Cao Joseph,  Pfeifer Cory

Final Pr. ID: Poster #: SCI-004

The principle of ALARA and its application in the pediatric population serves as the focus of the Image Gently campaign. Tertiary care institutions dedicated to the care of children are well situated to be regional leaders in maximizing the ALARA concept. This study compares the size-specific dose estimates of computed tomography (CT) studies performed at our institution to those from outside facilities referring patients for emergent care. Read More

Authors:  Cao Joseph , Pfeifer Cory

Keywords:  ALARA, Radiation, SSDE

Shah Amisha,  Rees Mitchell,  Kar Erica,  Bolton Kimberly,  Panigrahy Ashok,  Lee Vince

Final Pr. ID: Poster #: SCI-029

To evaluate the effect of different levels of adaptive statistical iterative reconstruction (ASIR) in pediatric lower extremity CT scan to compare the radiation dose, objective imaging parameters and subjective diagnostic image quality ratings. Read More

Authors:  Shah Amisha , Rees Mitchell , Kar Erica , Bolton Kimberly , Panigrahy Ashok , Lee Vince

Keywords:  ASIR, Radiation dose, CT scan, pediatric, extremity

Shah Summit,  Krishnamurthy Ramkumar,  Wang Ling,  Krishnamurthy Rajesh

Final Pr. ID: Paper #: 086

To evaluate patterns of advanced imaging utilization and associated costs over an 8-year period in one of the largest pediatric Accountable Care Organizations (ACO) in the US covering over 300,000 children. Read More

Authors:  Shah Summit , Krishnamurthy Ramkumar , Wang Ling , Krishnamurthy Rajesh

Keywords:  Utilization, Cost, Radiation

Mwango Gladys,  Nyabanda Rose,  Kawooya Michael

Final Pr. ID: Poster #: SCI-087

Radiation safety is a critical component in pediatric imaging. In Africa, radiation-safety is championed by the AFROSAFE campaign under the umbrella of the African Society of Radiology (ASR). AFROSAFE was launched on 17^th February, 2015 during the 8^th biennial Pan African Congress of Radiology and Imaging (PACORI) which was held in Nairobi, Kenya. The mission of AFROSAFE is to ensure favorable benefit-risk ratio in the use of ionizing radiation in medicine through encouraging adherence to safety standards and guidelines as per the “Bonn Call for Action”. Through this Campaign, all the radiation health workers of Africa have agreed to unite with the common goal of identifying and addressing issues arising from radiation protection in medicine.

This is an educational poster that outlines the signifcant Milestones AFROSAFE has achieved one year later, the pertinent issues, challenges and success. Read More

Authors:  Mwango Gladys , Nyabanda Rose , Kawooya Michael

Keywords:  AFROSAFE, radiation safety, Africa

Royall Ivey,  Grekoski Vincent,  Hough Matthew,  Sensakovic William

Final Pr. ID: Poster #: SCI-005

To compare methods of estimating the fetal radiation dose delivered during computed tomography (CT) scanning. Further, to assess sources of variability in estimation methods. Read More

Authors:  Royall Ivey , Grekoski Vincent , Hough Matthew , Sensakovic William

Keywords:  Fetal, Radiation dose

Parikh Ashishkumar,  Pruthi Sumit,  Hernanz-schulman Marta

Final Pr. ID: Poster #: SCI-001

Recently JACHO proposed to address double scanning in pediatric chest CT, yet there are no data to determine whether this takes place; similarly, there is discussion regarding validity of sending pediatric patients to adult-focused practices for routine imaging by third party payors. Our purpose is to review the technical factors that impact upon radiation dose and image quality in CT scans of children referred from adult-focused practices to a children’s hospital, referenced to pre-Image Gently values. To our knowledge this is the first such review that includes body and neuro scans and extensive technique and exposure data Read More

