Children are particularly sensitive to radiation from imaging scans and cumulative radiation exposure to their developing bodies could well have adverse effects over time. It's estimated that between four and seven million CT scans were performed on children last year - and that number's growing. The techniques used in paediatric imaging, however, are not necessarily always tailored to children's smaller bodies, resulting in radiation exposures that are greater than needed.

Now, an alliance of 13 medical societies has launched the Image Gently campaign, an effort to ensure that medical protocols for imaging children keep pace with technology advances. This collaboration - the Alliance for Radiation Safety in Pediatric Imaging - was founded last July by four professional bodies: the American Association of Physicists in Medicine (AAPM); the Society for Pediatric Radiology (SPR); the American College of Radiology; and the American Society of Radiologic Technologists.

"Children are not just 'smaller adults'. Their bodies are different and require a different approach to imaging," explained Marilyn Goske, alliance chair and board chair of the SPR. "Ultimately, we hope to change the way all children are imaged in the US, using kid-size, not adult-sized radiation doses. It's an ambitious goal, but one that we feel must be achieved."

Dose dilemma
The Image Gently campaign will initially focus on reducing CT dose - a somewhat controversial issue of late, following a publication in the New England Journal of Medicine last November (N. Engl. J. Med. 357 2277). The article raised concerns about the escalating use of CT, stating that "the increasing exposure to radiation in the population may be a public health issue in the future". Bodies such as the AAPM, however, responded by emphasising that such concerns must not scare people away from CT scanning, which plays a critical role in saving lives.

"There may be disagreement within the medical community about the accuracy of the risk models or the degree to which the risks of radiation were emphasized by the authors," explained Goske, writing in the latest issue of the American Journal of Roentgenology (AJR 190 273). "These arguments will not be settled in the near term. However, one fact is indisputable: we must continue our efforts to do a better job of reducing radiation dose to children if and when they need a CT scan."

To raise awareness and help reduce radiation exposure from paediatric imaging exams, Image Gently is pushing four key guidelines:
• Reduce, or child-size, the amount of radiation used when obtaining a CT scan in children.
• Scan only when necessary, i.e., when the expected benefits to the patient exceed the overall risk.
• Only scan the indicated region, using an individualized protocol.
• Only scan once. Multiphase imaging can double or triple the dose and is rarely needed in children.

Poster
Poster

In addition, the campaign urges providers who perform imaging exams on children to work with medical physicists in order to monitor paediatric CT techniques, and to involve the radiology technologists to optimize scanning. To this end, the Image Gently website (www.imagegently.org) provides a raft of information describing how to achieve these goals.

For starters, the site contains child-specific imaging protocols that are independent of equipment manufacturer, age of machine or number of detectors. Other resources include the latest research and educational materials to help radiologists, technologists, medical physicists and other imaging stakeholders determine the appropriate radiation techniques to use when imaging children.

"Although CT provides outstanding images that are critical to the management of patient care, it is one of the higher dose examinations performed today," commented AAPM president Mary Martel. "For this reason, it is most important that physicians have a firm understanding of the physics and technology of CT to enable them to judiciously select imaging parameters to eliminate unnecessary doses to these children."

To date, nine organizations have also joined the alliance as affiliate partners: American Academy of Pediatrics; American Osteopathic College of Radiology; American Registry of Radiologic Technologists; American Roentgen Ray Society; Association of University Radiologists; Conference of Radiation Control Program Directors; National Council on Radiation Protection and Measurements; Radiological Society of North America; Society of Computed Body Tomography and Magnetic Resonance.