Dose Reduction in Paediatric Trauma Imaging

Congress:

EuroSafe Imaging 2018

Poster Number:

ESI-0068

Type:

EuroSafe Imaging

Keywords:

Plain radiographic studies, CT, Trauma, Radioprotection / Radiation dose, Paediatric, Action 5 - Performance indicators for radiation protection management, Action 2 - Clinical diagnostic reference levels (DRLs), Action 1 - Guidelines, implementation policies, and Clinical Decision Support (ESR iGuide), Action 9 - Development of criteria for safe imaging procedures, Action 3 - Optimisation, diagnostic reference levels, image quality, Action 1 - Clinical decision support, clinical imaging guidelines, Dosimetry, Radiation safety

Authors:

A. Fagan, P. Osborne, E. A. Dick, A. Alavi, S. Fetherston, A. Rahman, N. Djavad, B. Davis

DOI:

10.1594/esi2018/ESI-0068

DOI-Link:

https://dx.doi.org/10.1594/esi2018/ESI-0068

Fig. 1: DLP of trauma CT scans from 2012-2016

Fig. 2: Increase in number of trauma CT scans from 2012-2016

Background/introduction

Trauma accounts for a large percentage of deaths during childhood, ranging from 16% of 1-4 year olds to 50% of older teenagers. Imaging of paediatric patients is increasing rapidly year on year. It is of particular importance to reduce the dose of paediatric CT scans because of the increase in risk of cancer in later life. Paediatric tissue is more radiosensitive and children have a longer life expectancy, during which cancer can develop. The 2014 RCR guidelines for imaging of paediatric trauma patients highlight the...

Description of activity and work performed

Imperial college NHS trust became a level one trauma centre in 2010, with a dedicated trauma CT scanner established in 2011. It now receives approximately 35-40 paediatric trauma cases per month. Since that time, a particular effort has been made to reduce the dose per CT scan in paediatric patients (see Fig. 1). A number of radiographic factors have been optimised since then: The method of image reconstruction was changed from filtered back projection to iterative reconstruction. This technique reduces noise in the final image,...

Conclusion and recommendations

The RCR guidelines underline the importance of justifying the use of ionising radiation, by asking whether the patient truly needs imaging. This must be the first step in reducing the radiation dose to paediatric trauma patients. Secondly, one must consider whether plain films, ultrasound, or MR imaging can answer the question being asked. For example, a normal chest x-ray can avoid the significant radiation dose associated with a CT of the thorax. Finally, the technical factors must be considered. In our own institution, DLP and...

Personal/organisational information

Dr. Aisling Fagan, Department of Radiology, Imperial College London, U.K. Dr. Piers Osborne, Department of Radiology, Imperial College London, U.K. Dr. Elizabeth Dick, Department of Radiology, Imperial College London, U.K. Shirley Fetherston, Department of Radiology, Imperial College London, U.K. Dr. Asif Rahman, Department of Radiology, Imperial College London, U.K. Dr. Noor Javad, Department of Radiology, Imperial College London, U.K. Dr Bethan Davis, Department of Radiology, Great Ormond Street Hospital, U.K.

References

1. Bayreuther, J., Wagener, S., Woodford, M., Edwards, A., Lecky, F., Bouamra, O., & Dykes, E. (2009). Paediatric trauma: injury pattern and mortality in the UK.Archives Of Disease In Childhood - Education And Practice,94(2), 37-41. http://dx.doi.org/10.1136/adc.2007.132787 2. Paediatric trauma protocols. (2014).www.rcr.ac.uk. Retrieved 12 January 2018, from https://www.rcr.ac.uk/system/files/publication/field_publication_files/BFCR(14)8_paeds_trauma.pdf