Purpose or Case Report: Since children are more susceptible to the potential effects of ionizing radiation, every opportunity to lower pediatric radiation dose will be explored.
Methods & Materials: Literature from Journals of the American Society of Radiologic Technoligists; recommendations from the FDA, recommendations from Pediatric Radiologists, IAEA (International Atomic Energy Agency), Image Gently
Results: The ALARA principle to reduce the risk to a minimum by strict adherence to justification and optimization; modern recommendations for dose reduction when possible such as use (higher kvp, lower mas; short exposure times; high DQE digital systems; avoid unnecessary repeat exposures or duplicate examinations; encourage alternate exams that use less or no radiation exposure when possible; back to basics "Image Gently" which recommends measuring the body parts using calipers; posistion the patient properly; avoid using grids; collimate; shield gonads and breasts whenever possible; use AEC only when appropriate; use "child-size" techniques; center properly; immobilize; use proper distance selection; use PA instead of AP when possible; if possible, purchase equipment designed for use with pediatric patients; use pediatric protocols and technique charts; justify x-ray imaging exams by determining if the examination is needed to answer a clinical question; check the patient's medical imaging history to avoid duplicate exams; communication with the physician and imaging team ensures the patient receives the appropriate exam; if using fluoroscopy use pulsed or last-image hold to decrease dose.
Conclusions: Since children are more radiosensitive the adults, a variety of methods are used to reduce the risk. The individual risk from a necessary imaging exam is quite small when compared to the benefit of aiding an accurate diagnosis. If the x-ray prodecure is medically necessary then the medical benefit will alwasys exceed the cancer risk. The decision of whether an exam is justified needs to be made by the child's physician based on the medical needs of that particular child and the information the exam could provide. All exams must be justified and optimized.