Pediatric Imaging

Safety appropriateness are the hot topics in both pediatric and general diagnostic imaging today. There are patient safety concerns over the radiation burden delivered to the population from medical imaging. These safety concerns and the rising costs of healthcare have in turn led to an appropriate refocusing on the appropriate choice of imaging studies for both adults and children. This is a good thing to be sure, because in a world where healthcare is becoming more corporate and potentially impersonal, focusing on the appropriate and safe choice of an imaging study for your sick child or family member is a very patient- oriented and personal point of care. Safety and appropriateness have always been core values of pediatric radiologists and it’s nice to see their re-emphasis.

The Alliance for Radiation Safety in Pediatric Imaging (ARSPI) started the Image Gently campaign in 2007 to raise awareness of the opportunities to lower radiation dose in the imaging of children. The number of CT scans done on children brought to a hospital ER had increased five-fold from 1995 to 2008 and nearly 5% of children in the ER received a CT scan in 2008 compared with 1% in 1995. To crudely put radiation dose in perspective, the Adult effective dose of a standard chest X-ray is 10mRem whereas a CT scan of the Abdomen and pelvis imparts an Adult effective dose of 1000 mRem. Simply put, a CT scan of the belly is roughly the equivalent of 100 chest X-rays. The issue is compounded by the fact that children are more sensitive to radiation and have a longer life span to demonstrate its harmful effects, like cancer. The bottom line is nicely summarized in a letter from the ARSPI to parents where they state “We do not know if medical imaging causes cancer. But we should remain cautious and act as if there is a small risk.” On the other hand, I must tell you that CT scans SAVE kid’s lives when used appropriately, especially in the settings of trauma, cancer, and complicated conditions or infections. Therefore, it is wise to adopt the Image Gently philosophy and ask the following questions:

(1) How will having this exam improve my child’s health care?

(2) Are there alternatives that do not use radiation which are equally as good?

(3) Will my child receive a “kid-size”radiation dose? and

(4) Is the imaging facility accredited, i.e. do the doctors and technologists have the appropriate training and is the equipment checked to be sure it functions properly?

The Image Gently campaign is ongoing and recently launched successful campaigns for decreasing radiation dose from fluoroscopic and digital x-ray procedures. Radiation safety concerns have driven research into dose reduction techniques for CT and new applications for radiation-free modalities like MRI and ultrasound. The website offers a great deal of useful information for parents and professionals at www.imagegently.org.