Children’s bodies are more sensitive to radiation so it is imperative that they are exposed to the least amount of radiation as possible to avoid a lifetime of cumulative damage.
Research conducted at Children’s Mercy showed the hospital uses up to 80% less radiation than community imaging centers for some procedures.
The hospital’s protocols are based on the child’s size and weight, and take into consideration the body part to be imaged.
In addition, a PhD medical physicist helps calibrate imaging equipment to provide high quality images using the least amount of radiation.
In addition to following national Image Gently guidelines, Children’s Mercy offers additional services such as Child Life specialists, sedation and anesthesia to help keep children calm so high quality images are achieved without the need to rescan.
Doug Rivard, DO is here to discuss how Children’s Mercy is leading the way toward reducing the radiation your child is exposed to and answer any questions about keeping your child safe.
Selected Podcast
Image Gently: Reducing Radiation Exposure in Children
Featured Speaker:
Doug Rivard, DO
Doug Rivard, DO is the Chairman of the Department of Radiology; Associate Professor of Radiology, University of Missouri-Kansas City School of Medicine. Transcription:
Image Gently: Reducing Radiation Exposure in Children
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Mike Smith, and our topic is image gently reducing radiation exposure in children. My guest is Dr. Doug Rivard. He’s the chairman of the department of radiology and an associate professor of radiology at the University of Missouri, Kansas City. Dr. Rivard, welcome to the show.
Dr. Doug Rivard (Guest): Thank you, Dr. Smith.
Dr. Smith: Let’s just start off with a straightforward, simple question. Why are kids more radio-sensitive than adults?
Dr. Rivard: Sure. We know that ionizing radiation of any form, which occurs in many settings, but in the medical world, mostly in CT and in x-ray, that is a component that damages DNA at the molecular level. And we know that children’s DNA is much more sensitive, and that also, they have a longer life span in which to manifest any injury to that DNA that could occur.
Dr. Smith: What about the fact that -- so here you have a child who may be, for a variety of reasons, might undergo a significant number of CT scans, chest x-rays, whatever it is, aren’t we worried about the accumulation of that exposure over time, too? So for kids getting a lot of exposure young, are we a little bit more worried what might happen to them, to their DNA as they’re older?
Dr. Rivard: You’re absolutely correct. One of the things that we do know in addition to the fact that children are more sensitive is that exactly at this day, it can be a cumulative effect. So what we try to do is minimize or use alternative modalities. Also, all these things have to be weighed in the context of risks and benefits. For example, if we’ve got a kid that needs to be imaged for appendicitis, historically, we’d be entertaining CT or CAT scan as a modality to image that. Now, most contemporary practices utilize MRI or ultrasound, which don’t have any radiation and still provide the same diagnostic ability to make a finding.
Dr. Smith: Yes, so that’s obviously a change even happening at the resident level, right? I know when I was going through radiology residency, appendicitis, we were thinking CT scan, right? That’s a change even at the education level for young doctors. Let’s talk about the research you did specifically, because I found this interesting. This was published in the Journal of Pediatric Surgery. You showed that Children’s Mercy used 80 percent less radiation than a community imaging center. Tell us a little bit about that study, and what do you think are some of the reasons that the community center is using more radiation?
Dr. Rivard: Absolutely. We partnered with our pediatric surgeons, and we have a ton of kids that transfer into our facility from our surrounding metro area for appendicitis. It’s a very common problem in pediatrics, and adults, for that matter. What we did is we took historically retrospectively all the kids that came in from outside hospitals and got the dose information off those CAT scans, compared to the CAT scans that we did at our own facility and age masked controls and masked those off and discerned that the techniques and protocols that we were employing at our facility actually resulted in a pretty significant lower radiation dose. As we discussed, we feel like that’s important for multiple reasons, and the factors that we think contribute most are awareness and familiarity with imaging children. A lot of the facilities in our metro area imaged children only because they have to, whereas that’s exclusively what we do at our facility, and also at other children’s hospitals across the United States. Additionally, we made significant investments in our equipment that are available to reduce the dose of some of the things that the equipment has on it. It’s very sophisticated. Then lastly, the fact that you’ve got a pediatric radiologist who is much more in tune, I would say, and experienced with reading images that are acquired at a lower dose, because there’s still some difference in image quality that can require a little bit of finesse.