Authors:  Parikh Ashishkumar , Pruthi Sumit , Hernanz-schulman Marta

Keywords:  ALARA, Image Gently, Radiation

Semple Thomas,  Schofield Rebecca,  Petraco Da Cunha Ricardo,  Owens Catherine,  Nicol E,  King Lawrence,  Castellano I

Final Pr. ID: Poster #: EDU-009

To review the basics of CT dose calculation, in particular the nuances of dose calculation / estimation in cardiac CT and the many and varied methods of dose reduction in cardiac and cardiovascular CT. Read More

Authors:  Semple Thomas , Schofield Rebecca , Petraco Da Cunha Ricardo , Owens Catherine , Nicol E , King Lawrence , Castellano I

Keywords:  Dose Reduction, CT, Radiation, Physics, ALARA

Thomas Karen,  Marin Jennifer,  Mills Angela,  Boutis Kathy

Final Pr. ID: Poster #: SCI-037

Awareness of the need for benefit:risk assessment prior to imaging studies has increased dramatically over the past decade, but the impact of this on the disclosure practice of Emergency Department (ED) Physicians is not known. Our aim was to assess ED physician practice and attitudes towards CT radiation risk disclosure for stable patients. Read More

Authors:  Thomas Karen , Marin Jennifer , Mills Angela , Boutis Kathy

Keywords:  Radiation, CT, Emergency, consent, disclosure

Lodwick Daniel,  Krishnamurthy Rajesh,  Deans Katherine,  Cooper Jennifer,  Groner Jonathan,  Gonzalez Dani,  Lee Choonsik,  Kelleher Kelly,  Minneci Peter,  Shah Summit,  Stanley Rachel

Final Pr. ID: Poster #: SCI-054

Computed tomography (CT) imaging protocols and prescribing practices vary across institutions. Pediatric trauma patients treated at a pediatric trauma center (PTC) may receive less radiation if their CT imaging is performed at a PTC rather than at non-PTCs prior to transfer. The objective of the study was to determine differences in radiation exposure from CT imaging in pediatric trauma patients initially treated at a PTC center compared to non-PTCs. Read More

Authors:  Lodwick Daniel , Krishnamurthy Rajesh , Deans Katherine , Cooper Jennifer , Groner Jonathan , Gonzalez Dani , Lee Choonsik , Kelleher Kelly , Minneci Peter , Shah Summit , Stanley Rachel

Keywords:  Radiation, Computed Tomography, Trauma

Tabari Azadeh,  Li Xinhua,  Yang Kai,  Liu Bob,  Gee Michael,  Westra Sjirk

Final Pr. ID: Paper #: 138

Scanner console-provided volume CT Dose Index (CTDIvol) and Dose Length Product (DLP) are frequently added up inappropriately to obtain cumulative dose values in patients exposed to multiple multi-sequence CT exams, performed with varying z-axis coverage and often with longitudinal tube current modulation. We present the patient-size specific Dose Line Integral (DLI) as a new metric that allows this task to be performed in a more precise fashion across multiple scanner platforms Read More

Authors:  Tabari Azadeh , Li Xinhua , Yang Kai , Liu Bob , Gee Michael , Westra Sjirk

Keywords:  Radiation, CT, Quality

Zhu Xiaowei,  Whitaker Jayme,  Shellikeri Sphoorti,  Cahill Anne Marie

Final Pr. ID: Poster #: EDU-046

It is important for radiologists to recognize and discuss with patients and families the potential risks and clinical manifestations of high Peak Skin Dose. In children undergoing complex Interventional procedures accurate Peak Skin Dose estimates are complicated and time consuming despite reference point doses being available. The availability of the Dose Structure Report (SR) on modern fluoroscopic equipment allows such estimates to be timely and consistent. The process of creating a Peak Skin Dose estimate using a validated radiation data management system (RDMS), capable of collecting detailed acquisition data and modeling will be discussed. Read More

