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The Image Gently Campaign: Championing Radiation Protection for Children Through Awareness, Educational Resources and Advocacy

  • Marilyn J. Goske
  • Michael J. Callahan
  • Donald P. Frush
  • Sue C. Kaste
  • Gregory Morrison
  • Keith J. Strauss
Part of the Medical Radiology book series (MEDRAD)

Abstract

CT scans have been shown to improve pediatric patient care and because of its benefits, the use of this remarkable technology has grown worldwide. However, children are particularly vulnerable to potential effects from ionizing radiation due their small size, rapid cell division and longer lifetime to manifest changes. It is most important that radiologists ensure that every CT scan is justified by the medical indication, that alternative imaging such as ultrasound or magnetic resonance imaging cannot be substituted and that methods are used to “child-size” the technique for the scan. This chapter describes practical strategies to promote awareness, education and advocacy in radiation protection for children through “social marketing” used by the Alliance for Radiation Safety in Pediatric Imaging. The Alliance develops educational resources, including “universal protocols” and online modules for radiologists and radiologic technologists and parents. The chapter includes a discussion of the new Size Specific Dose Estimate (SSDE) and how it may be used for individual patient reports, approaches to optimize pediatric CT protocols in practice, particularly for oncology patients and finally postulates future trends in imaging and dose recording in children.

Keywords

Compute Tomography Examination Patient Dose Dose Length Product Organ Dose Radiologic Technologist 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Adamson PC (2009) Imaging in early phase childhood cancer trials. Pediatr Radiol 39(Suppl 1):S38–S41PubMedCrossRefGoogle Scholar
  2. American College of Radiology (2008) New CT accreditation dose requirements effective. 1 Jan 2008. http://www.acr.org/accreditation/FeaturedCategories/ArticlesAnnouncements/NewDoseReq.aspx. Accessed 2 Oct 2011
  3. Andreasen A (2006) The role of social marketing. In: Andreasen A (ed) Social marketing in the 21st century. Sage Publications, Thousand Oaks, pp 87–107Google Scholar
  4. Armstrong GT, Liu W, Leisenring W, Yasui Y, Hammond S, Bhatia S, Neglia JP, Stovall M, Srivastava D, Robison LL (2011) Occurrence of multiple subsequent neoplasms in long-term survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol 29:3056–3064PubMedCrossRefGoogle Scholar
  5. BEIR (2006) Committee to assess health risks from exposure to low levels of ionizing radiation. Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase II. National Academies Press, Washington, p 406Google Scholar
  6. Berland LL et al (2011) American College of Radiology. ACR practice guidelines for performing and interpreting diagnostic computed tomography. http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx/ct_performing_interpreting.aspx. Accessed 25 Sept 2011
  7. Berdon WE, Slovis TL (2002) Where we are since ALARA and the series of articles on CT dose in children and risk of long-term cancers: what has changed? Pediatr Radiol 32:699. doi: 10.1007/s00247-002-0794-4 PubMedCrossRefGoogle Scholar
  8. Birnbaum S (2008) Radiation safety in the era of helical CT: a patient-based protection program currently in place in two community hospitals in New Hampshire. J Am Coll Radiol 5:714–718PubMedCrossRefGoogle Scholar
