RSNA News article about radiologists\' initiative to make medical imaging safer for children.

1. FEATURE HOT TOPIC
Pediatric Radiologists Thrust
Radiation Safety into Spotlight
Photo by Jessica Tampas
W
HILE radiologists have long ogy. GE Healthcare
been vigilant about radiation liked the idea, he said,
dose, recent outreach by the and obtained permis-
pediatric radiology subspecialty has sion from Broselow-
inspired the strongest directives yet for Luten to use the same
professional organizations and industry. color zones in their CT
Adult patients generally trust that scanners.
the benefits of CT scanning outweigh “The technologists
the risks of their own radiation expo- really like the built-in
sure, but parents tend to ask more protocols,” said Dr.
questions about the increased risk to Frush. “There’s no
their children, said Robert K. Zeman, magic here, really—
M.D., professor and chair of radiol- just a way to build pro-
Donald P. Frush, M.D. Robert K. Zeman, M.D.
ogy and radiation oncology at George tocols directly into the Duke University Medical Center George Washington University
Washington University Medical Center scanners so the appro- Medical Center
in Washington. priate amount of radiation is given to
Manufacturers Follow Suit
“Many of us who practice adult kids of varying sizes.”
Manufacturers are becoming acutely
radiology had concerns about dose,” The idea that CT is a wonderful
mindful of radiologists’ demand for
Dr. Zeman said. “But it is our pediatric modality for specific problems—and
conscientious imaging, said Drs. Goske
radiology colleagues that have really if the exam is necessary, do it with
and Frush. “All the major vendors now
mobilized industry and our professional the lowest radiation dose possible—is
include radiation dose safety issues in
organizations to take action.” on the mind of all radiologists, said
Marilyn Goske, M.D., Silverman Chair their marketing platforms,” said Dr.
Pediatrics Well Positioned as Leader Frush. “Focus is turning to creating
for Radiology Education at Cincinnati
more efficient detector technology to
Pediatric radiologists have naturally Children’s Hospital Medical Center
increase image quality.”
emerged as some of the key figures in and past chair of the board of trustees
Added Dr. Goske, “Radiation dose
radiation dose management, as many for the Society for Pediatric Radiol-
has caught the attention of manufactur-
are old hands at techniques to reduce ogy (SPR). As SPR past-president, Dr.
ers not only because it’s the right thing
their young patients’ Goske helped establish
There’s no single dose in Image Gently, along with to do, but also because it sets them
exposure. Donald P.
any examination that’s Dr. Frush and a steer- apart from their competitors.”
Frush, M.D., and his
In addition to manufacturers, Dr.
colleagues at Duke
going to be appropriate ing committee from the Frush said that in recent years he has
University Medical American Society of
for all individuals. Radiologic Technologists, been pleased to see colleagues taking
Center now use scan-
an active interest in dose reduction. “I
ners that incorporate the The best we can do is American Association of
see that when we get studies from other
Broselow-Luten pediat- Physicists in Medicine
establish maximum and American College of institutions now, they’re tending to use
ric color-coded system,
and minimum dose.” Radiology. The pediatrics- much lower doses than they did seven
which assigns one of
or eight years ago,” he said. “Before
nine dosage zones based focused campaign is
Donald P. Frush, M.D. that, kids were scanned at the same set-
on the height and weight gaining attention with
tings as adults.”
of the child. a simple message, said Dr. Goske:
Since launching the Image Gently
“They’re the same zones used for “When CT is the right thing to do,
campaign, the Alliance for Radiation
medications, fluids and equipment like child size the kVP and mA. One scan
(single phase) is often enough, and scan Safety in Pediatric Imaging has assem-
endotracheal tubes,” said Dr. Frush,
bled 23 member organizations and
chief of the division of pediatric radiol- only the indicated area.”
