The ALARA (As Low As Reasonably Achievable) Concept in Pediatric Interventional and Fluoroscopic Imaging: Striving to Keep Radiation Doses as Low as Possible during Fluoroscopy of Pediatric Patients—A White Paper Executive Summary

Abstract

ALARA represents a practice mandate adhering to the principle of keeping radiation doses to patients and personnel As Low As Reasonably Achievable. This concept is strongly endorsed by the Society for Pediatric Radiology, particularly in the use of procedures and modalities involving higher radiation doses such as CT and fluoroscopic examinations of pediatric patients. There is no doubt that medical imaging, which has undergone tremendous technological advances in recent decades, is integral to patient care. However, these technological advances generally precede the knowledge of end-users concerning the optimal use and correct operation of the resulting imaging equipment, and such knowledge is essential to minimizing potential risks to the patients. Current imaging methods must be optimized for radiation dose reduction in pediatric patients who might be as much as ten times more radiosensitive than adults. Unlike straightforward radiographic examinations, radiation dose to the patient during fluoroscopy is dependent on the operator’s training, experience with the fluoroscope, and efficiency in completing a diagnostic study. The range of pediatric radiation doses from fluoroscopy is wide because this examination is performed not only by pediatric radiologists but also by general radiologists who occasionally care for children, interventional cardiologists, gastroenterologists, urologists and others. Thus, a venue where multidisciplinary interaction by this variety of operators can occur serves to improve pediatric patient care. The third ALARA conference organized by the Society for Pediatric Radiology was held in Orlando, Fla., on 11–12 February 2006. It was co-sponsored by the Office of Rare Diseases and the National Cancer Institute of the National Institutes of Health (NCI/NIH). The conference was funded by unrestricted educational grants from three manufacturers of fluoroscopic and interventional equipment (GE, Philips, Siemens) and financial support from the Society for Pediatric Radiology and NCI/NIH. The 22 faculty members consisted of 8 pediatric radiologists, 5 medical physicists, 3 pediatric subspecialists, 3 industry speakers, and 3 radiation epidemiology researchers. A diverse cadre of 74 pediatric radiologists, medical physicists, radiologic technologists, researchers, pediatric subspecialists and vendors met to examine the risk of radiation exposure from fluoroscopic and interventional procedures, identify means by which to reduce ionizing radiation exposure, and explore future technologic modifications that could optimize imaging while further reducing radiation exposures.