Dr. Smith: That kind of was shown in the study as well, because not only were they using more radiation, I guess they didn’t actually diagnose the appendicitis as well as the dedicated pediatric centers. Is that correct?
Dr. Rivard: You’re absolutely right. And I think among these things that I would like to make is that since we do at our facility only children, I would probably be just as uncomfortable reading from adult imaging. So, not to say that those folks don’t know what they’re doing, but it’s just a matter of more niche and frequent practice in that area that helped us with that.
Dr. Smith: Absolutely. As I mentioned before, Dr. Rivard, I myself I did some radiology residency. I ended up not liking radiology and going into internal medicine, but I did some pediatric radiology. It was tough. It was like a totally different field, to be honest with you. So I appreciate your points there. Now, there is something called the National Image Gently guidelines, correct? What are those?
Dr. Rivard: Sure, you bet. That’s an organization that is primarily composed of -- it was kind of started by several prominent pediatric radiologists in North America, and it’s basically devoted to advancing the lowest possible dose in any kind of imaging study that we can use and if possible, use a modality that doesn’t use radiation, like we talked about, ultrasound or MRI. Again, it’s something that the pediatric community is pretty aware of, and we’ve all been doing this very aggressively, as that research outlined. And that’s not probably unique to just us. I would imagine all the other facilities are doing that as well. What we want to do is get that out to the other places. We know that the majority of children are not imaged at a children’s facility, and we want to try to educate all the other folks in the communities and other parts of the country that they could optimize and do a better job with their own techniques when it’s designed to be very basic. We’ve got some advanced faculty we employ, including a physicist, that helps us very extensively with our protocols, but some of these things are very basic. It can be applied even by the community providers, even if they’re not doing pediatrics routinely.
Dr. Smith: Obviously, Children’s Mercy would be a good resource maybe to call up to get these guidelines, but is there a way that some of these community centers, these imaging centers can get online and download these guidelines and start putting them into practice?
Dr. Rivard: Absolutely. The website is called imagegently.org, and it’s got various areas in there. Some of them are for radiologists. Some are for referring physicians to get information for families. One of the things that this opens up at these discussions is -- and we have these increasingly as discussions with families that are very keenly aware of radiation and have a lot of questions. The topics, as you know, can be a little confusing. There’s a lot of alarm that is generated by it, and that’s a great website to start with.
Dr. Smith: Let me ask you this. Obviously, in some cases, a child really has no choice but to get imaged in a community imaging center. Maybe the pediatric hospital is just not close enough, whatever. But if it is feasible, do you suggest that if a child needs a procedure using any form of ionized radiation that they try their best to get to a dedicated center like Children’s Mercy?
Dr. Rivard: I think in the setting of CT and MRI and ultrasound and typically more advanced modalities, no question. Knowing that most of these kids are not going to require them, the vast majority of children are imaged from pneumonia and minor fractures and things. And luckily, those are lower dose types of studies, so they’re not as much potential to have impact with the technique. But yes, for some of those higher things I personally would. And again, that is probably a little self-serving, but just again, we were really surprised to see when those numbers came to pass with that research how much difference there really is in some of the more advanced modality.
Dr. Smith: Yeah, and I think because of that published research, Dr. Rivard, I think that’s a legitimate point that for those more advanced type procedures that going to a dedicated pediatric hospital is probably the best choice. Not only that though, not only do you have the radiologists that are more trained in pediatric radiology, you also have, like you mentioned, a medical physicist on staff. And I also found at Children’s Mercy you have child life specialists. Who are they, and how important are they to what you do every day?
Dr. Rivard: Sure. They’re an integral part of the hospital and specifically in radiology and a lot of the procedural areas. Basically what they do, they have training in basically helping distract these kids while we’re trying to obtain images. And what that does is allow us many times to get the images we need on one shot, where historically we’d have to say, “You know what? That child didn’t hold still. We have to re-take the images,” thus increasing the dose. They’re an integral part of our team, and in fact, in radiology, they’re embedded in our department every day and work side by side with the radiologists and the techs.
