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Marilyn J Goske, Keith J Strauss,
Laura P Coombs,
Keith E Mandel,
Alexander J Towbin,
David B Larson,
Michael J Callahan,
Kassa Darge,
Daniel J Podberesky,
Donald P Frush,
Sjirk J Westra,
Jeffrey S Prince
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ABSTRACT: Purpose:To develop diagnostic reference ranges (DRRs) and a method for an individual practice to calculate site-specific reference doses for computed tomographic (CT) scans of the abdomen or abdomen and pelvis in children on the basis of body width (BW).Materials and Methods:This HIPAA-compliant multicenter retrospective study was approved by institutional review boards of participating institutions; informed consent was waived. In 939 pediatric patients, CT doses were reviewed in 499 (53%) male and 440 (47%) female patients (mean age, 10 years). Doses were from 954 scans obtained from September 1 to December 1, 2009, through Quality Improvement Registry for CT Scans in Children within the National Radiology Data Registry, American College of Radiology. Size-specific dose estimate (SSDE), a dose estimate based on BW, CT dose index, dose-length product, and effective dose were analyzed. BW measurement was obtained with electronic calipers from the axial image at the splenic vein level after completion of the CT scan. An adult-sized patient was defined as a patient with BW of 34 cm. An appropriate dose range for each DRR was developed by reviewing image quality on a subset of CT scans through comparison with a five-point visual reference scale with increments of added simulated quantum mottle and by determining DRR to establish lower and upper bounds for each range.Results:For 954 scans, DRRs (SSDEs) were 5.8-12.0, 7.3-12.2, 7.6-13.4, 9.8-16.4, and 13.1-19.0 mGy for BWs less than 15, 15-19, 20-24, 25-29, and 30 cm or greater, respectively. The fractions of adult doses, adult SSDEs, used within the consortium for patients with BWs of 10, 14, 18, 22, 26, and 30 cm were 0.4, 0.5, 0.6, 0.7, 0.8, and 0.9, respectively.Conclusion:The concept of DRRs addresses the balance between the patient's risk (radiation dose) and benefit (diagnostic image quality). Calculation of reference doses as a function of BW for an individual practice provides a tool to help develop site-specific CT protocols that help manage pediatric patient radiation doses.© RSNA, 2013Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13120730/-/DC1.
Radiology 03/2013; · 5.73 Impact Factor
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Quentin T Moore,
Steven Don,
Marilyn J Goske, Keith J Strauss,
Mervyn Cohen,
Tracy Herrmann,
Robert Macdougall,
Lauren Noble,
Greg Morrison,
Susan D John,
Lois Lehman
Radiologic technology 09/2012; 84(1):93-9.
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Pediatric Radiology 04/2012; 41:207-209. · 1.67 Impact Factor
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ABSTRACT: BackgroundPrior studies in adults suggest that a wedge-shaped peripheral consolidation may be predictive of pulmonary embolism (PE).
In contrast, a previous study in children provided no evidence of an association between this finding and PE, but it was limited
by a small sample size and was not specifically designed to answer this question.
ObjectiveTo compare the frequencies of parenchymal and pleural abnormalities in children with and without PE at multidetector computed
tomographic pulmonary angiography (CTPA).
Materials and methodsThe study population included 22 consecutive pediatric patients (11 males, 11 females; mean age 13.2 ± 5.8years; range 4months
to 18years) with PE diagnosed by CTPA from July 2004 to January 2009 and identified using our hospital database. The comparison
group included 22 randomly selected pediatric patients (10 males, 12 females; mean age 15.2 ± 3.3years; range 5.6 to 18years)
who underwent CTPA studies without evidence of PE during the same study period. All CTPA studies were reviewed by consensus
by two pediatric radiologists for the presence of parenchymal and pleural abnormalities including: wedge-shaped peripheral
consolidation, other forms of consolidation, atelectasis, linear opacity, ground-glass opacity, mosaic attenuation pattern,
nodule, mass, focal patchy increased attenuation, and pleural effusion. Differences in frequencies of parenchymal and pleural
abnormalities between the two groups were analyzed by logistic regression to determine odds ratios for association with PE.
The two groups were also compared with respect to risk factors for PE.
