Campaign Focuses on Need to "Pause and Pulse" in Pediatric Fluoroscopy
Continuing its mission of increasing awareness of the opportunities to lower
radiation dose in pediatric imaging, the Alliance for Radiation Safety in
Pediatric Imaging (the Alliance) is launching the Image Gently™ campaign’s
fourth phase - "Pause and Pulse" - with a focus on diagnostic fluoroscopic
Since its inception three years ago, the Alliance has grown into an
international coalition of 57 member medical societies. In previous campaign
phases, Image Gently™ reached out to radiologists, referring physicians, medical
physicists, radiologic technologists, and parents, to spotlight benefits and
potential risk related to medical imaging in computed tomography (CT) (January
2007) and interventional radiology (August 2009), and to promote medical
literacy among parents (January 2008).
"There is no doubt that medical imaging saves lives, but children are
particularly susceptible to the potential adverse effects of radiation, so
fluoroscopic procedures should be used wisely with dose optimization in
accordance with the ALARA principle — As Low as Reasonably Achievable," says
Marta Hernanz-Schulman, MD, FAAP, FACR, professor of radiology and pediatrics at
Vanderbilt University Medical Center and chair of the fluoroscopy campaign.
The availability of endoscopy and CT has reduced the number of fluoroscopic
procedures, but fluoroscopy sometimes provides the only non-invasive method of
making a diagnosis or monitoring treatment. The international push to lower
radiation dose has spurred tremendous innovation in fluoroscopic equipment. The latest equipment, Hernanz-Schulman
notes, often achieves "significant reductions in dose while maintaining, and
sometimes significantly improving, image quality."
“Pulsing the X-ray is one of the
greatest dose-savings measures in fluoroscopy and is especially important to
children with smaller bodies and greater vulnerability to radiation," Hernanz-Schulman
says. "But even before this, radiologists need to pause and make sure the study
is indicated for the clinical problem. As with any test, there should be clear reasons to request the study. In some
situations ultrasound or occasionally magnetic resonance imaging (MRI)
could provide similar information without exposing a child to radiation."
Radiologists can utilize numerous techniques to significantly decrease the amount of radiation
children are exposed to while still allowing diagnostic-quality images. These
having a clear initial understanding of the patient’s problems and goals of
limiting fluoroscopic time in general and limiting use of magnification mode
careful collimation to the area of interest and appropriate shielding
matching tube output (kVp and mAs) to the size of the child
utilizing pulsed digital fluoroscopic equipment with adjustable frame speeds
as well as last image hold and capture capability
To ensure that a qualified, experienced and credentialed medical team is performing the
fluoroscopic examination with fluoroscopic equipment suitable to children,
referring physicians and parents are encouraged to ask:
if the facility is
accredited by the ACR
technologists are certified
how frequently the
facility performs the requested fluoroscopic study in children
board-certified radiologist with pediatric experience or a pediatric radiologist
will be performing and interpreting the study
Ishtiaq Hussain Bercha,
MSc, lead medical physicist on the fluoroscopy phase of Image Gently™ and a
medical physicist at The Children’s Hospital, Colorado, notes, "The medical
physicist, having a background in physical sciences as applied to medicine,
is uniquely positioned to help optimize the whole procedure, including radiation
safety. The bottom line is that the physicist should work very closely with all of the
professionals involved." He also notes the need
to recognize potential radiation exposure to the fluoroscopist and assisting
personnel when the medical team is trying to immobilize and position the child
during a procedure.
As always, the radiologic technologist has a key role.
"Reducing dose is a team effort.
Acquiring an optimal pediatric fluoroscopic exam with
minimal radiation dose to the patient must be a coordinated effort between the
radiologist, physicist and the
radiologic technologist,” says Greg Morrison, MA, RT(R), CNMT, CAE, chief
operating officer of the American Society of Radiologic Technologists (ASRT) and
a member of the Alliance’s steering
"We really need to image our kids with care,"
Hernanz-Schulman notes. "During the fluoroscopy, the Image Gently™ Pause and Pulse Campaign
reminds medical professionals to pause
to properly plan and prepare for study; to activate dose saving features of
equipment; to take no exposures unless necessary; to depress last image hold
instead; and to pulse at the lowest
possible frame rate."
More information is available at www.imagegently.org.