Four steps radiologists and technologists can take

Reduce or "child size" the amount of radiation used - this can be done by talking to a medical physicist and asking him or her to determine the baseline radiation dose for an adult for your equipment and compare that dose with the ACR Standards. You can then access the Image Gently web site and view the protocols provided for children.


Scan only when necessary - the risk/benefit ratio for performance of a CT examination enhances the role of the radiologist consultant and provides an opportunity for educational interaction with the child's pediatrician who has unique medical knowledge critical to the care of the patient.

Scan only the indicated region - children protocols should be individualized.

Multiphase scanning is usually not necessary in children - CT with and without contrast material is rarely needed in children. Multiphase imaging often will double or triple the dose to the child and rarely adds to the diagnostic information of the study.

Dr. Phillip Silberberg, Pediatric Radiologist at Kosair Children's Hospital, Louisville, recognizes the importance of radiologists limiting radiation exposure during CT, especially to radiosensitive regions and recommends breast shielding be utilized in children and adolescents during a chest and abdominal CT. He stresses that "there is at least a 30% reduction of radiation to the breast by utilization of breast shields during chest and abdomen CTs, where the breasts are exposed. Children are particularly sensitive to radiation from CT scans," says Silberberg. "Research has shown that the younger the child at the time of the radiation exposure, the greater the risk of development of a cancer."

It is estimated that between four and seven million CT scans were done on children in 2007. And it appears that number is growing. There is no doubt that CT is an extremely valuable diagnostic imaging tool. It is, however, the increase in radiation to children that has become a public health issue, and the Image Gently campaign merely asks those that are in the practice of radiology to take a fresh look at their protocols and make adjustments accordingly - remembering that when it comes to children there must be an ongoing effort to ensure that medical protocols keep pace with advancing technology.

Dr. Margulis' paper also indicated that the review article in NEJM also failed to point out that companies manufacturing CT equipment also have been responsive in raising awareness of the dangers of performing unnecessary CT scans in children and have developed and recommended the use of dose reduction techniques for children.

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