Pause and Pulse: Radiation Dose in Pediatric Fluoroscopy

Abstract

1. Beverley Newman, MD* 2. Susan John, MD† 3. Marilyn Goske, MD‡ 4. Marta Hernanz-Schulman, MD§ 1. *Professor of Radiology, Department of Pediatric Radiology, Lucile Packard Children's Hospital at Stanford University, Stanford, CA. 2. †Professor of Diagnostic Imaging and Pediatrics, University of Texas Houston Medical School, Houston, TX. 3. ‡Staff Radiologist, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 4. §Medical Director, Vanderbilt University Medical Center, Diagnostic Imaging, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN. After completing this article, readers should be able to: 1. Understand the issues and concerns surrounding ionizing radiation in children and the relative doses associated with different imaging procedures. 2. Recognize the role of the pediatrician in patient and parent preparation, providing useful clinical information, and collaborating with radiology to obtain the most appropriate imaging study at an experienced and properly equipped facility. 3. Describe the most important dose-saving measures available in pediatric fluoroscopy. 4. Access the Image Gently online educational materials on pediatric radiation dose reduction, including the most recent Pause and Pulse fluoroscopy initiative. A mother brings her 9-week-old infant to your office. The child is lethargic and has a history of bilious vomiting. You suspect a malrotation complicated by a midgut volvulus. You consult the pediatric radiologist with whom you collaborate and request an upper gastrointestinal (UGI) examination. The radiologist calls to inform you that the child, indeed, has a malrotation with mid-gut volvulus. You call the emergency department and expedite her admission to the hospital for urgent surgery, which later confirms your clinical diagnosis. Medical imaging has revolutionized patient care, expediting management and obviating unnecessary surgery and more invasive procedures. As in the case study, medical imaging has the potential to help diagnose potentially life-threatening conditions. Yet, many imaging techniques, such as radiographs, fluoroscopy, computed tomography (CT) scan, and nuclear medicine, use ionizing radiation to produce diagnostic images. The medical community, government agencies, and the news media all have expressed concern about medical radiation dosing. (1)(2)(3)(4) Rare instances of medical error leading to excessive radiation and patient injury have been highlighted in …