The pediatric radiologists and radiologic technologists at the Joe Buck Imaging Center at St. Louis Children’s Hospital are aiming to become a national leader in low-dose radiology for one important reason: the welfare of their patients.
“When you are dealing with children, it isn’t ‘one size fits all,’” says Elissa Rogers, RT(R), supervisor, ancillary services for the imaging center. “At Children’s, we provide radiology services to premature infants weighing less than a pound to 18 year olds weighing 200 pounds. Our goal is to use the least amount of radiation to produce quality images that provide physicians with the information they need for diagnosis and treatment. This is especially critical because many of the pediatric patients we see have chronic illnesses that require multiple imaging studies over time.”
The imaging center adheres to the ALARA radiation safety principle: keeping radiation as low as reasonably achievable. It also supports the efforts of Image Gently, an initiative of the Alliance for Radiation Safety in Pediatric Imaging that has the goal of changing practice by increasing awareness of opportunities to lower the radiation dose in the imaging of children.
“Our first advantage over other imaging centers is that our equipment is calibrated exclusively to the pediatric population. We aren’t using adult machines adjusted for children,” says Rogers. “All of our radiation technologists are registered with the American Registry of Radiologic Technologists, but beyond that they receive in-depth training in how to image children. Each patient’s radiation dose is calculated based on the child’s age, weight and health. For instance, the radiation dose for a child with cystic fibrosis would be different than that of a healthy child of the same age and weight. We do this for every patient, even for those who have reached what would be considered their full growth.”
To ensure that the lowest radiation doses possible are used, ongoing quality improvement projects continually improve upon existing knowledge. “As an example, we are currently watching doses on head and facial CT scans to determine if we can lower the dosage but still obtain a quality image,” says Rogers. “The volume of patients we see allows us to gather the kind of statistical data we need to make improvements.”
That volume leads to another advantage of SLCH’s imaging center—experience. In 2009, the imaging center served more than 7,000 patients needing CT scans, 68,000 needing plain X-rays and approximately 1,200 undergoing nuclear medicine imaging. Within the imaging center’s new interventional radiology suite, 1,000 patients underwent procedures.
Jim Duncan, MD, PhD, interventional radiologist with the Mallinckrodt Institute of Radiology, compares the experience of pediatric radiologists and radiologic technologists at the imaging center with that of a professional musician.
“An experienced musician can ‘name that tune’ after three or four notes, while someone without that background needs to hear a whole verse before recognizing the song,” he says. “Pediatric radiologists and pediatric interventional radiologists work with and think about children every day. As a result, they can determine whether they have enough information to make a diagnostic decision much more quickly than those who don’t have that expertise. That results in lower doses of radiation for pediatric patients across the board.”
Dr. Duncan has used his expertise in pediatric interventional radiology to help imaging center staff members further their efforts in studying and implementing low-dose radiation procedures. Among those efforts is establishing the means to track the amount of radiation patients receive over time.
“The pediatric interventional radiology equipment we use indicates how much radiation is being used second to second and how much is used for the whole procedure. We are beginning to use the same process for CT exams so that we have an easily accessible, accurate record for each patient,” says Dr. Duncan. “For any radiologic procedure, the basic principle should be that we have a radiation budget. For each patient, we need to spend our radiation wisely, live within the budget and always try to reduce the amount of radiation which in turn improves the long-term result.”