  9. Bogdanich W (2009) New York Times. Radiation overdoses point out dangers of CT scans. http://www.nytimes.com/2009/10/16/us/16radiation.html. Accessed 2 Oct 2011
  10. Bogdanich W (2010) Radiation worries for children in dentists chair. New York Times. http://www.nytimes.com/2010/11/23/us/23scan.html. Accessed 2 Oct 2011
  11. Bongartz G, Golding S, Jurik A, Leonardi M, van Meerten EvP, Geleijns J, Jessen KA, Panzer W, Shimpton PC, Tosi G (2004) European guidelines for multslice computed tomography. European CommissionGoogle Scholar
  12. Boone JM (2007) The trouble with CTD100. Med Phys 34(4):1364–1371PubMedCrossRefGoogle Scholar
  13. Boone JM, Strauss KJ, Cody DD, McCollough CH, McNitt-Gray MF, Toth TL Goske MJ, Frush DP (2011) Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations. AAPM Report No. 204 posted at http://www.aapm.org. ISBN: 978-1-936366-08-8, ISSN: 0271-7344. http://www.aapm.org/pubs/reports/RPT_204.pdf. Accessed 2 Oct 2011
  14. Braddock CH 3rd, Edwards KA, Hasenberg NM et al (1999) Informed decision making in outpatient practice: time to get backto the basics. JAMA 282:2313–2320PubMedCrossRefGoogle Scholar
  15. Brenner DJ, Elliston CD, Hall EJ, Berdon WE (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR 176(2):289–296PubMedGoogle Scholar
  16. Brink JA, Goske MJ, Patti J (2011) Informed decision-making trumps informed consent for medical imaging with ionizing radiation. Radiology (in press)Google Scholar
  17. Broder J, Fordham LA, Warshauer DM (2007) Increasing utilization of computed tomography in the pediatric emergency department, 2000–2006. Emerg Radiol 14(4):227–232PubMedCrossRefGoogle Scholar
  18. Bulas D, Goske M, Applegate K, Wood N (2009) Image gently: improving health literacy for parents about CT scans for children. Pediatr Radiol 39:112–116PubMedCrossRefGoogle Scholar
  19. Bushberg JT, Seibert JA, Leidholdt EM, Boone JM (2012) The essential physics of medical imaging. Lippincott Williams and Wilkins, Philadelphia, p 1030Google Scholar
  20. Callahan MJ (2011) CT Dose reduction in practice. Pediatric Radiol 41(Suppl 2):S488–S492. doi: 10.1007/s00247-011-20990y CrossRefGoogle Scholar
  21. Cancer Survivors (2011) United States 2007 MMWR Morb Mortal Wkly Rep 60(9): 269–272Google Scholar
  22. Cardinal JS, Gunderman RB, Tarver RD (2011) Informing patients about risks and benefits of radiology examinations: a review article. J Am Coll Radiol 8:402–408PubMedCrossRefGoogle Scholar
  23. Chong AL, Grant RM, Ahmed BA, Thomas KE, Connolly BL, Greenberg M (2010) Imaging in pediatric patients: time to think again about surveillance. Pediatr Blood Cancer 55:407–413PubMedCrossRefGoogle Scholar
  24. Chu CM, Rasalkar DD, Hu YJ, Cheng FW, Li CK, Chu WC (2011) Clinical presentations and imaging findings of neuroblastoma beyond abdominal mass and a review of imaging algorithm. Br J Radiol 84(997):81–91PubMedCrossRefGoogle Scholar
  25. Computed tomography dose check (2010) NEMA Standards Publication XR 25-2010, pp 1–15Google Scholar
  26. Crawley MT, Booth A, Wainwright A (2001) A practical approach to the first iteration in the optimization of radiation dose and image quality in CT: estimates of the collective dose savings achieved. Br J Radiol 74:607–614PubMedGoogle Scholar
  27. Dixon RL (2003) A new look at CT dose measurement: beyond CTDI. Med Phys 30(6):1272–1280PubMedCrossRefGoogle Scholar
  28. Dixon RL (2006) Restructuring CT dosimetry: a realistic strategy for the future requiem for the pencil chamber. Med Phys 33(10):3973–3976PubMedCrossRefGoogle Scholar
  29. Dobbs MD, Lowas SR, Hernanz-Schulman M, Holt GE, Yu C, Kan JH (2010) Impact of abdominopelvic CT on Ewing sarcoma management. Acad Radiol 17:1288–1291PubMedCrossRefGoogle Scholar
