Balancing Dose with Image Quality in Pediatric Imaging
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Carestream offers innovative X-ray solutions to help meet the unique needs of imaging children.
The goal of every radiology exam is to produce a high-quality image that helps to accurately diagnose a disease or condition – and create that image at the lowest possible dose of radiation. Balancing dose with image quality is even more important in pediatric imaging. Not only are children more radiosensitive than adults (the cancer risk per unit dose of ionizing radiation is higher), but children also have a longer expected lifetime, which puts them at risk of cancer due to radiation exposure.(1)
Striking the right balance of image quality and dose
Fortunately, there have been significant amounts of research and development over the last decade to help protect children from excessive radiation. At Carestream, we develop our products based on:
- The recommendations of the Image Gently Alliance for Radiation Safety in Pediatric Imaging
- The radiation safety principle of As Low As Reasonably Achievable (ALARA)
- Government guidelines for pediatric imaging (FDA and EC)
The Image Gently Alliance is a coalition of healthcare organizations dedicated to providing safe, high-quality pediatric imaging around the world. Its primary objective is to raise awareness and thereby change practice throughout the imaging community to adjust radiation dose when imaging children. (2)
ALARA is the guiding principle of radiation safety, per the CDC. It means that even if a small dose of radiation offers no direct benefit, it should be avoided. And to achieve ALARA, it’s essential to use the three basic protective measures in radiation safety: time, distance and shielding. (3)
In addition, government agencies in the US (the FDA), the European Commission (EC) and other countries have developed guidelines for pediatric imaging and dose that include:
- Definitions of the pediatric population by seven (7) age / weight categories
- Automatic exposure control that’s designed and tested for a broad range of patient sizes, including pediatric
- Proper filtration, positioning and shielding
- Display and recording of each patient dose
- Quality-control testing
The pediatric patient’s size is more important than age
The Federal Food, Drug, and Cosmetic Act (FDA&C) defines pediatric patients as people aged 21 or younger at the time of their diagnosis or treatment. In the past, these patients were classified in different groups by age ranges – neonates, infants, children and adolescents. However, age is not a good indicator. A 17-year-old can weigh as much as an adult, or a child might be small for his or her age. That’s why in pediatric medical X-ray imaging, size – not age – determines how much radiation is required to produce a quality medical image. (4)
Carestream’s Eclipse image processing uses parameters optimized for each of the seven different pediatric age / weight categories. These parameters can be adapted to display the features of the clinical information in a more informative way, compared to using adult image-processing configurations. Eclipse automatically adjusts and tailors image processing to deliver improved noise suppression and detail enhancement, which can help radiologists see subtle abnormalities that are difficult to detect and diagnose in the tiny anatomies of neonates and infants.
More ways Eclipse image processing helps with pediatric imaging and diagnosing
Naturally, everything is smaller in children, especially with neonates. Carestream’s Eclipse engine powers specialized image processing options, like Tube and Line Visualization. This option creates a companion image and applies a set of parameters that enhance frequencies that correspond to the size of the catheters, helping radiologists view breathing and feeding tubes, and PICC lines that are otherwise difficult to see in small anatomies. Another highly useful software application is Pneumothorax Visualization, which accentuates the appearance of free air in the chest cavity. indicating the presence of a pneumothorax.
Our small-format detector further reduces dose for infant exams
Balancing dose and image quality in pediatrics requires the image processing software to be coupled with high-performance detectors.
Carestream’s DRX Plus 2530C Detector has a small pixel pitch (98microns) that translates to high spatial resolution. Additionally, it operates with Cesium iodide (Csl) technology, providing up to a 30 percent dose reduction compared to gadolinium oxysulfide detectors.
This is especially beneficial for neonates or infants who require frequent diagnostic imaging. Together with our Eclipse image processing, this software automatically adjusts the parameters for each patient to automatically determine the shortest possible exposure for effective imaging results.
Also, the DRX Plus 2530C is custom-engineered with a small-format design to fit easily into most neonatal incubator and bassinet X-ray trays, with no need to move these little patients.
DRX-L Detector offers long-length imaging with a single exposure
Another innovation for balancing dose and image quality in pediatrics is the Carestream DRX-L Detector. New in 2020, our DRX-L Detector is especially helpful in diagnosing scoliosis and spine abnormalities in adolescents.
Traditional long- length imaging exams require multiple exposures. With the DRX-L Detector, a long-length imaging exam can be completed with a single exposure. Because it’s a single exposure, there’s no need to align and stitch multiple images allowing for more precise measurement and treatment planning.
In addition to requiring less dose, the exam requires less time Traditional multi-shot imaging exams can take 14 seconds or more for image acquisition. With the DRX-L, the total acquisition time is less than one second; The rapid display of the preview image allows the radiographer to quickly determine whether the patient’s anatomy was correctly captured.
Balancing dose with image quality to protect the littlest of patients
Imaging pediatric patients at the lowest possible dose, while still producing an image that is diagnostically viable, requires high-performance digital detectors with very good dose efficiency, image processing techniques that can be optimized to further lower dose, and mechanisms for dose tracking. Carestream will continue to innovate on all three fronts to help strike that essential balance for pediatric imaging.
Dave Foos is Senior Director of Research and Development at Carestream. Together with his team of researchers at Carestream, he has been focusing for a number of years on the optimization of image quality and dose for imaging children.
- Pediatric Diagnostic Reference Levels
- Shriners Hospital for Children: Insights for Imaging Children
- ImageView Software Powered by Eclipse
- DRX Plus 2530C Detector
- DRX-L Detector
- Neonatal Fluoroscopic Imaging at the Bedside
1 U.S. Food & Drug Administration: Pediatric X-ray Imaging
2 The Image Gently Alliance https://www.imagegently.org/
3 Centers for Disease Control and Prevention https://www.cdc.gov/nceh/radiation/alara.html
4 U.S. Food & Drug Administration: Pediatric X-ray Imaging https://www.fda.gov/radiation-emitting-products/medical-imaging/pediatric-x-ray-imaging
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