ResultsWedge-shaped peripheral consolidation was seen in eight children (36%) with PE and in two children (9%) without PE [odds ratio = 5.7,
95% confidence interval (CI): 1.2 to 30, p = 0.03]. There were no significant differences in the frequency of other findings between the groups (all p-values > 0.10). Prior history of neoplasm was the only independent risk factor significantly associated with the presence
of PE (p = 0.006).
ConclusionWedge-shaped peripheral consolidation is significantly associated with PE on CTPA studies of children. The identification
of a wedge-shaped peripheral consolidation in children should alert radiologists to carefully evaluate for concurrent PE.
Pediatric Radiology 04/2012; 40(2):173-181. · 1.67 Impact Factor
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ABSTRACT: We report our use of portable head computed tomography (CT) and the diagnostic yield and radiation dose from head CT in the pediatric intensive care unit (PICU).
204 PICU patients underwent head CT during 2008-2009. Therapeutic interventions and resource intensity during CT were categorized. Severity of illness was summarized using the pediatric risk of mortality (PRISM-III) model. Estimates of patient radiation dose were based on dose measurements made in four anthropomorphic head phantoms.
242 (62%) out of 391 head CT studies were portable. New pathology was identified on 80 (40%) scans. CT findings prompted a change in management in 46 (23%) patients; 25 of these resulted in life-extending treatments and 21 had forgoing of life-sustaining treatments within 24 hours. 26 patients with PRISM score greater than 30% underwent CT; 23 (88%) of these were portable. More portable versus fixed examinations were performed in patients requiring extracorporeal membrane oxygenation, inhaled nitric oxide, high levels of positive end expiratory pressure, and those with high vasopressor scores (P < 0.05). Estimated patient dose from portable CT was 83 ± 6 mGy compared to 72 ± 5 mGy for patients imaged on a fixed scanner (P < 0.0001).
Two-thirds of CT scans obtained in the PICU were portable because of patients' intensity of therapy and illness severity. Portable CT showed major new pathology in greater than 1/3 and led to a change in management in 1/4 of higher acuity patients scanned. The estimated radiation dose from portable CT is within the current national guidelines.
Neurocritical Care 09/2011; 16(2):251-7. · 2.47 Impact Factor
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ABSTRACT: State-of-the-art CT scanners typically display two dose indices: CT dose index (CTDI(vol) [mGy]) and dose length product (DLP [mGy-cm]) based on one of two standard CTDI phantoms (16- or 32-cm diameter) used in the calculation of CTDI(vol). CTDI(vol) represents the radiation produced by the CT scanner, not the radiation dose to an individual patient. Pediatric radiologists, aware of this discrepancy, have requested a method to estimate the CT patient dose based on the size of the pediatric patient or small adult. This paper describes the method developed by AAPM Task Group 204 to provide a better estimate of CT patient dose. These improved estimates of patient dose provide radiologists with a practical tool to better manage the radiation dose their patients receive. In the future, size-specific dose estimates (SSDE) received by the patient should be included in the patient's electronic medical record to help radiologists better assess risk versus benefit for their patients.
Pediatric Radiology 09/2011; 41 Suppl 2:472-82. · 1.67 Impact Factor
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Marilyn J Goske,
Kimberly E Applegate,
Dorothy Bulas,
Priscilla F Butler,
Michael J Callahan,
Brian D Coley,
Steven Don,
Donald P Frush,
Marta Hernanz-Schulman,
Sue C Kaste,
Gregory Morrison,
Manrita Sidhu, Keith J Strauss,
S Ted Treves
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ABSTRACT: Significant progress has been made in radiation protection for children during the last 10 years. This includes increased awareness of the need for radiation protection for pediatric patients with international partnerships through the Alliance for Radiation Safety in Pediatric Imaging. This paper identifies five areas of significant progress in radiation safety for children: the growth of the Alliance; the development of an adult radiation protection campaign Image Wisely™; increased collaboration with government agencies, societies and the vendor community; the development of national guidelines in pediatric nuclear medicine, and the development of a size-based patient dose correction factor by the American Association of Physicists in Medicine, Task Group 204. However, many challenges remain. These include the need for continued education and change of practice at adult-focused hospitals where many pediatric CT exams are performed; the need for increased emphasis on appropriateness of pediatric imaging and outcomes research to validate the performance of CT studies, and the advancement of the work of the first pediatric national dose registry to determine the "state of the practice" with the final goal of establishing ranges of optimal CT technique for specific scan indications when imaging children with CT.
