Minimising Ionising Radia-on Exposure in Paediatric Radiology
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1 Minimising Ionising Radia-on Exposure in Paediatric Radiology Alexandra Tavares Ferreira Hospital Dona Estefânia CHLC Coordenadora Radiologia- Dra. Eugénia Soares 19 Setembro 2013
2
3 Imaging Exams Ultrasound Xray/ Fluoroscopy CT MRI
4 Imaging Exams Ultrasound Xray/ Fluoroscopy CT MRI Children: Ø more radiosensi-ve Ø Increased life-me cancer risk
5 Imaging Exams Ultrasound Xray/ Fluoroscopy CT MRI Disney. Pixar
6 Imaging Exams Ultrasound Xray/ Fluoroscopy CT MRI Disney. Pixar
7 Dose Datamed report 1, 2008 Exam type Typical E per examina9on (msv) Thorax (PA + lat) 0, ,05 CT chest 4, ,76 Dose Datamed 2 Portugal, 2012
8 1. Do we need it?
9 Reduce radia9on exposure Avoid unnecessary exams NO EXAM = NO RADIATION!
10 Reduce radia9on exposure Avoid unnecessary exams NO EXAM = NO RADIATION! Adequate communica-on between referring physician and radiologist Eliminate inappropriate CT referrals
11
12 CT limita9ons in Children Few visceral fat 11 Y 48 Y
13 CT limita9ons in Children Respiratory ar-facts ü Do not cooperate ü Seda-on
14 Reduce radia9on exposure Use alterna-ve examina-ons with less or no radia-on exposure US first- line imaging exam most abdominal, neck and musculoskeletal indica-ons
15 N=1014
16 CT MRI US X ay Fluo
17 2. Let s do it!
18 As Low As Reasonably Achievable
19 As Low As Reasonably Achievable Diagnos9c image quality vs Op9mal image quality (certain amount noise is acceptable)
20 Radia9on Dose Image Quality
21 Protec9ve shields Xray Energy delivered by CT is not fully contained within the scanning volume
22 Adjust protocol to clinical informa9on Limit volume scan Limit number phases ü avoid precontrast CT scan ü if unenhanced imaging is indicated, limit scanning area Diagnos-c/ follow- up ü low- dose CT
23 CT scan parameters Tube current Pa-ent dose directly propor-onal to tube current Lowest possible ma Protocols ü Weight- based ü Adapted to body region
24 CT scan parameters Tube current Siegel, Pediatric body CT, 2008 Thorax: inherent high contrast resolu-on Abdomen: structures low- contrast resolu-on
25 CT scan parameters Tube voltage Reduc-on tube voltage: ü Reduc-on radia-on ü Increase noise 80 kv 120 kv Siegel, Pediatric body CT, 2008
26 CT scan parameters Tube voltage Reduc-on tube voltage: ü Reduc-on radia-on ü Increase noise 80 kv Low- voltage for smaller pa-ents, usually < 45 Kg 120 kv Siegel, Pediatric body CT, 2008
27 Take home messages Ø Jus-fica-on eliminate innapropriate referrals alterna-ve imaging modali-es with no radia-on Ø Op-misa-on dose op-misa-on rather than dose reduc-on per se weight- based protocols, adapted to clinical indica-ons and body region
28 Bibliography Nievelstein RAJ, van Dam I, van der Molen AJ. Mul-detector CT in children: current concepts and dose reduc-on strategies. Pediatric Radiology 2010; 40: Kalra MK et al. Strategies for CT radia-on dose op-miza-on. Radiology 2004; 230: Siegel MJ. Pediatric body CT nd ed Lippincoj Williams& wilkins, Philadelphia Donnelly LF. Reducing radia-on dose associated with pediatric CT by decreasing unnecessary examina-ons. AJR 2005; 184: Donnelly LF, et al. Minimizing radia-on dose for pediatric body applica-ons of single- detector helical CT:strategies at a large children s hospital.ajr 2001; 176: Wrixon AD. New ICRP recommenda-ons. Journal of Radiological Protec-on. 2008; 28: Interna-onal Comission on Radiological Protec-on. Publica-on Schauer DA, Linton O. Na-onal Council on Radia-on Protec-on and Measurements report shows substan-al medical exposure increase. Radiology 2009; 253: European comission. Radia-on protec-on N 154, DD report 1, review of recent na-onal surveys of popula-on exposure from medical xrays in europe Teles P et al, Dose Datamed 2 portugal Huda w, Ogden KM, Khorasani MR. Conver-ng dose- length product to effec-ve dose at CT. Radiology 2008; 248:
29 Thank you!
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