Authors:  Zhu Xiaowei , Whitaker Jayme , Shellikeri Sphoorti , Cahill Anne Marie

Keywords:  Peak Skin Dose Estimation, Interventional fluoroscopic, Radiation Data Management System

Yang Ronald,  Hayes Kari,  Milla Sarah,  Zhou Wei

Final Pr. ID: Poster #: SCI-005

Fluoroscopy is a valuable diagnostic tool, but it also exposes patients to radiation. Our study assesses variation in pediatric fluoroscopy radiation dose performance by hospital site and radiologist experience. Read More

Authors:  Yang Ronald , Hayes Kari , Milla Sarah , Zhou Wei

Keywords:  Fluoroscopy, Radiation Dose, Alara

Abdullah Selwan,  Shet Narendra,  Watkins Runa,  Kim Jane

Final Pr. ID: Poster #: SCI-024

Many institutions include a scout radiograph in the protocol for pediatric upper gastrointestinal (UGI) fluoroscopic studies. Recently, it has been shown that the scout radiograph does not add to the interpretation of VCUG examinations. Given that the scout radiograph is a significant portion of the total radiation exposure of the study, we sought to determine if the scout radiograph contributes to the interpretation of the outpatient pediatric UGI study. Read More

Authors:  Abdullah Selwan , Shet Narendra , Watkins Runa , Kim Jane

Keywords:  Scout radiograph, Upper GI Series, Radiation Exposure

Luhar Aarti,  Vu Dan,  Holmes Nathan,  Renella Pierangelo

Final Pr. ID: Poster #: SCI-069

Computed Tomography Angiography (CTA) is a valuable non-invasive tool for assessment of congenital heart disease in neonates. Though it requires less radiation, contrast and sedation than catheter angiography, which is the current standard of care, traditional CTA can still necessitate significant radiation dose, sedation, breath-holding and/or low heart-rates to achieve diagnostic studies. In this frequently imaged neonatal patient population, it is imperative to minimize cumulative radiation to limit the lifetime risk of cancer. At our institution, we have successfully used a new fast-acquisition FLASH CTA protocol to achieve high quality imaging of neonates with complex congenital heart disease with minimal radiation dose and without sedation. Read More

Authors:  Luhar Aarti , Vu Dan , Holmes Nathan , Renella Pierangelo

Keywords:  Computed Tomography Angiography, Congenital Heart Disease, Radiation Dose Reduction

Minkemeyer Vivian,  Frush Don,  Koran Mary Ellen,  Mettler Fred,  Mahesh Mahadevappa

Final Pr. ID: Paper #: 135

From NCRP Report 184, to (1) provide summary data from diagnostic medical radiation exposure in children compared with adults and (2) identify challenges and needs with such reporting. Read More

Authors:  Minkemeyer Vivian , Frush Don , Koran Mary Ellen , Mettler Fred , Mahesh Mahadevappa

Keywords:  Pediatric, Radiation

Park Ji Eun,  Choi Young Hun,  Cheon Jung-eun,  Kim Woo Sun,  Kim In-one,  Cho Hyun Suk

Final Pr. ID: Poster #: SCI-013

The use of pediatric abdominal CT has been increasing rapidly. However increased radiation exposure is a public health concern for children because of children are more sensitive to radiation than adults. The purpose of this study is to estimate which patient-related factors affect radiation dose, to pediatric patients undergoing abdominal CT Read More

Authors:  Park Ji Eun , Choi Young Hun , Cheon Jung-eun , Kim Woo Sun , Kim In-one , Cho Hyun Suk

Keywords:  Radiation dose, Abdominal CT

Machnitz Judit,  Son Jennifer,  Dunn Emily,  Bokhari Danial,  Spevak Melissa,  Tekes-brady Aylin