Pediatric Radiology 09/2011; 41 Suppl 2:461-6. · 1.67 Impact Factor
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ABSTRACT: OBJECTIVE: The Image Gently Campaign of The Alliance for Radiation Safety in Pediatric Imaging seeks to increase awareness of opportunities to lower radiation dose in the imaging of children. Pause and Pulse is the most recent phase of the campaign, addressing methods of dose optimization in pediatric fluoroscopy. CONCLUSION: This article discusses 10 steps that can be taken for fluoroscopic dose optimization in pediatric diagnostic fluoroscopy.
American Journal of Roentgenology 08/2011; 197(2):475-81. · 2.78 Impact Factor
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Marilyn J Goske,
Kimberly E Applegate,
Dorothy Bulas,
Priscilla F Butler,
Michael J Callahan,
Brian D Coley,
Steven Don,
Shawn Farley,
Donald P Frush,
Marta Hernanz-Schulman,
Sue C Kaste,
Gregory Morrison,
Manrita Sidhu, Keith J Strauss,
S Ted Treves
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ABSTRACT: The Radiation Protection in Medicine conference, reviewed in this journal supplement, outlined nine strategies to promote radiation protection for patients. The Alliance for Radiation Safety in Pediatric Imaging has focused its work on three of those areas: creating awareness of the need and opportunities for radiation protection for children; developing open-source educational materials for medical professionals and parents on this critical topic for improved patient safety and communication; and lastly, advocating on behalf of children with industry, government and regulatory bodies to improve equipment design and safety features, standardisation of nomenclature and displays of dose reports across vendor platforms that reflect the special considerations of children.
Radiation Protection Dosimetry 07/2011; 147(1-2):137-41. · 0.82 Impact Factor
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Pediatric Radiology 05/2011; 41(5):547-8. · 1.67 Impact Factor
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ABSTRACT: This study aimed to characterize radiation dose during cardiac catheterization in congenital heart disease and to assess changes in dose after the introduction of a radiation monitoring policy.
Minimizing radiation exposure is an important patient safety initiative and relatively few data are available characterizing radiation dose for the broad spectrum of congenital cardiac catheter-based interventions.
Radiation dose data were reviewed on all cases since 7/1/05 at a single large center. Procedures were classified according to 20 common case types then subdivided into five age categories. Groups with <20 cases were excluded. Radiation dose was estimated by cumulative air KERMA (mGy) and DAP (dose area product, μGym(2)) which were reported as median and interquartile range (IQR). We also examined differences in radiation dose before and after the implementation of a radiation policy.
Between 7/1/05 and 12/10/08, 3,365 cases were identified for inclusion. Radiation dose increased with age and procedural complexity. Patients were characterized into low, medium, and high dose categories relative to each other. "Low" dose cases included isolated pulmonary or aortic valvotomy, pre-Fontan assessment, and ASD closure. "High" dose cases involved multiple procedures in pulmonary arteries or veins. After introduction of a radiation policy, there was a significant decrease in radiation dose across a variety of case types, particularly among infants and young children.
Radiation dose in congenital cardiac catheterization varies by age and procedure type. A radiation monitoring and notification policy may have contributed to reduced radiation dose.
Catheterization and Cardiovascular Interventions 04/2011; 79(2):294-301. · 2.29 Impact Factor
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ABSTRACT: The primary goal of radiation management in interventional radiology is to minimize the unnecessary use of radiation. Clinical radiation management minimizes radiation risk to the patient without increasing other risks, such as procedural risks. A number of factors are considered when estimating the likelihood and severity of patient radiation effects. These include demographic factors, medical history factors, and procedure factors. Important aspects of the patient's medical history include coexisting diseases and genetic factors, medication use, radiation history, and pregnancy. As appropriate, these are evaluated as part of the preprocedure patient evaluation; radiation risk to the patient is considered along with other procedural risks. Dose optimization is possible through appropriate use of the basic features of interventional fluoroscopic equipment and intelligent use of dose-reducing technology. For all fluoroscopically guided interventional procedures, it is good practice to monitor radiation dose throughout the procedure and record it in the patient's medical record. Patients who have received a clinically significant radiation dose should be followed up after the procedure for possible deterministic effects. The authors recommend including radiation management as part of the departmental quality assurance program.
