David H. Foos

Patient safety underscores the future of pediatric imaging

March 12, 2021
By David H. Foos

Keeping the tiniest of patients safe during an X-ray exam underpins the advancement of digital radiography solutions for the pediatric population.

Reducing the pediatric patient’s amount of radiation exposure while still obtaining a viable image of high diagnostic quality has been a worthy aim in the realm of digital radiography. As we look ahead, optimizing dose efficiency will remain a key guidepost as new imaging solutions and software emerge in response to clinicians’ needs.

It is no secret that digital X-ray has become the most convenient imaging modality. It is often the first line of defense when it comes to obtaining accurate diagnoses. Still, children have unique needs. Not only are children more radiosensitive than adults, but they also have a longer expected lifetime, putting them at greater risk for cancer due to radiation exposure.

Keeping in mind the guidelines of the Image Gently Alliance and the radiation safety principle of As Low As Reasonably Achievable (ALARA), medical imaging research will continue to strive to minimize the number of needed exposures, focus on patient comfort and foster the relationship between the patient and provider.

Optimizing acquisition technique and processing parameters within the imaging pipeline are valuable mechanisms that can be leveraged to reach the appropriate radiation dose level for a patient. Software that provides a mechanism to index exposure and processing techniques based on a pediatric patient’s size offer flexibility for radiographic imaging systems to deliver diagnostic quality images that meet the display preferences among sites. More recently, machine learning methods to reduce noise appearance in digital radiographs, while preserving anatomical detail, have been demonstrated as effective means to improve the quality of images acquired at low dose — where noise appearance may be more pronounced. Additionally, diagnostic task-specific image-processing options such as tube and line visualization, pneumothorax enhanced visualization and rib contrast suppression are available to further assist radiologists to see subtle abnormalities.

Balancing dose and image quality when imaging pediatric patients requires high-performance detectors that offer excellent dose efficiency and high spatial resolution. For neonatal intensive care unit imaging, the best performing DR detectors are built with CsI scintillators, have 100 micron or less pixel pitch and will have form factors that allow the detector to readily fit into isolettes. Long-length imaging exams that formerly required multiple DR exposures be captured in sequence, then stitched together, have become easier with large form factor DR detectors that can acquire full spine or full leg radiographs in a single exposure. This advancement reduces the likelihood for repeat imaging caused by intra-exposure patient motion.

A more forward-looking technology that is under development will allow for some basic fluoroscopic exams to be performed at the patient bedside using a traditional portable DR machine. Recent studies have reported that such a capability could preclude the need to transport critically ill neonatal ICU patients to fluoroscopy rooms to perform upper GIs and voiding cystourethrograms (VCUGs), thus allowing these patients to remain within the security of the ICU. The benefit of such an approach could be considerable, as patient transport to and from the fluoroscopy room may require as much as two hours—thus increasing the possibility of adverse events—yet the exam itself may only require 10 minutes or less to perform. The ability to perform these procedures effectively at the patient bedside has the potential to reduce the risk of adverse events and lead to improved outcomes.

David H. Foos
Looking toward the next decade, technological innovations around dose efficiency, image quality and patient comfort will drive further progress as radiologists seek better health outcomes. As we aim to transform medical imaging in pediatrics, let’s remember to strike the essential balance for pediatric imaging and Image Gently.

About the author: David H. Foos is senior director of research and development at Carestream.