Hospital Staff Cuts Dose for Pediatric Exams in Half with a Testing/Evaluation Process
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Casey Dye, (RT) Diagnostic Coordinator, Intermountain Primary Children’s Medical Center
In keeping with the Image Gently Campaign, our staff reduced dose for pediatric patients by up to half. We image patients on a DRX-Revolution Mobile X-ray system that replaced a CR unit. A cesium iodide detector maximizes resolution. We also installed pediatric optimization and enhancement software that contains techniques for each of the seven pediatric categories.
Equipped with these tools, our technologists began testing lower exposures when exams were ordered for our patients. Each time we lowered the dose, we conferred with radiologists to make sure that the image offered sufficient resolution for optimal diagnosis. We continued lowering dose until the radiologist reported that visualization was impaired, and then we set the default exposure technique at the previous setting. Over the course of several weeks, we imaged enough patients to set new exposure techniques for all seven pediatric categories.
In some cases exposures are altered from the standard dose to accommodate specific needs, such as viewing a PICC line (which requires slightly less dose) or detecting pneumonia (which requires slightly more dose).
Our physicians and radiologists are extremely pleased with the improvement in visualization of soft tissues and small structures for all children, but they report the difference is especially pronounced in premature babies and infants.
Converting from CR to DR is always helpful in lowering dose, but achieving the lowest dose possible requires a concerted effort by each facility’s staff and also depends upon the capabilities of the individual CR or DR platforms at the site.
Intermountain Primary Children’s Medical Center (Salt Lake City, Utah) is a member of Intermountain Healthcare. It is recognized by U.S. News & World Report and other organizations as one of the top children’s hospitals in the United States.
Jasna Davidovic
All this sounds wonderful… How do you manage radiologist’s concern about possible incidental findings while decreasing dose & image quality? How exactly do you set a limit to image-dose optimization?
Casey Dye
Great Question Jasna. What we did is took our morning portables that we new what our technique was and those are the patients that we adjusted. We also did it on patients that were receiving a PICC line. If the x-ray was their first one, we used a technique that was approved by the Radiologist. Whenever we would adjust our technique, we would show our Radiologists. Then they would give us feedback on the image quality and if they felt the technique was adequate. Once we got down to our base technique then knew what our optimal dose limit was. I hope this helps.