CT Dose Optimization in Pediatric Radiology: A Multiyear Effort to Preserve the Benefits of Imaging While Reducing the Risks

Greenwood, Taylor J.; Lopez-Costa, Rodrigo I.; Rhoades, Patrick D.; Ramírez-Giraldo, Juan Carlos; Starr, Matthew R.; Street, Mandie; Duncan, James R.; McKinstry, Robert C.

doi:10.1148/rg.2015140267

Cited by 43 publications

(25 citation statements)

References 24 publications

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“…Nevertheless, as the information obtained by MRI and CT is often complementary, our institutional practice includes an MRI examination (if possible without sedation) followed by a low-dose CT protocol to assess bony structures for improved lesion characterization or for presurgical planning. As suggested in the literature [6], the radiation dose delivered by CT should be minimized in accordance to the As Low As Reasonably Achievable (ALARA) principle, in particular as children have a higher risk for expressing radiation effects during their life span than adults [6]. Therefore, whenever CT is needed, the size of the scanned body region should be limited to the minimum necessary and a low-dose protocol should be applied.…”

Section: Imaging Techniquesmentioning

confidence: 99%

Non-odontogenic tumors of the facial bones in children and adolescents: role of multiparametric imaging

et al. 2017

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Tumors of the pediatric facial skeleton represent a major challenge in clinical practice because they can lead to functional impairment, facial deformation, and long-term disfigurement. Their treatment often requires a multidisciplinary approach, and radiologists play a pivotal role in the diagnosis and management of these lesions. Although rare, pediatric tumors arising in the facial bones comprise a wide spectrum of benign and malignant lesions of osteogenic, fibrogenic, hematopoietic, neurogenic, or epithelial origin. The more common lesions include Langerhans cell histiocytosis and osteoma, while rare lesions include inflammatory myofibroblastic and desmoid tumors; juvenile ossifying fibroma; primary intraosseous lymphoma; Ewing sarcoma; and metastases to the facial bones from neuroblastoma, Ewing sarcoma, or retinoblastoma. This article provides a comprehensive approach for the evaluation of children with non-odontogenic tumors of the facial skeleton. Typical findings are discussed with emphasis on the added value of multimodality multiparametric imaging with computed tomography (CT), magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), positron emission tomography CT (PET CT), and PET MRI. Key imaging findings and characteristic histologic features of benign and malignant lesions are reviewed and the respective role of each modality for pretherapeutic assessment and post-treatment follow-up. Pitfalls of image interpretation are addressed and how to avoid them.

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Section: Imaging Techniquesmentioning

confidence: 99%

Non-odontogenic tumors of the facial bones in children and adolescents: role of multiparametric imaging

et al. 2017

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“…In a recent study from the Mallinckrodt Institute of Radiology, St. Louis Children's Hospital, Washington University School of Medicine, Greenwood et al . report substantial variation in radiation exposure per CT examination, even when repeat studies were performed on the same patient [18]. In this project, investigation into such process variation revealed that multiple age and condition-specific pediatric head CT protocols were available on their institution's two scanners, and that there was more variability on weekends and evenings because less experienced technologists were on duty during these times [18].…”

Section: Discussionmentioning

confidence: 99%

“…report substantial variation in radiation exposure per CT examination, even when repeat studies were performed on the same patient [18]. In this project, investigation into such process variation revealed that multiple age and condition-specific pediatric head CT protocols were available on their institution's two scanners, and that there was more variability on weekends and evenings because less experienced technologists were on duty during these times [18]. Interestingly, in our own study, a similar issue regarding off-hours staffing and variability in CT technologists' level of expertise in protocoling patients on the CH's single CT scanner was articulated by the CH imaging director.…”

Section: Discussionmentioning

confidence: 99%

“…The practice of using the same radiation exposure factors for CT examinations of children as those for adults is not uncommon [16, 17], and continues today, particularly in non-pediatric focused facilities [18]. Of the estimated 8 million CT studies performed on children, up to 6.8 million are performed at sites outside the auspices of a dedicated pediatric facility [19].…”