Final Pr. ID: Poster #: EDU-080

Sonography is well established, effective and radiation free imaging tool in pediatric chest conditions, primarily and widely used for evaluation of pleural effusions and assessment of chest wall abnormalities. Beyond that, it can also provide valuable information in evaluation of congenital abnormalities, anatomical variations, infectious process and malignancies in the chest. Read More

Authors:  Machnitz Judit , Son Jennifer , Dunn Emily , Bokhari Danial , Spevak Melissa , Tekes-brady Aylin

Keywords:  chest ultrasound, under utilization, radiation free

Miyazaki Osamu,  Sawai Hideaki,  Yamada Takahiro,  Murotsuki Jun,  Horiuchi Tetsuya,  Nishimura Gen

Final Pr. ID: Poster #: SCI-014

Fetal CT has almost the same utility as a postnatal skeletal survey. Despite this benefit, the associated radiation exposure is disadvantageous and radiation dose reduction is mandatory. It is however impossible to measure the actual radiation dose to the fetus directly. Several previous reports have described the CT dose index (CTDI) volume and dose length product (DLP) as representing an imagined fetal dose. The actual fetal radiation dose needs to be confirmed using a phantom that practically corresponds to a pregnant woman. Read More

Authors:  Miyazaki Osamu , Sawai Hideaki , Yamada Takahiro , Murotsuki Jun , Horiuchi Tetsuya , Nishimura Gen

Keywords:  skeletal dysplasia, fetal CT, radiation dose

Seals Kevin,  Tesoriero Joseph,  Cagnon Christopher,  Boechat Ines,  Ghahremani Shahnaz,  Iskander Paul

Final Pr. ID: Poster #: EDU-097

We developed a free iOS application, RADiDOC, with the goal of simplifying the complex subject of medical radiation risk for pediatric patients and their parents. Utilization of medical imaging has risen over the past decade, making the topic of radiation safety an increasingly important issue that is increasingly featured in the popular media. Furthermore, given the unique risk profile of radiation exposure in the pediatric age group, there has been increased focus on the judicious use of ionizing radiation in the imaging of children. These efforts have resulted in the Image Gently campaign, which has offered an immense contribution to pediatric radiation safety issues.

In keeping with these efforts, we created the RADiDOC application to help pediatric patients and their parents understand key radiation safety information in a simple, intuitive way. To meet these ends, RADiDOC was created with three core functionality modes: (1) Consultation, (2) Radiation Log, and (3) Radiation 101. Consultation mode allows users to explore a multitude of imaging studies and image-guided procedures and learn about their associated radiation risk, including quantitative cancer risk estimated using the BIER VII dataset. To be more meaningful to patients, dose is described not only in terms of “effective dose” and its associated ACR category, but also in terms of intuitive measures such as the equivalent number of transatlantic flights and days of natural sun exposure. The Radiation Log mode allows patients or their parents to log additive radiation risk from all imaging received in their lifetime, creating a longitudinal radiation log of lifetime exposure. This may be of particular interest to pediatric oncology patients who receive long-term serial imaging. Finally, Radiation 101 offers a primer on the basics of radiation safety and radiation physics aimed at a broad audience of laypeople.

RADiDOC offers a free resource to facilitate the discussion of radiation risk between pediatric radiologists, clinicians, pediatric patients, and their parents. In this Technical Development presentation, we review key radiation safety concepts and elaborate on the core functionalities of this application and how it can be of use to pediatrics radiologists and their patients. Read More

Authors:  Seals Kevin , Tesoriero Joseph , Cagnon Christopher , Boechat Ines , Ghahremani Shahnaz , Iskander Paul

Keywords:  Radiation, Radiation Dose, Radiation Safety

Sellers Emily,  Marshall Emily,  Lu Zheng Feng,  Reiser Ingrid,  Ong Seng,  Feinstein Kate

