The Image Gently campaign raises awareness of opportunities for lowering radiation dose while maintaining diagnostic quality of images of children. The newest initiative in the campaign, Back to Basics, addresses methods for standardizing the approach to pediatric digital radiography, highlighting challenges related to the technology in imaging of patients of widely varying body sizes.

There is a clear and widespread need for comprehensive and practical education in digital image technology for radiologic technologists, especially those engaged in pediatric radiography. The creation of better educational materials and training programs, and the continuation of educational opportunities will require a broad commitment from equipment manufacturers and vendors, educational institutions, pediatric radiology specialty organizations, and individual imaging specialists.

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The development of digital radiography (DR) has provided numerous benefits for pediatric imaging, including the ability to post-process images and to make images immediately available for access by care providers. However, DR presents several significant challenges for the radiologic technologists who are responsible for operating the equipment and producing high-quality images in children. This paper discusses those challenges, including lack of standardization among vendors, particularly with regard to the exposure indicator; lack of pediatric-specific educational materials and pediatric techniques; the need for manual technique instead of the use of automatic exposure control in smaller children; and complications related to field size, collimation and shielding in small children. Specific actions and design modifications that might facilitate the effective management of these challenges will be also described. The implementation of measures to promote the production of optimal images while minimizing radiation exposure requires cooperation and communication among imaging professionals, manufacturers and regulatory agencies.