Protecting Our Smallest Patients

The Commission on Pediatric Radiology advocates for its patients and advances the subspecialty.

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The commission encompasses committees on Quality and Safety, Education, Economics, Advocacy, and Research.

Through the work of these committees, the commission works with the ACR to advance the benefits of subspecialty care to children; to provide safe, appropriate, and effective imaging for children; to optimize access to pediatric imaging services; to educate radiologists who provide imaging services to pediatric patients; and to encourage research to discover truly noninvasive and effective pediatric imaging procedures and protocols.

The commission works closely with the Society for Pediatric Radiology (SPR). Why is it important for pediatric radiologists to also join the ACR?

The Society for Pediatric Radiology is the home for our subspecialty. One of my goals as chair of the ACR commission is to work closely with the Commission on Membership and Communications to communicate to SPR members the immense value of membership in the ACR. This membership translates not just into many benefits for the individual, such as access to educational opportunities, but more importantly, it benefits our specialty and our profession. Moreover, within the ACR, the voice of pediatric radiologists can resonate within the mission and various commissions of the ACR, with the College's successes accruing to our pediatric patients.

What about radiation dose optimization in pediatric patients?

We believe that diagnostic imaging examinations should be optimized for patients of all ages. However, children need special treatment when it comes to imaging, which goes back to the oft-quoted axiom that children are not little adults. There are many reasons children must be imaged differently: because their cells are dividing, because they are likely to have many other studies in their lifetimes, because their remaining lifespan is sufficiently long to extend beyond the latency stage for development of malignancy, and because using the same imaging parameters appropriate for adults results in larger effective doses in smaller patients.

The Commission on Pediatric Radiology strongly supports the use of appropriate imaging parameters in the pediatric patient, and our members are involved in the Alliance for Radiation Safety in Pediatric Imaging (better known as the Image Gently® campaign), begun by the SPR, the ACR, the American Society for Radiologic Technologists, and the American Association of Physicists in Medicine. A major goal of the alliance has been to raise awareness of the importance of dose optimization for children in diagnostic imaging. One of the effects of this campaign and of the Image Wisely® campaign (which focuses on radiation dose for adult patients) has been to encourage vendors to engineer equipment that can deliver improved imaging with lower radiation doses. In fact, newer CT equipment design has greatly improved radiation dose, even compared to the equipment that was being used at the inception of the Image Gently and Image Wisely campaigns and the formation of this commission.

Within the commission, the Quality and Safety Committee focuses on optimization of radiation dose during pediatric imaging. In particular, the CR-DR Steering Committee is working with ACR Registries and, in cooperation with other groups, is determining the appropriate exposure for diagnostic imaging using computerized radiography.

Commission members also collaborate with the Alliance for Radiation Safety in Pediatric Imaging to educate radiologists, technologists, referring physicians, and families on the benefits and appropriate use of imaging studies. Radiation optimization does not mean no imaging — it means appropriate imaging. To that end, one of our immediate goals is to encourage imaging facilities to use the ACR Appropriateness Criteria® from within the medical record.

What type of research has the commission prioritized?

Our Research Committee is focused on multi-institutional pediatric research that leads to important and meaningful information. From there, the data can be translated into measurably improved care to pediatric patients. Heike E. Daldrup-Link, MD, co-chair of the committee, recently published a widely circulated single-center preliminary manuscript showing the effectiveness of ionizing radiation–free diagnostic imaging staging for pediatric cancer patients.1

How has imaging changed since you entered the field?

When I was a medical student, many trauma patients underwent exploratory laparotomy to ascertain the site and severity of injuries. Now CT accomplishes a knifeless laparotomy, enabling appropriate triage of the injured patient to the appropriate level and type of care. Yes, we are doing more CT scans, but this translates into fewer unnecessary surgeries — from any point of view, a great advantage for patients of all ages. That is the importance of diagnostic imaging. And to our commission members, this translates into the right study, done right, for the right patient at the right time, a principle embodied in our appropriateness criteria.


By Marta Hernanz-Schulman, MD, FACR, Chair, Commission on Pediatric Radiology

ENDNOTE
1.Klenk C, et al. "Ionising radiation-free whole-body MRI versus 18F-fluorodeoxyglucose PET/CT scans for children and young adults with cancer: a prospective, non-randomised, single-centre study." The Lancet Oncology 2014;15(3):275–285.

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