8 RSNA NEWS AUGUST 2008

2. more than 1,300 individuals have taken Supporters of the
pediatrics-focused Image
the Image Gently Pledge. “The organi-
Gently campaign are
zations represent about half a million
promoting a simple mes-
radiology professionals,” Dr. Goske sage: When CT is the right
said. “We have now gone international, thing to do, child size the
with member organizations not only in peak kilovoltage (kVP)
and milliamperes (mA).
the U.S. but beyond our borders.” (For
Remember that one scan
more information about the Image Gen-
(single phase) is often
tly campaign, see Dr. Goske’s My Turn
enough and scan only
column on Page 4.) the indicated area. More
ACR facility accreditation and other information about Image
Gently is available at www.
similar programs provide an incentive
imagegently.org.
for dose reduction, and industry and
regulatory agencies are also taking note,
said Dr. Frush. He added that the U.S.
Food and Drug Administration (FDA)
and the National Imagery and Mapping eral Hospital and chair of the American solely around reducing mAs.
Agency (NIMA) are calling for more College of Radiology (ACR) board of “Radiology practices should closely
consistent dose estimates, recording and trustees, “How low one can go is partly look at their CT protocols and consider
archiving estimates. “The Alliance’s up to the person who must interpret using automatic dose reduction on all
Vendor Summit will try to come to the images. We will not have uniform exams, more aggressively on exams
terms with how to do this,” he said. agreement.” that are unlikely to harbor subtle low
contrast lesions,” Dr. Zeman continued.
Vendor Summit Seen as Pivotal Individuals Must Seize Dose Reduction “A weight-based patient dose nomo-
Opportunities
The Image Gently Vendor Summit, gram is another effective tool for limit-
scheduled for Aug. 20 at Cincinnati Ultimately the radiologist must decide ing dose. Practices should not automati-
Children’s Hospital, will include repre- in his or her own practice what consti- cally use the thinnest sections allowed
sentatives of major CT manufacturers, tutes a diagnostic quality exam, said on a particular scanner, but rather use
Image Gently organizations, the FDA Dr. Zeman. “There is, however, consid- slightly thicker sections which will
and the Medical Imaging and Technol- erable ‘low hanging fruit,’ in terms of decrease image noise and allow for
ogy Alliance, a division of the National opportunities to reduce dose,” he said. lower doses. Using pitches of greater
Electrical Manufacturers Association. “Those opportunities do not revolve Continued on Page 11
The goal of the summit is to encourage
Learn More
manufacturers to develop products with For more information about the Image Gently campaign and the Aug. 20 vendor summit,
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radiation dose in mind and also incor- contact Jennifer Boylan, executive director of the Society for Pediatric Radiology, at jboy-
porate the campaign’s message into lan@acr.org.
their training programs and installation ■ Resources are available online for radiologists seeking radiation dose guidelines:
procedures. • American College of Radiology—the White Paper on Radiation Dose in Medicine is avail-
able at www.acr.org. Click Radiation Safety under Hot Topics.
Radiologists warn, however, against
• Image Gently Campaign—imagegently.org offers downloadable tools including a pediatric
expecting uniform standards for all
CT protocol guide and worksheet.
dosage protocols—neither the equip-
• RadiologyInfo.org—the RSNA-ACR public information Web site provides simple, patient-
ment nor the operating guidelines will
oriented language about radiation safety.
give radiologists a magic number.
“There’s not going to be a single way ❚
that all the scanners work—it’s just not
Radiation Dose at RSNA 2008
the nature of entrepreneurship,” said
“Contemporary Topics—Radiation Safety in CT” is the focus of the
Dr. Frush. “And there’s no single dose
Friday Imaging Symposium to be held during RSNA 2008. Moder-
in any examination that’s going to be
ated by Lane F. Donnelly, M.D., this session will present epidemiologic
appropriate for all individuals. The best
evidence related to cancer risk and radiation dose. Also discussed will
we can do is establish maximum and
be current and future clinical and educational tools that can be used to
minimum dose.”
minimize radiation dose from CT in children. Register for RSNA 2008
Added James H. Thrall, M.D., radi-
at RSNA2008.RSNA.org.
ologist-in-chief at Massachusetts Gen-
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3. F.R.C.P.C., F.R.C.R., program coordina- more people with subspecialties, and is a pilot, but ultimately the residents
tor Timona Obura, M.B.Ch.B., M.Med., for that reason we hoped this program felt that this program was very benefi-
and a few other radiology faculty mem- would supplement their onsite learning cial,” he said.