  30. Donnelly LF, Emery KH, Brody AS, Laor T et al (2001) Minimizing radiation dose for pediatric body CT applications of single detector helical CT strategies at a large children’s hospital. AJR 176(2):303–306PubMedGoogle Scholar
  31. Dorfman AL, Fazel R, Einstein AJ et al (2011) Use of medical imaging procedures with ionizing radiation in children: a population-based study. Arch Pediatr Adolesc Med 165:458–464PubMedCrossRefGoogle Scholar
  32. Fahey FH, Treves ST, Adelstein SJ (2011) Minimizing and communicating radiation risk in pediatric nuclear medicine. J Nucl Med 52:1240–1251PubMedGoogle Scholar
  33. FDA (2001) Public health notification reducing radiation risk from computed tomography for pediatric and small adult patients. http://www.fda.gov/cdrh/safety/110201-ct.html. Accessed 21 Aug 2011
  34. Frush DP (2009) Radiation, CT, and children: the simple answer is…it’s complicated. Radiology 252:4–6PubMedCrossRefGoogle Scholar
  35. Frush DP (2011) CT dose and risk estimates in children. Pediatr Radiol 41(Suppl 2):483–487PubMedCrossRefGoogle Scholar
  36. Goske MJ, Applegate KE, Boylan J et al (2008) The image gently campaign: working together to change practice. AJR 190:273–274PubMedCrossRefGoogle Scholar
  37. Goske MJ, Phillips RR, Mandel K, McLinden D, Racadio J, Hall S (2010) A web-based practice quality improvement program in CT safety for children (Invited Paper). AJR 194(5):1177–1182PubMedCrossRefGoogle Scholar
  38. Goske MJ, Applegate KE, Butler PF, Frush DP, Morrison G, Strauss KJ (2011a) Image gently: partnerships to promote radiation protection for children worldwide. Pediatr Radiol 41(Suppl 1):S207–S209CrossRefGoogle Scholar
  39. Goske M, Strauss KJ, Coombs L et al (2011b) Quality improvement registry in CT scans in children (QuIRCC): use of a new pediatric CT dose estimate (CTPD) to develop diagnostic reference levels (DRL) for abdominal CT. Pediatric Radiol (abstract) 41(Suppl 1):250–311Google Scholar
  40. Gray JE, Archer BJ, Butler PF, Hobbs BB et al (2005) Reference values for diagnostic radiology: application and impact. Radiology 235:354–358PubMedCrossRefGoogle Scholar
  41. Hall J, Angèle S (1999) Radiation, DNA damage and cancer. Mol Med Today 5:157–164PubMedCrossRefGoogle Scholar
  42. Hampton T (2010) Radiation oncology organization, FDA announce radiation safety initiatives. JAMA 303(13):1239–1240PubMedCrossRefGoogle Scholar
  43. Hricak H, Brenner DJ, Adelstein SJ et al (2011) Managing radiation use in medical imaging: a multifaceted challenge. Radiology 258:889–905PubMedCrossRefGoogle Scholar
  44. Huda W (2002) Dose and image quality in CT. Pediatr Radiol 32:709–713PubMedCrossRefGoogle Scholar
  45. Huda W, Scalzetti EM, Levin G (2000) Technique factors and image quality as functions of patient weight at abdominal CT. Radiology 217(2):430–435PubMedGoogle Scholar
  46. Huda W, Ogden KM, Khorasani MR (2008) Effect of dose metrics and radiation risk models when optimizing CT X-ray tube voltage. Phys Med Biol 53(17):4719–4732PubMedCrossRefGoogle Scholar
  47. IMV(2006) CT Marketing Summary Report. Des Plains, IL: IMV Medical Information DivisionGoogle Scholar
  48. International Commission on Radiological Protection (1991) 1990 recommendations of the international commission on radiological protection. ICRP publication no. 60, OxfordGoogle Scholar
  49. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ (2006) Cancer statistics 2006. CA Cancer J Clin 56(2):106–130PubMedCrossRefGoogle Scholar
