The Image Gently campaign, sponsored in part by the Society for Pediatric Radiology, was initiated to educate physicians of the importance of “child-sizing” the radiation dose when scanning children. Minimizing the amount of radiation that patients receive during X-rays and CT scans is an important goal for radiologists. Following the ALARA (as low as reasonably achievable) guidelines is critical. Children, in particular, should receive special consideration. The campaign’s goal is to get the message out initially to all medical professionals because many children get scans in adult facilities. “Children are different from adults in so many ways,” said Stuart Royal, MD, radiologist-in-chief of the Children’s Health System. “Their medical problems are different. They have issues related to just performing the examinations. Sometimes they have to be sedated. We want to have pediatric specialists taking care of children. We want to get the best diagnosis with the least amount of radiation.” Tests using radiation should only be conducted when absolutely necessary. “The first and most important thing about potential radiation exposure is, if you don’t need the test, then don’t do it,” Royal said. “That’s really the first, best and easiest way to avoid any radiation exposure.” If testing is needed, pick the right test for the situation. “There are some tests that have radiation, such as X-ray and CT, and others that don’t, such as ultrasound and MRI scanning. So if you pick the test appropriately, that may be a way to eliminate radiation exposure,” Royal said. Finally, if a child needs a CT scan or other radiation test, steps should be taken to limit radiation exposure. Child-size the radiation. With older scanners, children received more radiation than was necessary. “A by-word of the campaign is to ‘child-size’ the amount of radiation,” Royal said. “On the Image Gently Web site (www.imagegently.org), we have protocols that can be used to child-size the amount of radiation that a child would get if they do get a CT scan.” Only scan the area that is involved. “A lot of people scan a very broad area, but we should really just focus on the area that is indicated for the particular clinical problem,” Royal said. Only take one scan. “In adults, many times they do multiphase scans. With children, you virtually never need to do a multiphase scan. Taking just one scan can decrease your radiation dose by two or three times.” Sedate the child if necessary. “You cannot get a scan on an uncooperative child,” Royal said. “So sometimes we have to use sedation, and if it has to be done with sedation, then it needs to be done at a place that specializes in doing sedations for children. The worst thing is to conduct a test that doesn’t give you the answer. Now you’ve radiated the child and you have no information.” June 2008