Optimisation of protection in pediatric radiology

Over recent years there has been increasing concern over the level of radiation exposure to the population from diagnostic radiology, and this is particularly the case for paediatric radiology. In addition, many regulatory authorities place particular importance on the optimization of exposures to paediatric patients. This lecture aims to review and summarise the existing guidance for radiation protection in paediatric radiology and recent developments in technology and methodology. Guidelines on technique and dose in paediatric radiology have been produced by the CEC and by departments in the UK, among others, and these will be discussed along with the most recent surveys of radiation dose and diagnostic reference levels for paediatric patients. The varying attitudes to paediatric radiation protection between centres will be explored. There are a variety of equipment issues affecting dose reduction in paediatric radiology, and those to be discussed include tube filtration, automatic exposure control devices, anti-scatter grids and pulsed fluoroscopy. Choice of technique plays a big part in radiation dose, and exposure factors need to be scaled down for smaller patients. Other technique issues include neonatal chest/abdomen radiography, the use of a well collimated radiation beam and the use of lead shielding to protect radiosensitive organs. Optimization of computed tomography examinations for children is of particular concern, and some proposals for dose reduction will be presented and discussed. One of the most effective ways of reducing dose from an x-ray examination is to prevent the need for a repeat exposure – a common occurrence with scared or reluctant paediatric patients. Some practical suggestions and examples of easy measures that can be taken in this regard will conclude the lecture, along with a brief mention of the associated radiation protection issues for staff and carers involved in paediatric radiology.