  50. Kan JH, Hwang M, Lowas SR, Hernanz-Schulman M (2011) Impact of pelvic CT on staging, surveillance, and survival of pediatric patients with Wilms tumor and hepatoblastoma. AJR Am J Roentgenol 196:W515–W518PubMedCrossRefGoogle Scholar
  51. Kaste SC (2009) Imaging challenges: a US perspective on controlling exposure to ionizing radiation in children with cancer. Pediatr Radiol 39(Suppl 1):S74–S79PubMedCrossRefGoogle Scholar
  52. Kaste SC (2011) Oncology protocols: how can we do better? Pediatr Radiol 41(Suppl 1):S166–S169PubMedCrossRefGoogle Scholar
  53. Kleinerman RA (2009) Radiation-sensitive genetically susceptible pediatric sub-populations. Pediatr Radiol 39(Suppl 1):S27–S31PubMedCrossRefGoogle Scholar
  54. Kleinman PL, Strauss KJ, Zurakowski D, Buckley KS, Taylor GA (2010) Patient size measured on CT images as a function of age at a tertiary care children’s hospital. AJR Am J Roentgenol 194(6):1611–1619. doi: 10.2214/AJR.09.3771 Google Scholar
  55. Kovanlikaya A, Karabay N, Cakmakci H, Uysal K, Olgun N, Ergör G (2003) Surveillance imaging and cost effectivity in pediatric brain tumors. Eur J Radiol 47(3):188–192PubMedCrossRefGoogle Scholar
  56. Lakhoo K, Sowerbutts H (2010) Neonatal tumours. Pediatr Surg Int 26:1159–1168PubMedCrossRefGoogle Scholar
  57. Larson DB, Rader SB, Forman HP et al (2007) Informing parents about CT radiation exposure: it’s OK to tell them. AJR 189:271–275PubMedCrossRefGoogle Scholar
  58. Larson DB, Johnson LW, Schnell BM, Goske MJ, Salisbury SR, Forman HP (2011) Increasing utilization of CT in children visiting emergency departments in the United States, 1995–2007. Radiology 259(3):793–801PubMedCrossRefGoogle Scholar
  59. Li X, Da Zhang D, Liu B (2011a) Automated extraction of radiation dose information From CT dose report images. AJR 196:W781–W783PubMedCrossRefGoogle Scholar
  60. Li X, Samei E, Frush D et al (2011b) Patient-specific dose estimation for pediatric abdomen-pelvis CT. SPIE 7258:725804-1725804-10Google Scholar
  61. Li X, Samei E, Frush D et al (2011c) Patient-specific radiation dose and cancer risk estimation in CT: Part II. Applications to patients. Med Phys 38:408–419PubMedCrossRefGoogle Scholar
  62. Li X, Samei E, Frush D et al (2011d) Patient-specific dose estimation for pediatric chest CT. Med Phys 35:5821–5828CrossRefGoogle Scholar
  63. Li X, Samei E, Frush D et al (2011e) Patient-specific radiation dose and cancer risk estimation in CT: Part I. Development and validation of a Monte Carlo program. Med Phys 38:397–407PubMedCrossRefGoogle Scholar
  64. Li X, Samei E, Frush D et al (2011f) Patient-specific radiation dose and cancer risk for pediatric chest CT. Radiology 259:862–874PubMedCrossRefGoogle Scholar
  65. Linet MS, Kim KP, Rajaraman P (2009) Children’s exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol 39(Suppl 1):S4PubMedCrossRefGoogle Scholar
  66. Linton OW, Mettler FA (2003) National conference on dose reduction in CT with an emphasis on pediatric patients. AJR 181:321–329PubMedGoogle Scholar
  67. Little MP, Wakeford R, Tawn EJ, Bouffler SD, Gonzalez AB (2009) Risks associated with low doses and low dose rates of ionizing radiation: Why linearity may be (almost) the best we can do. Radiology 251:6–12PubMedCrossRefGoogle Scholar
  68. Lucaya J, Piqueras J, Garcia-Pena P, Enriquez G, Garcia-Macias M, Sotil J (2000) Low-dose high-resolution CT of the chest in children and young adults: dose, cooperation, artifact incidence, and image quality. AJR Am J Roentgenol 175:985–992PubMedGoogle Scholar
  69. Maris JM (2010) Recent advances in neuroblastoma. N Engl J Med 362:2202–2211PubMedCrossRefGoogle Scholar
