Image gently, or when the diagnostic is worse than the disease

From the time I was little I had an awareness of the potential dangers of medical X-rays. My mom was always careful to limit the number and frequency of dental x-rays she let us have, and luckily we rarely needed X-rays for anything else. Her concern was probably based on scientific awareness coupled with regret from playing with fluoroscopes in shoe-stores in the 1950s. I'm sure it also had something to do with the fact that a relative whom we saw a couple of times a year had a developmentally disabled daughter, most likely having something to do with working as an x-ray technician in the 1950s while pregnant.So with the rise of imaging, especially high-radiation CT scanners, I've written about the possible dangers (see Saying no to CT). It's shocking to me the number of CT scans that individuals receive, in some cases approaching or exceeding the radiation exposure from survivors of Nagasaki and Hiroshima.I'm glad to see that the Alliance for Radiation Safety in Pediatric Imaging has announced an "image gently" campaign, designed to educate radiologists, technologists, medical physicists and parents to minimize radiation dose in children. They have an excellent website, which I recommend. See for example, the section for parents, which advises on how to be an advocate for your child. Even if you are shy about taking an active role in your own care, I urge you to do so when it comes to your kids.The site lists five steps that radiologists should take to improve care: 

• Increase awareness for the need to decrease radiation dose to children during CT scanning. Protocol development recommendations are offered under What can I do?
• Be committed to make a change in your daily practice by working as a team with your technologists, physicist, referring doctors and parents to decrease the radiation dose! Sign the pledge! Click on the link on the home page to join the image gently campaign today.
• Contact your physicist to review your adult CT protocols and then use the simple CT protocols on this website to "down-size" the protocols for kids. More is not better….adult size KV and mAs are not necessary for small bodies.
• Single phase scans are usually adequate. Pre- and post contrast, and delayed CT scans rarely add additional information in children yet can double or triple the dose! Consider removing multi-phase scans from your daily protocols.
• Scan only the indicated area. If a patient has a possible dermoid on ultrasound, there is rarely need to scan the entire abdomen and pelvis. "Child-size" the scan and only scan the area required to obtain the necessary information.

  Imaging is expensive and growing rapidly. My guess is that CT utilization could be better controlled if patients had a better awareness of what's involved.