A Gentler Approach Initiative Aims to Educate Providers to ‘Child-size’ Radiation Dose in Pediatric Imaging

As medical imaging exams have replaced more invasive procedures, benefiting patients and revolutionizing medicine, Americans’ exposure to medical radiation has increased, raising concerns among imaging providers.

Children in particular are more sensitive to radiation received from imaging scans than adults, and cumulative radiation exposure to their smaller, developing bodies could, over time, have adverse effects. Therefore, an alliance of radiology organizations is encouraging providers who perform imaging exams on children to significantly reduce, or ‘child-size,’ the amount of radiation used.

Specifically, they’re being asked to scan only when necessary, only in a very specific region, and only once per visit, avoiding multi-phase scanning.

In addition, the initiative encourages radiologists to be ‘team players,’ involving not only technologists but medical physicists to monitor pediatric CT techniques.

These are the central messages of the “Image Gently” campaign launched by the Society for Pediatric Radiology (SPR), the American College of Radiology (ACR), the American Society of Radiologic Technologists (ASRT), and the American Association of Physicists in Medicine (AAPM), founding members of the Alliance for Radiation Safety in Pediatric Imaging.

Growth Pattern

“Children are not just ‘smaller adults.’ Their bodies are different and require a different approach to imaging,” said Dr. Marilyn Goske, chair of the Alliance for Radiation Safety in Pediatric Imaging, board chair of the SPR, and Silverman Chair for Radiology Education at Cincinnati Children’s Hospital Medical Center. “Ultimately, we hope to change the way all children are imaged in the U.S., using kid-size, not adult-sized, radiation doses. It’s an ambitious goal, but one that we feel must be achieved.”

The Image Gently campaign will initially focus on computed tomography (CT) scans. There were approximately 4 million pediatric CT scans performed in 2006. In fact, the number of pediatric CT scans performed in the U.S. has tripled in the last five years as rapidly evolving CT technology replaces more invasive and often more costly techniques. The Image Gently campaign is an effort to help ensure that medical protocols for the imaging of children keep pace with advancing technology.

“As the stewards of nearly 100 years of radiology safety knowledge, radiologists are committed to ensuring that patients receive safe, necessary imaging care,” said Dr. Arl Van Moore Jr., chair of the ACR Board of Chancellors.

The Image Gently campaign is an important opportunity for radiologists to help referring physicians and medical imaging professionals understand which exams may be most appropriate for children and how these exams may be carried out in a safe, effective manner.”

The Image Gently Alliance Web site (www.imagegently.org) contains the latest research and educational materials to aid radiologists, radiologic technologists, medical physicists, and other imaging stakeholders in determining the appropriate radiation techniques to be used in the imaging of children and how the radiation received from these exams may affect pediatric patients over time.

A key feature of the site is a library of helpful protocols that can be used for the imaging of children. Radiologists and other imaging providers are urged to visit the site and publicly pledge to do their part to ‘child-size’ the radiation dose used in children’s imaging.

“Although CT provides outstanding images that are critical to the management of patient care, it is one of the higher-dose examinations performed today,” said Dr. Mary Martel, AAPM president. “For this reason, it is most important that physicians have a firm understanding of the physics and technology of CT to enable them to judiciously select imaging parameters to eliminate unnecessary doses to these children.”

Reaching Out

The four charter organizations of the alliance represent more than 160,000 physicians, radiologic technologists, and medical physicists who serve a primary role in medical imaging.

Nine affiliate organizations have joined the effort to publicize the Image Gently campaign to their members. Through E-mail messages to their affiliate members and articles in professional society publications, the campaign is estimated to reach more than 500,000 medical professionals.

“Radiologic technologists are the final link in the chain of exposure as they perform CT scans,” said Connie Mitchell, ASRT president. “The Image Gently campaign provides a powerful forum to communicate to our members the importance of applying the correct protocol for size and body type of the patient.”

This article is provided by the American College of Radiology. The Image Gently campaign is partially funded by an unrestricted educational grant from General Electric Healthcare.