The Image Gently pediatric digital radiography safety checklist: tools for improving pediatric radiography.

Transition from film-screen to digital radiography requires changes in radiographic technique and workflow processes to ensure that the minimum radiation exposure is used while maintaining diagnostic image quality. Checklists have been demonstrated to be useful tools for decreasing errors and improving safety in several areas, including commercial aviation and surgical procedures. The Image Gently campaign, through a competitive grant from the FDA, developed a checklist for technologists to use during the performance of digital radiography in pediatric patients. The checklist outlines the critical steps in digital radiography workflow, with an emphasis on steps that affect radiation exposure and image quality. The checklist and its accompanying implementation manual and practice quality improvement project are open source and downloadable at www.imagegently.org. The authors describe the process of developing and testing the checklist and offer suggestions for using the checklist to minimize radiation exposure to children during radiography.

Pediatric digital radiography education for radiologic technologists: current state.

BACKGROUND: Digital radiography (DR) is one of several new products that have changed our work processes from hard copy to digital formats. The transition from analog screen-film radiography to DR requires thorough user education because of differences in image production, processing, storage and evaluation between the forms of radiography. Without adequate education, radiologic technologists could unknowingly expose children to higher radiation doses than necessary for adequate radiograph quality. OBJECTIVE: To evaluate knowledge about image quality and dose management in pediatric DR among radiologic technologists in the U.S. MATERIALS AND METHODS: This communication describes a survey of 493 radiologic technologists who are members of the American Society of Radiologic Technologists (ASRT) and who evaluated the current state of radiological technologist education in image quality and dose management in pediatric DR. The survey included 23 survey questions regarding image acquisition issues, quality assurance, radiation exposure and education in DR of infants and children. RESULTS: Radiologic technologists express many needs in areas of training and education in pediatric DR. Suggested improvements include better tools for immediate feedback about image quality and exposure, more information about appropriate technique settings for pediatric patients, more user-friendly vendor manuals and educational materials, more reliable measures of radiation exposure to patients, and more regular and frequent follow-up by equipment vendors. CONCLUSION: There is a clear and widespread need for comprehensive and practical education in digital image technology for radiologic technologists, especially those engaged in pediatric radiography. The creation of better educational materials and training programs, and the continuation of educational opportunities will require a broad commitment from equipment manufacturers and vendors, educational institutions, pediatric radiology specialty organizations, and individual imaging specialists.

Image Gently: challenges for radiologic technologists when performing digital radiography in children.

The development of digital radiography (DR) has provided numerous benefits for pediatric imaging, including the ability to post-process images and to make images immediately available for access by care providers. However, DR presents several significant challenges for the radiologic technologists who are responsible for operating the equipment and producing high-quality images in children. This paper discusses those challenges, including lack of standardization among vendors, particularly with regard to the exposure indicator; lack of pediatric-specific educational materials and pediatric techniques; the need for manual technique instead of the use of automatic exposure control in smaller children; and complications related to field size, collimation and shielding in small children. Specific actions and design modifications that might facilitate the effective management of these challenges will be also described. The implementation of measures to promote the production of optimal images while minimizing radiation exposure requires cooperation and communication among imaging professionals, manufacturers and regulatory agencies.

Assessment of radiation dose awareness among pediatricians.

BACKGROUND: There is increasing awareness among pediatric radiologists of the potential risks associated with ionizing radiation in medical imaging. However, it is not known whether there has been a corresponding increase in awareness among pediatricians. OBJECTIVE: To establish the level of awareness among pediatricians of the recent publicity on radiation risks in children, knowledge of the relative doses of radiological investigations, current practice regarding parent/patient discussions, and the sources of educational input. MATERIALS AND METHODS: Multiple-choice survey. RESULTS: Of 220 respondents, 105 (48%) were aware of the 2001 American Journal of Roentgenology articles on pediatric CT and radiation, though only 6% were correct in their estimate of the quoted lifetime excess cancer risk associated with radiation doses equivalent to pediatric CT. A sustained or transient increase in parent questioning regarding radiation doses had been noticed by 31%. When estimating the effective doses of various pediatric radiological investigations in chest radiograph (CXR) equivalents, 87% of all responses (and 94% of CT estimates) were underestimates. Only 15% of respondents were familiar with the ALARA principle. Only 14% of pediatricians recalled any relevant formal teaching during their specialty training. The survey response rate was 40%. CONCLUSION: Awareness of radiation protection issues among pediatricians is generally low, with widespread underestimation of relative doses and risks.

Pediatric patient surface doses in neuroangiography.

BACKGROUND: Neuroangiographic techniques (diagnostic and interventional) can be lengthy and complex and can be associated with high radiation entrance skin doses from fluoroscopy and digital subtraction angiography (DSA). OBJECTIVE: To measure entrance surface doses received by pediatric patients undergoing neuroangiographic procedures and to (1) compare these doses with thresholds for deterministic effects, (2) compare these doses with those reported in adults, and (3) to understand the dose relationships among diagnostic and interventional procedures, DSA and fluoroscopy. MATERIALS AND METHODS: A neurobiplane unit with fluoroscopic and DSA capabilities was used for all neuroangiographic procedures. An automated patient dosimeter, installed on both planes of the unit, calculated maximum surface dose. The dosimeter also recorded the number of angiographic frames and the length of fluoroscopy time for each procedure. RESULTS: This retrospective study analyzed entrance surface doses to 100 pediatric patients, 76 of whom underwent neuroangiographic diagnostic procedures and 24 of whom underwent neuroangiographic interventional procedures. The DSA acquisitions ranged from 44 frames to 1,428 frames per procedure and fluoroscopy times ranged from 1.1 to 85.6 min per procedure. The mean surface dose from fluoroscopy was 68.1 mGy (max: 397.1 mGy) in the frontal (PA) plane; in the lateral (LAT) plane, the mean surface dose was 40.9 mGy (max: 418.5 mGy). The mean surface doses from DSA were 263.1 and 126.9 mGy in the frontal and lateral planes, with maximum doses of 924.4 and 410.1 mGy, respectively. Mean fluoroscopy dose rates were 5.4 mGy/min in the PA plane and 4.7 mGy/min in the LAT plane. The DSA largely contributed to the overall procedural surface dose, accounting for 82% of the combined surface dose in the each of the imaging planes. CONCLUSION: The surface dose for each procedure measured in this study was found to be below thresholds for deterministic effects. Interventional procedures consistently yield the highest doses.