Radiology 11/2010; 257(2):321-32. · 5.73 Impact Factor
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ABSTRACT: OBJECTIVE: The Image Gently, Step Lightly campaign is an education and awareness campaign focusing on radiation safety in pediatric interventional radiology. To promote radiation safety by standardizing workflow and encouraging team responsibility, the campaign Website includes a procedural checklist that the medical team may use to review radiation safety steps before each pediatric interventional procedure. CONCLUSION: Use of this checklist can be an effective tool in the ongoing effort to maximize radiation safety during interventional procedures.
American Journal of Roentgenology 10/2010; 195(4):W299-301. · 2.78 Impact Factor
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ABSTRACT: Pediatric interventional radiology procedures are becoming increasingly common in the medical community, in part due to the significant medical benefit derived from these studies. At the same time, the medical radiation used for these studies contributes to the radiation dose to this unique population of patients. As children are more sensitive to radiation than adults and have a longer lifetime to manifest those changes, a concerted effort should be made toward radiation protection in this setting. Pediatric interventional procedures may differ from adult examinations in several ways, including the small size of the patient, the proximity of the operator's body and hands to the beam, and small body spaces resulting in precarious wire purchase. We describe specific strategies to improve patient and staff safety. These include staff education, safety checklists, a team approach, and formalized review and quality assurance programs. Practical steps to reduce patient dose are reviewed, and tools to assist in achieving the goal of optimizing radiation safety in children undergoing interventional procedures are provided.
Techniques in vascular and interventional radiology 09/2010; 13(3):158-66.
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ABSTRACT: The purpose of our study was to measure patient size on CT images as a function of age at a large tertiary care children's hospital to develop current patient size data for modeling optimal x-ray exposure factors in children.
Anteroposterior and transverse dimensions of the head, thorax, abdomen, and pelvis were measured on CT examinations of pediatric patients less than 21 years old performed between June and November 2007. Patients with diseases that could affect measurements were excluded. From 1,009 patients, 336 examinations of each of four body regions were selected; 2,688 measurements were made and separated into 21 groups. Statistical model building and prediction equations were established for each region and 95% prediction intervals were used for analyses.
Rapid growth of the head occurred from birth to approximately 2 years followed by a gradual plateau until 21 years. The thoracic, abdominal, and pelvic regions showed a linear relationship between age and size. Fitted equations showed transverse trunk measurements increased more rapidly than anteroposterior measurements. The anteroposterior trunk size growth rate was relatively region independent; transverse pelvic dimensions grew more rapidly than thoracic or abdominal regions. There was a broad overlap of predicted patient size ranges as a function of age within each region. Excellent interobserver agreement was measured by Pearson's correlation coefficient (r) (all p < 0.0001).
Fitted average patient sizes are age dependent; however, predicted individual patient size does not correlate well with age. Our study suggests that pediatric patient body size should be determined for individual patients before performing diagnostic imaging procedures that entail radiation risks.
American Journal of Roentgenology 06/2010; 194(6):1611-9. · 2.78 Impact Factor
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American Journal of Roentgenology 04/2010; 194(4):868-73. · 2.78 Impact Factor
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ABSTRACT: The aim of this study was to assess the effects of radiation dose reduction on the assessment of the tracheal lumen on expiratory multidetector computed tomographic (MDCT) images of pediatric patients referred for evaluation for tracheomalacia (TM).
The hospital information system was used to retrospectively identify 20 standard-dose and 20 reduced-dose paired inspiratory and expiratory MDCT studies performed for the evaluation of suspected TM in pediatric patients (aged <or= 18 years). The reduced-dose technique used a 50% reduction of the tube current for the expiratory portion of the study compared to the standard-dose technique. Two experienced pediatric radiologists, who were blinded to the tube current of the study, reported their levels of confidence for measuring the tracheal lumen using a four-point scale ranging from zero (no confidence) to three (highest level of confidence). The difference in confidence level between the two groups of studies was analyzed using the Mann-Whitney U test. The percentage of radiation dose reduction using the reduced-dose technique in comparison to the standard-dose technique was estimated using anthropomorphic thorax phantoms. The presence or absence of TM (>or=50% expiratory reduction in tracheal cross-sectional luminal area) on MDCT imaging was compared to bronchoscopic results for the subset of 32 patients who underwent both procedures.
