A Systematic Approach to Pediatric Low Dose

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Don Thompson, Digital Capture Solutions, Marketing Manager, Carestream U.S. & Canada

For years radiology has worked on this problem—how to minimize X-Ray dose for children, who are vulnerable not only because of their sensitivity but because of the cumulative effect of radiation that stays with the patients their entire lives.

Carestream supports the “Image Gently” campaign of the Alliance for Radiation Safety in Pediatric Imaging at www.pedrad.org. The remainder of the post outlines guidelines that we and the alliance believe are important.

One size does not fit all…

There’s no question:  X-rays are important tools in pediatric care.  But when we image, radiation matters.  Children are more sensitive to radiation.  What we do now lasts their lifetimes.  So, when we image, let’s image gently.

More is often not better–when X-ray is the right thing to do:

• Measure patient thickness for “child-size” technique
• Avoid using grids for body parts less than 10–12 cm thick
• X-ray only the indicated area with proper collimation and shielding
• Check exposure indicators and image quality

We have developed a Carestream white paper “Maximizing Dose Efficiency for Pediatric Patient Imaging,” available at http://bit.ly/15yCe0k. In this paper we discuss dose reduction in image acquisition as well as efficiencies in image processing, image display, and in quality control. Our DRX-Revolution Mobile X-ray System is now doing rounds in many children’s wards and hospitals, with the result that we hear repeated often:

“We started noticing that we could drop our doses down, so we went down a little more. We found that with our DRX portable, we were cutting our dose in half,” said Casey Dye, Diagnostic Coordinator, Intermountain Primary Children’s Hospital

New low-dose, small-format DR detector.

In addition, with the introduction of our new small-format DRX 2530C wireless DR detector, we can provide clinicians yet another opportunity to reduce dose: our smaller detector is designed to fit into pediatric incubator trays and offer higher DQE (detective quantum efficiency) with its Cesium scintillator, which can lead to lower dose requirements than CR cassettes or gadolinium scintillator detectors. The DRX 2530C is compatible with both our DRX Revolution Mobile X-ray System as well as with other portables upgraded with our DRX-Mobile Retrofit Kit.

Technique based on the patient’s size and age, new DRX portables, and our new Cesium detector (the DRX 2530C) help to keep dose to a minimum. In addition, image processing optimized for the size and age of the patient can also be employed to emphasize appropriate details in the image after acquisition, sometimes providing an acceptable image in a situation that might otherwise require a repeat. Finally, new analytic reporting software allows the clinician to evaluate performance over time and to identify areas for possible improvement.

To make the imaging experience more comfortable for our young patients, Carestream has developed a coloring book for children about X-rays, titled “I can see your bones,” available by visiting this link.