When Caring for Kids,
One Size Does Not Fit All
While it's difficult to prove that radiation exposure from CT scans and X-rays in children leads to cancer in later years, most health care professionals agree that radiation should be "dialed down" for smaller, developing bodies that have a lifetime to develop cancer.
The Alliance for Radiation Safety in Pediatric Imaging, a consortium of professional societies concerned about radiation exposure in children, launched a campaign called "Image Gently," which prompted hospitals and parents to look closely at how radiologic testing is administered to kids.
In 2009, the National Quality Forum (NQF) included in its publication, Safe Practices in Better Healthcare, a statement advising healthcare professionals that "when CT imaging studies are undertaken on children, child-size techniques should be used to reduce unnecessary exposure to ionizing radiation."
CT Scan Largest Contributor to Radiation Exposure
The largest contributor to radiation exposure in the world of radiologic studies is the CT scan. The United States is the second highest user of CT in children in the world, second only to Japan. In children, 33 percent of CT scans are performed on those younger than ten years old. "Healthcare professionals should consult a pediatric radiologist to determine if CT scan is indicated or if another modality without ionizing radiation can be performed," says Kristin Crisci, M.D., who is board certified in adult radiology with added qualifications in pediatric radiology. "CT scans can provide valuable and life-saving information, but we have to be mindful of how we deliver these tests to our youngest patients."
At Abington, through the leadership of Crisci, Joan Diaz, manager, Department of Radiology, Chrissy Lauro, R.N., safety/quality specialist, Center for Patient Safety and Healthcare Quality, and Ramanik Patel, senior medical physicist, an "Image Gently" campaign has been implemented whereby radiation protocols for adults have been altered for children.
According to Lauro, one of the ways this was accomplished was through the use of "phantoms," child-sized dummies that are put into the CT scanner to help calibrate the radiation based on their size and weight. Then the protocols are defined. So when a 60-pound eight-year-old comes into the Emergency Trauma Center after falling from a bike, our staff can rule out a head injury with a CT scan appropriate for a child this young based on its calibration with the phantom, as opposed to providing a standard scan which is set for a 165-pound adult.
"The level of radiation needed for adults is far more than what is needed for a child," says Lauro. "You don't want kids getting radiation doses equal to adults. Says Crisci, "As we use the lowest possible radiation dose for CT scans in our pediatric patients, we adjust other parameters to ensure image quality."
In addition to the establishment of new protocols and practices for delivering radiologic tests, practitioners were educated about when certain tests are indicated in children and "just in time" education occurs at time of test ordering.