRECT AND INDIRECT EFFECTS OF RADIATION

SO WHY ARE CHILDREN MORE SUSCEPTIBLE TO
IONISING RADIATION….
2. LIFE SPAN ( ATOMIC BOMB
SURVIVORS)
• SINCE EFFECTS OF RADIATION TAKE
YEARS TO DEVELOP, THEIR YOUTH
YEARS EXTENDS TO THE TIME FOR
ANY POTENTIAL
EFFECTS FROM IONIZING RADIATION
TO OCCUR. THEY LIVE VERY LONG
ESPECIALLY FOR THE STOCHASTIC
EFFECT TO MANIFEST
• FOR A GIVEN RADIATION DOSE,
INFANTS AND CHILDREN ARE MORE
AT RISK THAN ADULTS OF
DEVELOPING A VARIETY OF

WHY ARE CHILDREN MORE SUSCEPTIBLE TO
IONISING RADIATION….
3. HEREDITARY EFFECTS
• THEY PROCREATE AND THE HEREDITARY EFFECT CAN
MANIFEST IN THEIR OFFSPRING FOR MANY
GENERATIONS.
• THESE EFFECTS HAVE BEEN OBSERVED IN OFFSPRING
BORN AFTER ONE OR BOTH PARENTS HAD BEEN
IRRADIATED PRIOR TO CONCEPTION
• STUDY ON DESCENDANTS OF HIROSHIMA AND
NAGASAKI SURVIVORS:
• A COHORT OF 31,150 CHILDREN BORN TO PARENTS
WHO WERE WITHIN 2 KM OF THE HYPOCENTER AT THE
TIME OF THE BOMBING WAS COMPARED WITH A
CONTROL COHORT OF 41,066 CHILDREN:
• NO INDICATOR WAS SIGNIFICANTLY MODIFIED BY
PARENTAL RADIATION EXPOSURE.
BUT
• IN THE ABSENCE OF HUMAN DATA THE ESTIMATION
OF HEREDITARY EFFECTS IS BASED ON ANIMAL
STUDIES.

DUE TO SENSITIVITY OF CHILDREN TO IONIZING RADIATION, SPECIAL ATTENTION IS REQUIRED WHEN
IMAGING PAEDIATRIC PATIENTS.
THESE OBSERVATIONS OF THE EFFECT OF RADIATION ON PAEDIATRIC PATIENTS THEREFORE CREATED A
LOT OF CONCERN AMONGST PAEDIATRIC RADIOLOGISTS AND SO THAT WE DON’T HAVE MORE OF
THESE:

IMAGE GENTLY ALLIANCE WAS BORN………
• THE IMAGE GENTLY ALLIANCE BEGAN AS A COMMITTEE WITHIN THE SOCIETY FOR
PEDIATRIC RADIOLOGY IN LATE 2006. IN 2007, THE SPR LEADERSHIP REACHED
OUT TO FRIENDS AND COLLEAGUES IN SISTER SOCIETIES REPRESENTING THE KEY
MEMBERS OF THE IMAGING TEAM, ACR, ASRT AND AAPM, TO FORM "THE WRITERS
GROUP." THESE ORGANIZATIONS DEVELOPED THE CONCEPT OF THE ALLIANCE
AND THEIR REPRESENTATIVES DEVELOPED THE CAMPAIGN IN THE SUMMER OF
2007.
• IMAGE GENTLY, THE FIRST IS NOW A WORLD-WIDE NETWORK OF CAMPAIGN
PARTNERS, HAS BECOME A RECOGNIZED PRESENCE AT BOTH NATIONAL AND
INTERNATIONAL VENUES.
• SINCE RADIATION EFFECT IS ALSO SEEN IN ADULTS WE ALSO HAVE IMAGE WISELY

WHAT CAN WE DO…..
• WE MUST TELL PARENTS/ENCOURAGE THEM TO ASK QUESTIONS
• WE MUST EDUCATE OUR COLLEAGUES AND INSIST ON THE ALTERNATIVES….USS
• TRAINING AND RETRAINING OF RADIATION PERSONNEL ON THE IMPORTANCE OF
QUALITY CONTROL AND THAT RADIATION SAFETY SHOULD BE ENSURED ESPECIALLY
IN OUR PEDIATRIC AND ADOLESCENCE PATIENTS
• THERE SHOULD BE CONSTANT AUDITING OF THE PRACTICE OF IMAGING ESPECIALLY
OF THOSE EQUIPMENT USING IONIZING RADIATION BY THE ESTABLISHED
DEPARTMENTAL RADIATION SAFETY COMMITTEE, SO AS TO ENFORCE QUALITY
ASSURANCE (QA).
• EQUIPMENT MANUFACTURERS/ VENDORS / SUPPLIERS SHOULD BE COMPELLED TO
ADEQUATELY TRAIN RADIOGRAPHERS, THE MEDICAL PHYSICIST AND RADIOLOGISTS
ON THE EFFICIENT USE OF THE EQUIPMENT ESPECIALLY TO EMPHASIZE THESE
EQUIPMENT INBUILT FACILITIES USED TO DRASTICALLY REDUCE RADIATION
WITHOUT COMPROMISING IMAGE QUALITY.
• RADIOGRAPHERS SHOULD SUB SPECIALISE IN PEDIATRIC IMAGING
• PACORI SHOULD FORM A PRESSURE GROUP TO ENSURE THAT DEDICATED X RAY
EQUIPMENT/ ROOM IS RESERVED FOR CHILDREN.

Otherwise….

BECAUSE WE WILL NOT BE AROUND TO
WITNESS IT’S

THANKS FOR YOUR ATTENTION

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