bers, uploaded the cases to a Web site by expanding their exposure to more While RSNA has over the years
from which the residents could down- cases and more subspecialty radiology,” supported a lot of international educa-
load the cases to their computers. said Dr. Brant. tion, he said, the e-mentoring program
After three initial weekly sessions, Joyce Sande, M.D., one of residents creates a “real-time” opportunity for
Dr. Brant talked to the residents live involved in the e-learning project, said supplementing education in developing
online once a month for two hours, exposure to a “spectrum of pathology” countries, said Dr. Brant.
using a commercial program that was one of the main reasons the pro- “A lot of faculty can participate and
allowed him to share his desktop with gram was a success. “While we do see assist programs in developing countries
the students. “We were able to discuss a lot of normal exams, which is still at a much lower cost,” he said. “We can
the cases live and the delay was less of use, the experience we got from the therefore have a continuing relationship
than a second, so that was not bad,” sessions built our confidence in terms that can really develop over the years.”
said Dr. Brant. of conditions that we may face in the S.M. Faisal Mosharraf, M.B.B.S.,
While many government hospitals future,” Dr. Sande said. who supervised the e-mentoring ses-
in Africa are very poor and lacking sions and facilitated discussion on the
Program Prompts Discussion Among
equipment, Dr. Brant noted that Aga Aga Khan end, praised the project as
Residents
Khan is fairly well-funded. “It has novel and innovative but said there is
been there for a long time and in the Residents said the program benefited room from improvement. Residents
past five years they have decided to them in other ways as well. “The way learned from the sessions, he said,
make post-graduate education one of in which it was run encouraged us to however more must be done to encour-
the functions of the hospital, with the discuss various cases together,” said age them to apply their new knowledge
hopes that it leads to a medical school,” Dr. Sande. “In doing this, we were able to their day-to-day work.
he said. “I think this hospital will be a to enhance each others’ strengths and “I think we have to further think
good training ground for more radiolo- minimize weaknesses. This is espe- and bring some innovative ideas to
gists to work in Kenya.” cially so because during the discussions make the project a complete success,”
Dr. Brant added that Aga Khan has different points were raised by different said Dr. Mosharraf.
most of the same equipment as he has residents such that at the end of a dis- Dr. Sande said she would recom-
available at the University of Virginia, cussion, we all had made fullest use of mend the program to other residents.
something very important to the pro- each case.” “It has helped in my studies by giv-
gram. “They had top notch ultrasound, Dr. Brant, who traveled to see ing me guidelines on how to approach
state-of-the-art MR and a multislice CT the residents in person again in mid- self-directed learning, and the time
scanner,” said Dr. Brant. “Their big- June, said he believes that “everyone taken to explain the cases has give us
gest deficiency was plain radiography, involved considers this program a great a strong foundation because it will be
believe it or not.” venture,” but notes there initially might difficult to forget what was learned,”
The University of Virginia’s radiol- have been some hesitation on the part she said. “When you understand why
ogy department currently has three to of the Aga Khan residents. certain pathology occurs and why
four times as many clinical faculty and “I think at first they thought they it appears as it does, the memory is
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residents as Aga Khan. “We have many may be guinea pigs of a sort, since this grounded deeper.”
Pediatric Radiologists Thrust Radiation Safety into Spotlight
through the cast to see the hip is with a tly will be reaching out to parents,” Dr.
Continued from Page 9
than one is a great way to reduce dose CT scan,” said Dr. Goske. “However, Goske continued. “But we must first
while reducing scan times.” we only need to see gross anatomy, so remind radiologists, radiology technol-
One of the simplest ways to cut we can bring the dose way down and ogists and physicists, and then referring
dose, Drs. Zeman and Goske point out, do a very short spiral, maybe 3 centime- physicians.”
remains the same—scanning only the ters. The referring doctor may order a Added Dr. Zeman, “We are not
necessary area. “For example, if you scan of the pelvis, but we don’t need the currently positioned to be the gatekeep-
have a child who has chronic hip dislo- whole pelvis. We just need a couple of ers of the entire referral process, but
cation, has had surgery to reduce the hip centimeters through the hip joint. we can be the gatekeepers of patient
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and is in a cast, the only way to look “The third phase of the Image Gen- dose.”
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