A high level of confidence was reported for measuring the tracheal lumen on MDCT imaging for both standard-dose (median, 3.0) and reduced-dose (median, 3.0) expiratory sequences (P = .80). The total radiation dose of the paired inspiratory-expiratory computed tomographic (CT) exam was decreased by 23% with the reduced-dose technique. TM was diagnosed by CT imaging in seven patients who underwent standard-dose and six patients who underwent reduced-dose paired inspiratory and expiratory MDCT studies. CT results for the presence or absence of TM were concordant with the results of bronchoscopy in all 32 patients who underwent both procedures.
The radiation dose of paired inspiratory-expiratory CT imaging can be reduced by 23% while maintaining similar diagnostic confidence for assessment of the tracheal lumen compared to a standard-dose technique in pediatric patients. Thus, a reduced-dose technique is recommended for evaluating TM in children.
Academic radiology 04/2010; 17(4):504-10. · 2.09 Impact Factor
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Marilyn J Goske,
Kimberly E Applegate,
Coreen Bell,
Jennifer Boylan,
Dorothy Bulas,
Penny Butler,
Michael J Callahan,
Brian D Coley,
Shawn Farley,
Donald P Frush,
Ceela McElveny,
Marta Hernanz-Schulman,
Neil D Johnson,
Sue C Kaste,
Gregory Morrison, Keith J Strauss
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ABSTRACT: The Alliance for Radiation Safety in Pediatric Imaging is an organization of over 45 international professional societies and agencies with the goal of promoting radiation safety for children. The Alliance, through the Image Gently campaign, uses social marketing techniques and critical partnerships with vendors, government agencies, and not-for-profit organizations, to advocate best practices in radiation use and safety. Advocacies include improving education regarding radiation risk to patients from medical imaging for radiologists, technologists, and referring physicians; promoting standardization of dose measurements and display across vendor equipment; and improving medical literacy for parents.
Seminars in Ultrasound CT and MRI 02/2010; 31(1):57-63. · 1.24 Impact Factor
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Medical Physics 12/2009; 36(12):5719-20. · 2.83 Impact Factor
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ABSTRACT: The purpose of this study was to address the controversy whether the quality of volumetric high-resolution CT (HRCT) images is as good as that of axial nonvolumetric HRCT images by assessing the degree of motion artifact on images acquired with the two methods at MDCT of pediatric patients with known or suspected lung disease.
A search of the hospital information system was conducted to identify the cases of pediatric patients with clinically suspected or known interstitial lung disease who underwent 16-MDCT of the chest with both volumetric and axial HRCT acquisitions (both 1.25-mm slice thickness) from March 2005 to July 2008. Two pediatric radiologists reviewed the images for the presence of motion artifacts at three anatomic levels (upper, middle, and lower lung zones). Motion artifacts were given numerical grades representing no artifact to severe artifact, and the paired Student's t test was used to compare the scores for the two acquisition methods. A total motion score for each acquisition was calculated by summing the scores for each of the three lung zones, and the scores for the two imaging methods were compared. Correlation between degree of motion artifact and age was evaluated. Effective radiation doses were estimated for volumetric and axial CT acquisitions.
The study population consisted of 54 children (28 boys, 26 girls; mean age, 11.7 +/- 3.8 years; range, 5-18 years; eight inpatients, 46 outpatients) who underwent a total of 54 MDCT chest studies with volumetric and axial HRCT acquisitions. Motion artifact scores were higher for axial than for volumetric HRCT images of the upper (1.2 vs 1.0), middle (1.6 vs 1.2), and lower (2.2 vs 1.5) lung zones (p < 0.05 at each level). The total motion score of the axial HRCT images (mean, 5; range, 1-9) was higher than that of the volumetric HRCT images (mean, 3.6; range, 1-8) (p < 0.05). Younger age correlated with higher motion artifact score on axial HRCT images (r = -0.36, p < 0.01), whereas no correlation was found between age and motion artifact score on volumetric HRCT images (r = -0.12, p = 0.38). The effective radiation doses were 0.57 mSv for axial HRCT acquisition and 7.6 mSv for volumetric acquisition. The addition of axial acquisition increased the total radiation dose of the MDCT examination 7.1%.
At CT of pediatric patients, reconstructed HRCT images from volumetric MDCT acquisition have significantly less motion artifact than images obtained with traditional axial acquisition.
American Journal of Roentgenology 11/2009; 193(5):1414-8. · 2.78 Impact Factor
