“Image Gently” Pediatric Campaign Underway Educates Providers of Pediatric Imaging on the Need to “Child-Size” Radiation Dose

“Image Gently” Pediatric Campaign Underway Educates Providers of Pediatric Imaging on the Need to “Child-Size” Radiation Dose

On Jan. 22, 2008, the charter members of the Alliance for Radiation Safety in Pediatric Imaging — the Society for Pediatric Radiology, the American College of Radiology, the American Society of Radiologic Technologists and the American Association of Physicists in Medicine — launched the highly anticipated Image Gently campaign, a national initiative that will educate providers of pediatric imaging care about the importance of “child-sizing” radiation doses.

The campaign’s central message is that children may be more sensitive to radiation received from medical imaging scans than adults, and that cumulative radiation exposure to their smaller bodies could, over time, have adverse effects. Therefore, radiologists who perform imaging exams on children are urged to:

• ”Child-size” the scan: this often reduces the amount of radiation used
• Not overscan:
• Scan only when necessary
• Scan only the indicated region
• Scan once; multi-phase scanning (pre- and post-contrast, delayed exams) is rarely helpful
• Be a team player:
• Involve medical physicists to monitor pediatric CT techniques
• Involve technologists to optimize scanning

During the campaign’s rollout phase, the message will focus on computed tomography (CT) scans. In 2006, U.S. physicians performed approximately 4 million pediatric CT scans — triple the number from five years ago. CT is a powerful modality that continues to replace more invasive and costlier non-CT techniques, but as technology evolves, the Image Gently campaign will help to ensure that medical protocols for pediatric imaging are keeping pace.

“CT is a great imaging modality that has revolutionized medical practice and saved countless lives, but it’s also among the higher dose examinations we perform,” said Donald P. Frush, M.D., chair of the ACR Pediatric Radiology Commission. “We want to ensure that children are imaged using kid-sized, not adult-sized, radiation doses.”

“A national campaign is important, “ said Marilyn Goske, M.D., chair of the Alliance for Safety in Pediatric Imaging and chair of the Board of Directors of the Society for Pediatric Radiology. “Medicine evolves; as we increase our knowledge, we have to change our practice.”

Radiologic technologist Allen Croat, R.T. (R)(CT), chair of ASRT’s CT Chapter, said the campaign’s message is needed. “Technologists are the ones who are actually imaging these children, so we welcome the campaign’s emphasis on the ALARA format: As Low as Reasonably Achievable. We have to be protocoling our patients with our radiologists and imaging only what is necessary for the diagnosis.”

The campaign’s “radiation matters” theme drives home two fundamental concepts. One, more imaging is usually not better, and two, the effects of pediatric imaging last a lifetime. Correct dosage is key, Frush said. “Just as the appropriate dose of an antibiotic given to a child differs from the dose given to an adult, a small child needs a much smaller radiation dose than an adult.”

The focus on children makes sense. “The relative risk to a young pediatric patient is higher compared to a 70-year-old adult because the child typically has a much longer lifespan after being imaged,” said James M. Hevezi, Ph.D., medical physicist and chair of the ACR Commission on Medical Physics. An overdose by medicine may produce obvious, immediate symptoms, but radiation is an invisible medium whose effects from overdose might not be seen for years.

Frush sees radiologists as having a special duty to young patients. “They entrust their care to their parents and to us as health care providers. We need to guard their welfare. We don’t know what’s going to happen, but at age 40 or 50 they may need a dozen or more CT scans. If they were scanned five scans as a kid, that’s a cumulative dose that doesn’t go away.”

The Image Gently campaign will target three audiences, Goske said. The first are radiologists, medical physicists and technologists who primarily work in adult hospitals or imaging centers and who image children as a very small part of their patient volume. Second, it will target referring ER physicians, pediatricians, pediatric orthopedists and other physicians. Last, and once the medical core is educated, the campaign will reach out to parents.
Radiation exposure is a serious matter, but Frush and Goske counsel perspective. All medical procedures entail some degree of risk, they said. Studies have repeatedly shown CT to be highly accurate and have a positive impact on patient care.

Imaging stakeholders can visit the Image Gently Alliance Web site (www.imagegently.org) for the latest research and educational materials including information on optimizing CT protocols in pediatric patients. The campaign has been funded in part by an unrestricted educational grant from GE Healthcare.