Caring About Kids: The Proof is in the Dose

For all the talk about reducing dose, you’d think doing so would require exotic tools. Yet, reduced dose is not only possible, but also practical and well within the reach of everyday radiology. All that’s needed is the will to do so and the expertise to make it happen. Pediatricians at Spectrum Health Helen DeVos Children's Hospital in Grand Rapids, MI, can attest to that.

Their research, published this week in the Journal of American Radiology (http://www.jacr.org/article/S1546-1440(11)00784-8/abstract), documents that dedicated pediatric computed tomography (CT) technologists, using pediatric protocols, routinely expose children under their care to less CT radiation than their nonspecialized colleagues.  In obtaining this documentation, the researchers retrospectively reviewed abdominal and pelvic CTs of 244 patients scanned in a dedicated pediatric radiology department to 495 cases performed in a combined pediatric and adult radiology department. The key, they found, may be as simple – and challenging – as adhering to pediatric protocols.

The researchers determined that imaging pediatric patients in a dedicated pediatric imaging department with dedicated pediatric CT technologists may result in greater compliance with pediatric protocols established in accordance with the ALARA (As Low As Reasonably Achievable) principle for patient exposure to ionizing radiation. 

ALARA is simple enough – and practical – when applied under tightly controlled conditions, such as a radiology department that serves only one type of patient. The problem, they say, comes when the patient population is mixed, a challenge that gets all the more difficult with increasing volume.

Consequently, it may be expecting too much for technologists to exactly match the ALARA protocol to the patient. So what, then, are the choices?

The Michigan researchers imply by the structure of their study that one solution may be to route pediatric patients away from high-volume radiology departments serving both adult and pediatric patients to one that specializes in pediatrics. Doing so may not be practical, at least not in all cases. There may, however, be another way.

The underlying problem appears to be matching patient to protocol. Engineers have already done much to automate the operation of imaging equipment to optimize the quality of images. If the IT systems that assist in patient scheduling were integrated with CT scanners, and the people who input the scheduling information include data specific to the type of patient and scan, IT algorithms might be written to automatically select and load ALARA protocols for consideration by the technologist running the scan.

Such automation would not supplant human control but rather enhance human performance, by simplifying an otherwise complex process, and in so doing, protect patients from unnecessary radiation exposure.