Dose Efficiency for Pediatric Patients via an Improved Image Formation Process
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Editor’s note: read the more recent blog on a task-based observer study conducted with Hershey Medical Center on pediatric fracture detection.
Radiography trends related to pediatric patients was a focal point at RSNA 2012 and it continues to pick up more steam as we move into 2013. From dose reduction to relying on digital radiography for improved diagnostics, radiologists have an encyclopedia of issues to address when it comes to their youngest patients.
The Society of Pediatric Radiology’s Image Gently campaign launched a “Back to Basics” initiative in September 2012, which encourages the use of imaging practices that are specific to pediatric patients. The following paragraphs outlines principles in general X-Ray procedures that should be followed throughout the three stages of the imaging process (Image acquisition, image processing for display, and image review and assessment) in an effort to provide safe imaging practices to pediatric patients.
Image acquisition: Adaptable acquisition protocols are essential in image acquisition when it comes to the various pediatric body sizes. The range of body habitus requires acquisition techniques to be tailored to each patient’s size and age. Based on recent FDA recommendations, it is important to offer the ability to select the pediatric patient body sizes from a range of categories. These recommendations around categories remain in-line with the new FDA material released in 2012 about the topic. The categories allow the system to choose default acquisition parameters and processing configurations that are appropriate for the different types of patients and detectors.
Once an image has been acquired via a DR system, the rapid display of the preview image allows the radiographer to quickly decide whether the patient’s anatomy was accurately captured or if another image needs to be taken. To help analyze these images faster, the new IEC Exposure Index (EI) standard should be implemented for a quick assessment of the amount of radiation used to create the image. The associated Deviation Index (DI) allows an immediate evaluation compared to the institutional target of exposure for the given exam. This type of immediate feedback helps the radiographer provide more consistent image quality from the detector to the next step of the image chain.
Image Processing for Display: Appropriate image processing must be performed to present the diagnostic information clearly and efficiently to the radiologist. Software is needed that can be tailored to adjust the image-processing parameters to a specific site’s preference. By possessing information about the patient’s size and age, the parameters can be adjusted to display the features of the clinical information in a more informative way compared to using the configurations for adults.
Image Review and Assessment: It’s important to have an ongoing quality control program in place that ensures a continuous high quality of the images delivered to radiologists. System capabilities should enable sites to easily track many of the important detector parameters that define acceptable images.. If departments require image capture and delivery across multiple facilities, then reporting and analysis software must allow the quality control personnel to query all of the systems across the network from a central location. This proactive initiative can quickly highlight irregular exposure levels, high repeat rates, or other image issues that can develop.
It’s clear that pediatric imaging presents issues that must be addressed separately from the other imaging trends faced when working with adults. To complement this trend in 2013, Carestream is working on the DRX 2530C Detector*–which is currently in development—and is intended to be a smaller-format, cesium iodide detector designed for dose-sensitive applications such as pediatrics. The detector is intended to have easy handling for fast, flexible positioning in pediatric incubator trays.
For more information on this topic, please check out our white paper, “Maximizing Dose Efficiency for Pediatric Patient Imaging.”
*Not commercially available