Pediatric Radiology

, 41:461

Image Gently: progress and challenges in CT education and advocacy

  • Marilyn J. Goske
  • Kimberly E. Applegate
  • Dorothy Bulas
  • Priscilla F. Butler
  • Michael J. Callahan
  • Brian D. Coley
  • Steven Don
  • Donald P. Frush
  • Marta Hernanz-Schulman
  • Sue C. Kaste
  • Gregory Morrison
  • Manrita Sidhu
  • Keith J. Strauss
  • S. Ted Treves
  • on behalf of the Alliance for Radiation Safety in Pediatric Imaging


Significant progress has been made in radiation protection for children during the last 10 years. This includes increased awareness of the need for radiation protection for pediatric patients with international partnerships through the Alliance for Radiation Safety in Pediatric Imaging. This paper identifies five areas of significant progress in radiation safety for children: the growth of the Alliance; the development of an adult radiation protection campaign Image Wisely™; increased collaboration with government agencies, societies and the vendor community; the development of national guidelines in pediatric nuclear medicine, and the development of a size-based patient dose correction factor by the American Association of Physicists in Medicine, Task Group 204. However, many challenges remain. These include the need for continued education and change of practice at adult-focused hospitals where many pediatric CT exams are performed; the need for increased emphasis on appropriateness of pediatric imaging and outcomes research to validate the performance of CT studies, and the advancement of the work of the first pediatric national dose registry to determine the “state of the practice” with the final goal of establishing ranges of optimal CT technique for specific scan indications when imaging children with CT.


