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Q&A with Dr. Donald P. Frush; A more personalized approach to pediatric CT exams

by John R. Fischer, Senior Reporter | March 09, 2018
CT Pediatrics X-Ray
From the March 2018 issue of HealthCare Business News magazine

DF: It’s one example of how this can be done to optimize your practice. It doesn’t say because this was published or what we did, now everyone can know how to do a CT scan in a child. What that model does is take into account things that we need to think about when we do CT scanning. That starts first of all with the questions, ‘What are you looking for? What kind of disease process or disorder are you looking for?’

It’s not necessarily chest CT-based or abdomen CT-based, meaning you don’t just do an abdomen CT for everything. Depending on what you’re looking for, that abdomen CT would be modified. It’s clinical indication and it’s size. That size from a public standpoint equates to age, which is not quite correct because you can have big young people and small old people. The size that we talk about is really cross-sectional area CT. It’s sometimes body surface area. It’s sometimes age. Those are variable, but the general term is size. The best physical dimension is the thickness of the patient.

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Aside from indication and size, what is the gender? What organ are you looking at when you’re trying to calculate and estimate risk? Girls, for instance, might have different sensitivities to radiation due to breast tissue and some other considerations, making this a gender-related matter.

It’s also what kind of image quality you want. Someone may feel comfortable looking at a noisy image for kidney stones and someone else may not feel that they can do that. It’s what the radiologist needs in overall image quality. It’s the scan indication. It’s the size of the patient and gender considerations related to risk.

What we did was take all of those ingredients and put them together. If you adjust doses, your risk is going to change. Your image quality is going to change. It’s the interplay in the relationship of those so that, in the end, taking all of those things into account for a specific indication, which might be lung nodules in a pediatric patient, you come out with a protocol that is accountable to all of these things.

HCB News: How does this approach to imaging compare with the conventional approach at most facilities?

DF: I think that most imaging professionals -- radiologists, technologists, medical physicists, that sort of a group of imaging professionals -- have an understanding and respect for these kinds of things. People understand that we use radiation, that radiation may cause injury. People understand we may need to do things a little differently based on size, and people have a general understanding that some types of exams of the abdomen can be done a little differently than other types of exams of the abdomen.

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