Alliance for Radiation Safety To Standardize Measurement and Reporting of Pediatric Dose from CT Scans

Representatives from leading medical imaging equipment manufacturers met in September 2008 with radiologist, medical physicist, and radiologic technologist representatives from the Alliance for Radiation Safety in Pediatric Imaging and agreed to work with the Alliance to create standardized radiation dose estimates and vendor-sponsored technologist education opportunities.

"This is an example of how all stakeholders in the medical imaging community can and must work together for the good of our pediatric patients and our profession. This summit and our subsequent agreement to work together, represents a major step forward in ensuring that medical protocols keep pace with rapidly advancing technology and are properly displayed on our CT [computed tomography] equipment,” said Marilyn Goske, M.D., chair of the Alliance for Radiation Safety in Pediatric Imaging (Reston, VA, USA), and Silverman Chair for Radiology Education, Cincinnati Children's Hospital Medical Center (OH, USA).

The August 20, 2008 event was sponsored by the Alliance for Radiation Safety in Pediatric Imaging, a coalition of 29 organizations dedicated to reducing radiation dose estimates that children receive from medical imaging examinations. The Alliance launched its Image Gently campaign in January 2008 to raise awareness of opportunities to reduce radiation dose estimates used in pediatric imaging.

"This agreement is a fundamental change in responsibility and accountability for the dose estimates that our children--and actually adults, too--receive during CT examinations,” said Donald Frush, M.D., chair of the American College of Radiology Pediatric Imaging Commission.

Currently, dose capture and reporting systems can vary depending on the manufacturer, making comparisons difficult. Moreover, dose estimates for CT scans can underestimate the radiation dose utilized in pediatric imaging because these estimates are often developed using adult phantoms.

"Children are three to five times more sensitive to radiation than adults, yet dose estimates are made using adult-sized phantoms,” said Keith Strauss, M.Sc., of the American Association of Physicists in Medicine and director of Radiology Physics and Engineering at Children's Hospital Boston (MA, USA). "Models need to be developed specifically for estimating dose to children undergoing CT exams utilizing phantoms that more appropriately take into consideration the size, shape, and composition of children's anatomies.”

Presenters at the meeting included representatives from Alliance organizations as well as from the U.S. Food and Drug Administration and MITA (Medical Imaging & Technology Alliance). Medical imaging vendors represented at the meeting were GE Healthcare (Chalfont St. Giles, UK), Philips Healthcare (Best, The Netherlands), Siemens Medical Systems (Erlangen, Germany), and Toshiba America Medical Systems (Tokyo, Japan).

Meeting participants produced a list of recommendations for application specialists who train technologists to use CT equipment: (1) Encourage application specialists to teach the key messages of the Image Gently campaign. (2) Provide training for all technologists, not just managers. (3) Provide online materials for technologists who cannot attend in-person training. (4) Develop uniform language to discuss technologic concepts. (5) Provide listservs or discussion boards for additional help. (6) Leave behind information about strategies to reduce dose for children. (7) Involve medical physicists with applications trainers to help with dose reduction techniques. (8) Share information about the Image Gently campaign with those whom they train

Greg Morrison, M.S., R.T.(R), CNMT, executive vice president and chief knowledge officer of the American Society of Radiologic Technologists, noted that of approximately 50,000 radiologic technologists who perform CT scans, only about 23,000 are certified in CT. "We need to give CT technologists additional training so technologists understand the implication of any changes they make to the scan protocols and how it impacts radiation dose for children” said Mr. Morrison. "For example, we want technologists to know that the lowest radiation dose is when the patient is perfectly centered within the gantry. These are things we could teach and implement very quickly.”

The Alliance for Radiation Safety in Pediatric Imaging is comprised of 29 organizations working together to reduce unnecessary radiation exposure from imaging examinations in children. It represents more than 500,000 health care professionals. Through its Image Gently campaign, the Alliance is raising awareness about the need to "child-size” radiation exposure. The Image Gently website provides recommendations, protocol guidance, and a worksheet for reducing radiation dose during pediatric CT scans. When properly implemented, these guidelines will significantly reduce the risk of harm to pediatric patients.

Related Links:
Alliance for Radiation Safety in Pediatric Imaging
Image Gently