Children CT scan Radiation protection Radiation safety 


  1. 1.
    Scaife ER, Rollins MD (2010) Managing radiation risk in the evaluation of the pediatric trauma patient. Semin Pediatr Surg 19:252–256PubMedCrossRefGoogle Scholar
  2. 2.
    Stratton KL, Pope JC, Adams MC et al (2010) Implications of ionizing radiation in the pediatric urology patient. J Urol 183:2137–2142PubMedCrossRefGoogle Scholar
  3. 3.
    Dorfman AL, Fazel R, Einstein AJ et al (2011) Use of medical imaging procedures with ionizing radiation in children. Arch Pediatr Adolesc Med. doi:10.1001/archpediatrics.2010.270, Jan 3 [Epub ahead of print]PubMedGoogle Scholar
  4. 4.
    Gray JE, Archer BR, Butler PF et al (2005) Reference values for diagnostic radiology: application and impact. Radiology 235:354–358PubMedCrossRefGoogle Scholar
  5. 5.
    Goske MJ, Applegate KE, Bell C et al (2010) Image Gently: providing practical educational tools and advocacy to accelerate radiation protection for children worldwide. Semin Ultrasound CT MRI 31:57–63CrossRefGoogle Scholar
  6. 6.
    Brink JA, Amis ES (2010) Image Wisely: a campaign to increase awareness about adult radiation protection. Radiology 257:601–602PubMedCrossRefGoogle Scholar
  7. 7.
    NCRP Commentary No 13 (1995) An introduction to efficacy in diagnostic radiology and nuclear medicine (justification of medical radiation exposure). Available via Accessed 20 Jan 2011
  8. 8.
    United States Food and Drug Administration, Center for Devices and Radiological Health. White paper: initiative to reduce unnecessary radiation exposure from medical imaging. Available via Accessed 30 Jan 2011
  9. 9.
    National Council on Radiation Protection and Measurements (2009) Ionizing radiation exposure of the population of the United States: NCRP Report No. 160. NCRP, Bethesda, MD, pp 142–146Google Scholar
  10. 10.
    World Health Organization. Global Initiative on Radiation Safety in Healthcare Settings. Available via Accessed 30 Jan 2011
  11. 11.
    Goske MJ, Applegate KE, Bulas D et al (2011) Approaches to promotion and implementation of action on radiation protection for children. Radiat Prot Dosim, in pressGoogle Scholar
  12. 12.
    Gelfand M, Parisi M, Treves ST (2011) Pediatric radiopharmaceutical administered doses: 2010 North American consensus guidelines. J Nucl Med 52:318–322PubMedCrossRefGoogle Scholar
  13. 13.
    Boone J, Strauss KJ, Cody DD et al (2011) Correction factors for patient size in CT dose estimation. AAPM Report No 204. Available via Accessed 30 Jan 2011
  14. 14.
    Slovis TL (2002) The ALARA concept in pediatric CT: myth or reality? Radiology 223:5–6PubMedCrossRefGoogle Scholar
  15. 15.
    Strauss KJ, Goske MJ, Frush DP et al (2009) Image Gently Vendor Summit: working together for better estimates of pediatric radiation dose from CT. AJR 192:1169–1175PubMedCrossRefGoogle Scholar
  16. 16.
    Larson DB, Johnson LW, Schnell BM et al (2011) Increasing use of CT in children visiting emergency departments, 1995–2007. Radiology 258:164–173PubMedCrossRefGoogle Scholar
  17. 17.
    American College of Radiology. CT accreditation program requirements. Available via Accessed 30 Jan 2011
  18. 18.
    American College of Radiology Appropriateness CT criteria. Available via Accessed 30 Jan 2011
  19. 19.
    American College of Radiology Practice Guidelines and Technical Standards. Available via Accessed 30 Jan 2011
  20. 20.
    Medina S, Applegate K, Blackmore CC (eds) (2010) Evidence-based imaging in pediatrics: optimizing imaging in pediatric patient care. Springer, New YorkGoogle Scholar
  21. 21.
    Kuppermann N, Holmes JF, Dayan PS et al (2009) Identification of children at very low risk of clinically-importantbrain injuries after head trauma: a prospective cohort study. Lancet 374:1160–1170PubMedCrossRefGoogle Scholar
  22. 22.
    Broder J, Fordham LA, Warshauer DM (2007) Increasing utilization of computed tomography in the pediatric emergency department, 2000–2006. Emerg Radiol 14:227–232PubMedCrossRefGoogle Scholar
  23. 23.
    Kalra MK, Saini S (2006) Standardized nomenclature and description of CT scanning techniques. Radiology 241:657–660PubMedCrossRefGoogle Scholar
  24. 24.
    Rehani M, Frush DP (2010) Tracking radiation exposure of patients. Lancet 376:754–755PubMedCrossRefGoogle Scholar
  25. 25.
    Donnelly LF, Emery KH, Brody AS et al (2001) Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large children’s hospital. AJR 176:303–306PubMedGoogle Scholar
  26. 26.
    Patterson A, Frush DP, Donnelly LF (2001) Helical CT of the body: are settings adjusted for pediatric patients? AJR 176:297–301Google Scholar
  27. 27.
    Gray JE, Archer BR, Butler PF et al (2005) Reference values for diagnostic radiology: application and impact. Radiology 235:354–358PubMedCrossRefGoogle Scholar
  28. 28.
    Conference of Radiation Control Program Directors (1994) Nationwide Evaluation of X-ray Trends (NEXT): summary of 1990 computed tomography survey and 1991 flouroscopy survey. CRCPD publication no. 94–2. Frankfort, KYGoogle Scholar
  29. 29.
    Nievelstein RA, van Dam IM, van der Molen AJ (2010) Mutidetector CT in children: current concepts and dose reduction strategies. Pediatr Radiol 40:1324–1344PubMedCrossRefGoogle Scholar
  30. 30.
    Reid J, Gamberoni J, Dong F et al (2010) Optimization of kVp and mAs for pediatric low-dose simulated abdominal CT: is it best to base parameter selection on object circumference? AJR 195:1015–1020PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Marilyn J. Goske
    • 1
  • Kimberly E. Applegate
    • 2
  • Dorothy Bulas
    • 3
  • Priscilla F. Butler
    • 4
  • Michael J. Callahan
    • 5
  • Brian D. Coley
    • 6
  • Steven Don
    • 7
  • Donald P. Frush
    • 8
  • Marta Hernanz-Schulman
    • 9
  • Sue C. Kaste
    • 10
  • Gregory Morrison
    • 11
  • Manrita Sidhu
    • 12
  • Keith J. Strauss
    • 13
  • S. Ted Treves
    • 14
  • on behalf of the Alliance for Radiation Safety in Pediatric Imaging
  1. 1.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Emory University School of MedicineAtlantaUSA
  3. 3.Department of Diagnostic Imaging and RadiologyChildren’s National Medical CenterWashingtonUSA
  4. 4.Breast Imaging Accreditation ProgramsAmerican College of RadiologyRestonUSA
  5. 5.Department of RadiologyChildren’s HospitalBostonUSA
  6. 6.Department of RadiologyNationwide Children’s HospitalColumbusUSA
  7. 7.St. Louis Children’s Hospital, Mallinckrodt Institute of RadiologyWashington University School of MedicineSt. LouiseUSA
  8. 8.Division of Pediatric RadiologyDuke University Medical CenterDurhamUSA
  9. 9.Department of Diagnostic ImagingVanderbilt Children’s HospitalNashvilleUSA
  10. 10.St. Jude Children’s Research HospitalMemphisUSA
  11. 11.American Society of Radiologic TechnologistsAlbuquerqueUSA
  12. 12.Seattle Children’s HospitalUniversity of Washington and Seattle RadiologistsSeattleUSA
  13. 13.Radiology Physics and Engineering, Department of Radiology, Children’s Hospital BostonHarvard Medical SchoolBostonUSA
  14. 14.Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Children’s HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations