First Look: Pediatric Dose Registry

Pediatric radiation dosage continues to be a hot topic in the news. Just recently, a new team of researchers stepped out with a goal of reducing overall radiation exposure level for pediatric patients. The team, called the Quality Improvement Registry in CT Scans in Children (QuIRCC), is made up of researchers from six children’s hospitals and is currently in the process of researching and developing the first pediatric CT dose index registry.

The QuIRCC comes after a May 9 mandate from the U.S .Food and Drug Administration (FDA) requiring manufacturers to design scanners with young patients in mind, intended to reduce overall radiation exposure levels in pediatric patients.  However, the QuIRCC project is about more than just manufacturing. In fact, the project is designed to help “child-size” scanning protocols by offering accurate metrics to measure radiation exposure in children.

The development of such a registry for children, alone, is especially important. But the other important feature here in this project is establishing the target ranges of dose per exam type that are considered acceptable. This should lower or damp down the large range of variance in dose for similar exam types between nearby medical centers.

Here at UW we know the importance of dose registry programs, as we got involved in the American College of Radiology Dose Index Registry pilot project right away.  This new dose index registry will make great strides for ensuring safe radiation practices for patients of all ages.

The Truth about CT Exposure: 1980 to 2012

recent article published in CA: A Cancer Journal for Clinicians states that education of referring physicians, more assertive radiologists, and an increased use of healthcare IT are the keys to reducing patient exposure to radiation.

While these assertions may be true, the article also touched on rising radiation exposure due, primarily, to CT scans. Since the early 1980s, the estimated per capita dose from medical radiation in the US has increased significantly. But this isn’t the whole story…

While it is true that medical radiation from CT has increased markedly since 1980, so has the benefit to health from CT. We no longer do “exploratory surgery” for example, in order to sort out complex diagnostic imaging challenges. The false negative rate from Appendix surgery has plummeted. And cancer diagnosis rates overall are declining while cancer cure rates have gone up substantially, particularly in the last 5 years.

Meanwhile, the radiation dose per CT scan has gone down dramatically as the principles of low-dose CT continue to be better understood and implemented. Scans that used to require 25 mSv of radiation are now being done for 20% of that amount. While negative effects from low dose radiation have never bee proven (below 50 mSv), we still strive to keep our doses as low as possible.

So the issue is not radiation cost, but cost/benefit ratio. Driving a car is dangerous too, but we accept the cost/benefit ration. For CT that ratio is much better!

RSNA 2011 Relections

RSNA (Radiological Society of North America) is the largest annual trade show in the world, with about 55,000 people in attendance for the 6 day event in Chicago, Illinois. The expo includes a large number of presentations and courses on science and modern radiology.

RSNA 2011’s two main themes were lower radiation dose in diagnostic radiology imaging (especially CT) and new technology. For lower dose, there was much material on tailoring a CT scan exactly to an individual patient – based on their body size, their cardiac output, their disease process, or the type of diagnostic challenge. Additionally, a lot about new iterative reconstructions in CT – both statistical and model based, was presented. Either method lowers dose a lot, but model based results in lowered radiation exposure by up to 80%.

New technology presentations and courses covered a range of topics including dual energy CT for better tissue characterization, and the combination of imaging modalities in one platform – like SPECT/CT, or PET/MR. These combined modalities may provide a better combination of disease identification plus precise localization.

In all, RSNA 2011 offered great insights and interesting presentations. Did you attend? Share your thoughts below!