Dr. Smith: I think that’s a great point, Dr. Rivard, that obviously a major issue with kids is they’re kids, rightly so. They’re squirmy. And to have to re-scan, that’s just… well, if you have to re-scan, you have to re-scan. But really, if you can decrease the number of re-scans, that’s going to help out significantly. And I think that’s a great point for having these child life specialists. Dr. Rivard, I want to thank you for coming on. You’re listening to Transformational Pediatrics with the doctors from Children’s Mercy Kansas City. For more information, you can go to childrensmercy.org. That’s childrensmercy.org. I’m Dr. Mike. Have a great day.
Image Gently: Reducing Radiation Exposure in Children
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Mike Smith, and our topic is image gently reducing radiation exposure in children. My guest is Dr. Doug Rivard. He’s the chairman of the department of radiology and an associate professor of radiology at the University of Missouri, Kansas City. Dr. Rivard, welcome to the show.
Dr. Doug Rivard (Guest): Thank you, Dr. Smith.
Dr. Smith: Let’s just start off with a straightforward, simple question. Why are kids more radio-sensitive than adults?
Dr. Rivard: Sure. We know that ionizing radiation of any form, which occurs in many settings, but in the medical world, mostly in CT and in x-ray, that is a component that damages DNA at the molecular level. And we know that children’s DNA is much more sensitive, and that also, they have a longer life span in which to manifest any injury to that DNA that could occur.
Dr. Smith: What about the fact that -- so here you have a child who may be, for a variety of reasons, might undergo a significant number of CT scans, chest x-rays, whatever it is, aren’t we worried about the accumulation of that exposure over time, too? So for kids getting a lot of exposure young, are we a little bit more worried what might happen to them, to their DNA as they’re older?
Dr. Rivard: You’re absolutely correct. One of the things that we do know in addition to the fact that children are more sensitive is that exactly at this day, it can be a cumulative effect. So what we try to do is minimize or use alternative modalities. Also, all these things have to be weighed in the context of risks and benefits. For example, if we’ve got a kid that needs to be imaged for appendicitis, historically, we’d be entertaining CT or CAT scan as a modality to image that. Now, most contemporary practices utilize MRI or ultrasound, which don’t have any radiation and still provide the same diagnostic ability to make a finding.
Dr. Smith: Yes, so that’s obviously a change even happening at the resident level, right? I know when I was going through radiology residency, appendicitis, we were thinking CT scan, right? That’s a change even at the education level for young doctors. Let’s talk about the research you did specifically, because I found this interesting. This was published in the Journal of Pediatric Surgery. You showed that Children’s Mercy used 80 percent less radiation than a community imaging center. Tell us a little bit about that study, and what do you think are some of the reasons that the community center is using more radiation?
Dr. Rivard: Absolutely. We partnered with our pediatric surgeons, and we have a ton of kids that transfer into our facility from our surrounding metro area for appendicitis. It’s a very common problem in pediatrics, and adults, for that matter. What we did is we took historically retrospectively all the kids that came in from outside hospitals and got the dose information off those CAT scans, compared to the CAT scans that we did at our own facility and age masked controls and masked those off and discerned that the techniques and protocols that we were employing at our facility actually resulted in a pretty significant lower radiation dose. As we discussed, we feel like that’s important for multiple reasons, and the factors that we think contribute most are awareness and familiarity with imaging children. A lot of the facilities in our metro area imaged children only because they have to, whereas that’s exclusively what we do at our facility, and also at other children’s hospitals across the United States. Additionally, we made significant investments in our equipment that are available to reduce the dose of some of the things that the equipment has on it. It’s very sophisticated. Then lastly, the fact that you’ve got a pediatric radiologist who is much more in tune, I would say, and experienced with reading images that are acquired at a lower dose, because there’s still some difference in image quality that can require a little bit of finesse.
Dr. Smith: That kind of was shown in the study as well, because not only were they using more radiation, I guess they didn’t actually diagnose the appendicitis as well as the dedicated pediatric centers. Is that correct?
Dr. Rivard: You’re absolutely right. And I think among these things that I would like to make is that since we do at our facility only children, I would probably be just as uncomfortable reading from adult imaging. So, not to say that those folks don’t know what they’re doing, but it’s just a matter of more niche and frequent practice in that area that helped us with that.