  70. Martin CJ (2007) Effective dose: How should it be applied to medical exposures?. Br J Radiol 80:639–647. Expand+European Heart Journaleurheartj.oxfordjournals.orgGoogle Scholar
  71. McCollough C, Branham T, Herlihy V et al (2006) Radiation doses from the ACR CT accreditation program: review of data since program inception and proposals for new reference values and pass/fail limits. Presented at the RSNA 92nd scientific assemblyGoogle Scholar
  72. McCollough CH, Christner JA, Kofler JM (2010) How effective is effective dose as a predictor of radiation risk? AJR Am J Roentgenol 194:890–896PubMedCrossRefGoogle Scholar
  73. Meinhold CB (1993) Report No. 116-limitation of exposure to ionizing radiation. National council on radiation protection and measurements. http://www.ncrppublications.org/Reports/116. Accessed 21 Aug 2011
  74. Mettler FA, Huda W, Yoshizumi TT et al (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalogue. Radiology 248(1):254–256PubMedCrossRefGoogle Scholar
  75. Mezrich R (2008) Are CT scans carcinogenic? J Am Coll Radiol 5:691–693PubMedCrossRefGoogle Scholar
  76. National Cancer Institute (2002) Radiation risks and pediatric computed tomography (CT): a guide for health care providers. http://www.cancer.gov/cancertopics/causes/radiation-risks-pediatric-CT. Accessed 2 Oct 2011
  77. Paterson A, Frush DP, Donnelly LF (2001) Helical CT of the body: are settings adjusted for pediatric patients. AJR Am J Roentgenol 176:297–301PubMedGoogle Scholar
  78. Prakash P, Kalra MK, Ackman JB et al (2010) Diffuse lung disease: CT of the chest with adaptive statistical iterative reconstruction technique1. Radiology 256:261–269. doi: 10.1148/radiol.10091487 PubMedCrossRefGoogle Scholar
  79. Preston DL, Pierce DA, Shimizu Y et al (2004) Effect of recent changes in atomic bomb survivor dosimetry on cancer mortality risk estimates. Radiat Res 162:377–389PubMedCrossRefGoogle Scholar
  80. Ratzan SC, Parker RM (2004) What is health literacy? In: Nielsen-Bohlman L, Panzer AM, Kindig DA (eds) Health literacy: a prescription to end confusion. Institute of Medicine of theNational Academies, p 32. http://www.nap.edu/openbook.php?record_id=10883&pa
  81. Rehani M, Frush DP (2010) Tracking radiation exposure of patients. Lancet 376:754–755PubMedCrossRefGoogle Scholar
  82. Rehani MM, Tsapaki V (2011) Impact of the international atomic energy agency (IAEA) actions on radiation protection of patients in many countries. Radiation Protection Dosimetry, pp 1–4. doi: 10.1093/rpd/ncr259
  83. Russo GL, Tedesco I, Russo M et al (2011) Cellular adaptive response to chronic radiation exposure in interventional cardiologists. Eur Heart J, 23 Aug 2011. [Epub ahead of print]Google Scholar
  84. Samei E, Li X, Chen B, Reiman B (2010) The myth of mean dose as a surrogate for radiation risk? Proc SPIE 7622:76220TCrossRefGoogle Scholar
  85. Schindera ST, Diedrichsen L, Muller HC et al (2011) Iterative reconstruction algorithm for abdominal multidetector CT at different tube voltages: assessment of diagnostic accuracy, image quality and radiation dose in a phantom study. Radiology 260:454–462. doi: 10.1148/radiol.11102217 PubMedCrossRefGoogle Scholar
  86. Shope TB, Gagne RM, Johnson GC (1981) A method for describing the doses delivered by transmission X-ray computed tomography. Med Phys 8(4):488–495PubMedCrossRefGoogle Scholar
  87. Shrimpton PC, Hillier MC, Lewis MA, Dunn M (2006) National survey of doses from CT in the UK: 2003. Br J Radiol 79:968–980PubMedCrossRefGoogle Scholar
