Image Gently Think A-Head Campaign Focuses on Pediatric Head CT Protocols

  1. Emilee Palmer, BS, R.T.(R)(CT)

No doubt about it, as imaging technology has improved, so has patient care.1 As a result, the use of medical imaging, especially computed tomography (CT), has increased during the past several decades, particularly with pediatric patients, and for good reason: CT provides information to help providers quickly and accurately diagnose injuries. It saves lives and often prevents the need for more invasive procedures.1 However, inappropriate use of CT—or any imaging tool that uses ionizing radiation— can result in unnecessary risks to patients, particularly children.1

In 2001, several scientific articles claimed that pediatric patients who underwent CT procedures received estimated radiation doses as much as 3 times higher than those given to adults.2 Similar articles about the risks of overreliance on CT soon followed, spurring the need to implement a balanced approach to scanning the pediatric population that weighed the health benefits of CT with the known risks.2 In 2008, the Alliance for Radiation Safety in Pediatric Imaging, a coalition founded by the American Society of Radiologic Technologists, the Society for Pediatric Radiology, the the American College of Radiology, and the American Association of Physicists in Medicine, made a notable effort to strike that balance with the launch of the Image Gently campaign.

The campaign includes information about pediatric imaging examinations directed to radiologic technologists, medical physicists, radiologists, pediatricians, and parents. It also offers protocols for reducing pediatric radiation dose during CT examinations.3 In 2014, Image Gently introduced new protocols to address the additional innovative features installed in CT scanners since 2008, such as automatic tube current modulation, reduced tube voltage techniques, and iterative reconstructions.4 The 2014 protocols provided guidance for setting up techniques for newborns, children, and adults and for acquiring diagnostic-quality images using well-managed radiation dose levels regardless of CT scanner manufacturer and model.4 Thousands of individuals and facilities have joined the effort and taken the pledge to image gently when performing pediatric radiologic examinations.3

Building on the success of the Image Gently campaign, the Alliance launched the Think A-Head campaign in November 2016.4 The key drivers of the campaign’s development include the frequency of head trauma in children, the prevalence of CT use (it is the most common examination performed in children), and the wide variability in levels of radiation dose used in pediatric scans across the United States. The initial goal of the campaign was to offer information that would help providers determine whether a CT scan was the best option for diagnosing children with minor head injuries. It quickly expanded to include eliminating low-value procedures as well as establishing and following age-appropriate protocols for when scans are necessary.4

The campaign’s tools and resources help providers ensure that they are complying with the latest evidence-based medical guidelines regarding performing CT scans on children with minor head injuries. The material also is useful in helping the patient care team—from providers to parents—communicate in an informed manner about why the scan is or is not necessary and how to make the best-informed decision possible (see Box).4

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    Suggestions for Making an Informed Decision4

    The importance of optimizing dose has long been a guiding principle in the imaging profession, signified by technologists’ staunch commitment to the as low as reasonably achievable (ALARA) principle. Regardless how technology evolves, what must never change is the focus on patient care—something diagnostic imaging professionals are passionate about. Although it is challenging to be the technologist asked to perform a CT scan on a pediatric patient when it is unclear what is best for that patient, information from campaigns such as Think A-Head offer additional tools to open a dialog with physicians and others to help ensure the best care for their patients.

    Footnotes

    • Emilee Palmer, BS, R.T.(R)(CT), is imaging supervisor for OhioHealth Westerville Medical Campus. She also is a member of and ASRT representative to the Think A-Head campaign committee.

    References

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