Section: Introductionmentioning

confidence: 99%

“…Of the estimated 8 million CT studies performed on children, up to 6.8 million are performed at sites outside the auspices of a dedicated pediatric facility [19]. Since 2008, the volume of CTs performed at children's hospitals and pediatric emergency departments has reached a plateau and presently may be decreasing, credited in large part to dose reduction technology in new CT scanners and educational strategies and social media campaigns promoted by professional societies such as the American College of Radiology (ACR) Imaging 3.0 Program and the Alliance for Radiation Safety in Pediatric Imaging [18-21]. Notably, the radiation burden of these exams has also decreased [19, 22].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Toolkit for Pediatric CT Dose Reduction in Community Hospitals

Armao

Hartman

Shea³

et al. 2016

Journal of the American College of Radiology

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“Eighty percent of success is just showing up.”Woody AllenPediatric CT radiation dose optimization is a challenging process for pediatric-focused facilities and community hospitals alike. Ongoing experience and trial-and-error approaches to dose reduction in the large academic hospital setting may position these centers to help community hospitals who strive for CT quality improvement. In this pilot project, we describe our hands-on approach to develop a partnership between an academic medical center and a community hospital to develop a toolkit for implementing CT dose reduction. Our aims were to 1) assess the acceptability of an interactive educational program and electronic toolkit booklet, 2) conduct a limited test of the efficacy of the toolkit in promoting knowledge and readiness to change, and 3) assess the acceptability and practicality of a collaborative approach to implementing dose-reduction protocols in community hospitals. In partnering with the community hospital, we found that they had size specific radiation doses 2 to 3 times higher than those at our center. Survey results following a site visit with interactive educational presentations revealed an increase in knowledge, stronger opinions about the health risks of radiation from CT scans, and willingness and perceived ability to reduce pediatric CT doses.

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Efficacy and Toxicity of Calcitonin Treatment in Children with Cherubism: A Single-Center Cohort Study

Schreuder,

Meijer,

Cleven

et al. 2023

Journal of Bone and Mineral Research

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Cherubism is a rare autosomal dominant disease characterized by expansile osteolytic jawbone lesions. The effect and safety of off‐label calcitonin treatment during the progressive phase of the disease are not well described. In this retrospective study, we present data on the radiological response and adverse effects of subcutaneously administered calcitonin in a cohort of nine cherubism children (3 female, 6 male). Two of the nine patients underwent two separate treatment courses with a significant off‐treatment interval in between; therefore, a total of 11 treatment courses with a mean duration of 17.9 months (range <1–35, SD 10.8) were studied. To measure response, the cumulative volume of cherubism lesions was calculated from available three‐dimensional imaging. The primary outcome was the change in the volume of lesions during calcitonin treatment and only assessed for the eight treatment courses with a minimal duration of 6 months. A statistically significant reduction in the mean cumulative volume of lesions was seen regardless of treatment duration. Average volume reduction was highest in the first half year of treatment, with a gradual, ongoing reduction thereafter. For the secondary outcome, the change in the cumulative volume of lesions after treatment cessation was assessed for the seven treatment courses with follow‐up imaging available. After six of these seven treatment courses, the cumulative volume increased again but remained undoubtedly smaller than the initial volume at the start of therapy. Adverse effects were assessed for all 11 treatment courses and occurred in 73% of them. Most adverse effects were mild and low grade, with the most severe being one grade 3 symptomatic hypocalcemia requiring hospitalization and early treatment termination. Calcitonin treatment seems effective and tolerable in treating actively progressing cherubism in children. However, further research is required to better understand the pharmacological treatment of cherubism, including also other drugs, dosing, and protocols.This article is protected by copyright. All rights reserved.

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CT Dose Optimization in Pediatric Radiology: A Multiyear Effort to Preserve the Benefits of Imaging While Reducing the Risks

Cited by 43 publications

References 24 publications

Non-odontogenic tumors of the facial bones in children and adolescents: role of multiparametric imaging

Non-odontogenic tumors of the facial bones in children and adolescents: role of multiparametric imaging

A Toolkit for Pediatric CT Dose Reduction in Community Hospitals

Efficacy and Toxicity of Calcitonin Treatment in Children with Cherubism: A Single-Center Cohort Study

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