Final Pr. ID: Poster #: EDU-031

Gonadal shielding is currently the standard of care in most radiology practices with gonadal shielding occurring many times throughout the day in practices worldwide. Currently, the utility of gonadal shielding is being widely debated. The American Association of Physicists in Medicine (AAPM) recently published a policy recommending the discontinuation of shielding which was then endorsed by the American College of Radiology (ACR). However, other professional societies as well as many state regulations still recommend the use of gonadal shielding. This educational exhibit will outline the benefits as well as the risks involved in gonadal shielding that are currently being debated. It will also include how to identify the various imaging artifacts which can result from gonadal shielding. We will then discuss the best practices we use at our institution for gonadal shielding, including how to work closely with our radiology technologist colleagues to reduce artifact and radiation dose in order to help mitigate the negative consequences of gonadal shielding while maximizing the benefits. Read More

Authors:  Sellers Emily , Marshall Emily , Lu Zheng Feng , Reiser Ingrid , Ong Seng , Feinstein Kate

Keywords:  Shielding, Radiation

Butler Nikki,  Brinson Dana

Final Pr. ID: Poster #: EDU-04 (R)

In a Radiology Department that solely cares for pediatric patients, transitioning from computed radiography (CR) to digital radiography (DR) was a challenge. The software for the DR system is designed for imaging adults and has limited pediatric processing features. In the CR system, technologists would manually adjust the imaging technique to child appropriate values based on a technique chart and the usage of a vast array of processing tools. With DR, these charts and processing tools became obsolete. In addition, for the DR wireless flat panel detector to process the image correctly, four percent of the surface area must be exposed to radiation; a challenge in pediatric imaging. Therefore in order to achieve significant reduction in radiation exposure with DR equipment, extensive staff education, algorithm and technique chart modification is required. Read More

Authors:  Butler Nikki , Brinson Dana

Keywords:  Radiation Reduction, Digital Radiography, Computed Radiography, Education, ALARA

Zhou Wei,  Baldwin Heather,  Allen Jeron,  Butler Renee,  White Christina,  Milla Sarah,  Hayes Kari

Final Pr. ID: Poster #: SCI-013

To diagnose intestinal disease or guide an injection treatment, radiation from a fluoroscopy exam is often nontrivial. In addition to regulatory and accreditation requirements, it is clinically important to establish a mechanism to review and improve the use of fluoroscopy, particularly for pediatric patients who are more sensitive to radiation than adults. In this study, we aimed to implement a fluoroscopy dose monitor program, assess overall fluoroscopy performance, and evaluate radiologist performance, in a pediatric hospital system. Read More

Authors:  Zhou Wei , Baldwin Heather , Allen Jeron , Butler Renee , White Christina , Milla Sarah , Hayes Kari

Keywords:  Fluoroscopy, Radiation Dose, ALARA

Wong Lincoln,  Powers Andria

Final Pr. ID: Poster #: EDU-058

MR shoulder arthrography is a frequently ordered study in the pediatric population for shoulder symptoms relating to sports injuries. The traditional technique for injecting contrast into the shoulder joint has been with fluoroscopy. Following principles of ALARA, we set out to find ways to reduce or eliminate radiation from the procedure. Ultrasound has been utilized increasingly for diagnosing musculoskeletal pathology and is a well-established technique in the adult population to guide joint injection of medication. This educational exhibit aims to discuss how we implemented this technique at our hospital, outline tips and pitfalls we learned along the way, and discuss benefits and drawbacks with the procedure. Read More

Authors:  Wong Lincoln , Powers Andria

Keywords:  ultrasound, arthrography, shoulder, radiation, MR

Albers Brittany

Final Pr. ID: Poster #: SCI-002

Pneumomediastinum is a relatively common cause of hospitalization in the pediatric population. In this study, we evaluate the effect of chest CT on the management of spontaneous pneumomediastinum in the pediatric age group. If chest CT can be shown to have no significant effect on management, then radiation dose to the patient can be decreased. Read More

Authors:  Albers Brittany

Keywords:  pneumomediastinum, radiation reduction, best practices