  88. Singh S, Kalra MK, Moore MA et al (2009) Dose reduction and compliance with pediatric CT protocols adapted to patient size, clinical indication, and number of prior studies. Radiology 252(1):200–208PubMedCrossRefGoogle Scholar
  89. Singh S, Kalra MK, Hsieh J et al (2010) Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction. Tech Radiol 257:373–383. doi: 10.1148/radiol.10092212 CrossRefGoogle Scholar
  90. Singh S, Kalra MK, Gilman MD et al (2011) Adaptive statistical iterative reconstruction techniques for radiation dose reduction in chest CT: a pilot study. Radiology 259:565–573. doi: 101148/radiol.11101450 PubMedCrossRefGoogle Scholar
  91. Slovis TL (2002a) The ALARA concept in pediatric CT: myth or reality? Radiology 223:5–6PubMedCrossRefGoogle Scholar
  92. Slovis TL (2002b) ALARA Conference Proceedings. The ALARA concept in Pediatric CT-intelligent dose reduction. Pediatr Radiol 32:217–317PubMedCrossRefGoogle Scholar
  93. Strauss KJ (2008) Image gently universal protocols. http://www.pedrad.org/associations/5364/files/Protocols.pdf. Accessed 2 Oct 2011
  94. Strauss KJ, Goske MJ (2011) Estimated pediatric radiation dose during CT. Pediatr Radiol 41(Suppl 2):472–482Google Scholar
  95. Strauss KJ, Goske MJ, Frush DP, Butler PF, Morrison G (2009) Image gently vendor summit: working together for better estimates of pediatric radiation dose from CT. AJR Am J Roentgenol 192(5):1169–1175. doi: 10.2214/AJR.08.2172
  96. Strauss KJ, Goske MJ, Kaste SC et al (2010) Image gently: ten steps you can take to optimize image quality and lower CT dose for pediatric patients. AJR 194:868–873PubMedCrossRefGoogle Scholar
  97. Summary of the California Senate Bill 1237 (2011). http://www.leginfo.ca.gov/pub/09-10/bill/sen/sb_1201-1250/sb_1237_bill_20100929_chaptered.html. Last Accessed 9 Sep 2011
  98. The Alliance for Radiation Safety in Pediatric Imaging (2008) The Image Gently website. www.imagegently.org. Accessed 2 Oct 2011
  99. The Joint Commission Sentinel Event (2011) Alert Radiation risks of diagnostic imaging. Issue 47, pp 1–4. http://www.jointcommission.org/assets/1/18/SEA_471.PDF Accessed 2 Oct 2011
  100. The National Cancer Institute and the Society for Pediatric Radiology (2002) updated 2008. Radiation and pediatric computed tomography: a guide for health care providers. http://www.cancer.gov/cancertopics/causes/radiation/radiation-risks-pediatric-CT. Accessed 2 Oct 2011
  101. Tubiana M, Feinendegen LE, Yang C, Kaminski JM (2009) The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology 251:13–22PubMedCrossRefGoogle Scholar
  102. UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation) (2011) Sources-report to the general assembly scientific annexes a. and b. 2008 Report, vol 1. UNSCEAR (2010)Google Scholar
  103. U.S. Food and Drug Administration, White Paper (2010) Initiative to reduce unnecessary radiation exposure for medical imaging, 16 Feb 2010. http://www.fda.gov/Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/ucm199904.htm. Accessed 9 Nov 2010

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Marilyn J. Goske
    • 1
  • Michael J. Callahan
    • 2
  • Donald P. Frush
    • 3
  • Sue C. Kaste
    • 4
  • Gregory Morrison
    • 5
  • Keith J. Strauss
    • 1
  1. 1.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of RadiologyChildren’s HospitalBostonUSA
  3. 3.Division of Pediatric RadiologyDuke University Medical CenterDurhamUSA
  4. 4.Radiologic Science Division of Diagnostic ImagingSt Jude Children’s Research HospitalMemphisUSA
  5. 5.American Society of Radiologic TechnologistsAlbuquerqueUSA

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