Dr. Smith: Absolutely. As I mentioned before, Dr. Rivard, I myself I did some radiology residency. I ended up not liking radiology and going into internal medicine, but I did some pediatric radiology. It was tough. It was like a totally different field, to be honest with you. So I appreciate your points there. Now, there is something called the National Image Gently guidelines, correct? What are those?
Dr. Rivard: Sure, you bet. That’s an organization that is primarily composed of -- it was kind of started by several prominent pediatric radiologists in North America, and it’s basically devoted to advancing the lowest possible dose in any kind of imaging study that we can use and if possible, use a modality that doesn’t use radiation, like we talked about, ultrasound or MRI. Again, it’s something that the pediatric community is pretty aware of, and we’ve all been doing this very aggressively, as that research outlined. And that’s not probably unique to just us. I would imagine all the other facilities are doing that as well. What we want to do is get that out to the other places. We know that the majority of children are not imaged at a children’s facility, and we want to try to educate all the other folks in the communities and other parts of the country that they could optimize and do a better job with their own techniques when it’s designed to be very basic. We’ve got some advanced faculty we employ, including a physicist, that helps us very extensively with our protocols, but some of these things are very basic. It can be applied even by the community providers, even if they’re not doing pediatrics routinely.
Dr. Smith: Obviously, Children’s Mercy would be a good resource maybe to call up to get these guidelines, but is there a way that some of these community centers, these imaging centers can get online and download these guidelines and start putting them into practice?
Dr. Rivard: Absolutely. The website is called imagegently.org, and it’s got various areas in there. Some of them are for radiologists. Some are for referring physicians to get information for families. One of the things that this opens up at these discussions is -- and we have these increasingly as discussions with families that are very keenly aware of radiation and have a lot of questions. The topics, as you know, can be a little confusing. There’s a lot of alarm that is generated by it, and that’s a great website to start with.
Dr. Smith: Let me ask you this. Obviously, in some cases, a child really has no choice but to get imaged in a community imaging center. Maybe the pediatric hospital is just not close enough, whatever. But if it is feasible, do you suggest that if a child needs a procedure using any form of ionized radiation that they try their best to get to a dedicated center like Children’s Mercy?
Dr. Rivard: I think in the setting of CT and MRI and ultrasound and typically more advanced modalities, no question. Knowing that most of these kids are not going to require them, the vast majority of children are imaged from pneumonia and minor fractures and things. And luckily, those are lower dose types of studies, so they’re not as much potential to have impact with the technique. But yes, for some of those higher things I personally would. And again, that is probably a little self-serving, but just again, we were really surprised to see when those numbers came to pass with that research how much difference there really is in some of the more advanced modality.
Dr. Smith: Yeah, and I think because of that published research, Dr. Rivard, I think that’s a legitimate point that for those more advanced type procedures that going to a dedicated pediatric hospital is probably the best choice. Not only that though, not only do you have the radiologists that are more trained in pediatric radiology, you also have, like you mentioned, a medical physicist on staff. And I also found at Children’s Mercy you have child life specialists. Who are they, and how important are they to what you do every day?
Dr. Rivard: Sure. They’re an integral part of the hospital and specifically in radiology and a lot of the procedural areas. Basically what they do, they have training in basically helping distract these kids while we’re trying to obtain images. And what that does is allow us many times to get the images we need on one shot, where historically we’d have to say, “You know what? That child didn’t hold still. We have to re-take the images,” thus increasing the dose. They’re an integral part of our team, and in fact, in radiology, they’re embedded in our department every day and work side by side with the radiologists and the techs.
Dr. Smith: I think that’s a great point, Dr. Rivard, that obviously a major issue with kids is they’re kids, rightly so. They’re squirmy. And to have to re-scan, that’s just… well, if you have to re-scan, you have to re-scan. But really, if you can decrease the number of re-scans, that’s going to help out significantly. And I think that’s a great point for having these child life specialists. Dr. Rivard, I want to thank you for coming on. You’re listening to Transformational Pediatrics with the doctors from Children’s Mercy Kansas City. For more information, you can go to childrensmercy.org. That’s childrensmercy.org. I’m Dr. Mike. Have a great day.