RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY

RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY
Part No...., Module No....Lesson No Module title IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY L 21: Optimization of Protection in Pediatric Radiology Part …: (Add part number and title) Module…: (Add module number and title) Lesson …: (Add session number and title) Learning objectives: Upon completion of this lesson, the students will be able to: … . (Add a list of what the students are expected to learn or be able to do upon completion of the session) Activity: (Add the method used for presenting or conducting the lesson – lecture, demonstration, exercise, laboratory exercise, case study, simulation, etc.) Duration: (Add presentation time or duration of the session – hrs) Materials and equipment needed: (List materials and equipment needed to conduct the session, if appropriate) References: (List the references for the session) IAEA Post Graduate Educational Course in Radiation Protection and Safe Use of Radiation Sources

Part No...., Module No....Lesson No
Module title Introduction Good radiation protection policy in Pediatric radiology is essential. There exist International recommendations and code of good practice in this field which constitute a framework for an effective implementation of the optimization principle to diagnostic examinations. Explanation or/and additional information Instructions for the lecturer/trainer 21: Optimization of Protection in Pediatric Radiology IAEA Post Graduate Educational Course in Radiation Protection and Safe Use of Radiation Sources

General recommendations
Topics General recommendations Quality criteria for radiographic images (EUR document) Recommendations for X Ray equipment and rooms for pediatric radiology References 21: Optimization of Protection in Pediatric Radiology

Module title Overview To become familiar with the principles of radiation protection in pediatric radiology, the X Ray systems to be used and the principles of optimization and quality assurance. Lecture notes: ( about 100 words) Instructions for the lecturer/trainer 21: Optimization of Protection in Pediatric Radiology IAEA Post Graduate Educational Course in Radiation Protection and Safe Use of Radiation Sources

Part 21: Optimization of Protection in Pediatric Radiology
Part No...., Module No....Lesson No Module title IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology Part 21: Optimization of Protection in Pediatric Radiology Topic 1: General recommendations for pediatric radiology Part …: (Add part number and title) Module…: (Add module number and title) Lesson …: (Add session number and title) Learning objectives: Upon completion of this lesson, the students will be able to: … . (Add a list of what the students are expected to learn or be able to do upon completion of the session) Activity: (Add the method used for presenting or conducting the lesson – lecture, demonstration, exercise, laboratory exercise, case study, simulation, etc.) Duration: (Add presentation time or duration of the session – hrs) Materials and equipment needed: (List materials and equipment needed to conduct the session, if appropriate) References: (List the references for the session) IAEA Post Graduate Educational Course in Radiation Protection and Safe Use of Radiation Sources

General recommendations for pediatric radiology
General, equipment and installation considerations The generator should have enough power to allow short exposure times (3 milliseconds) and the timer should allow short exposure times The generator should be of high frequency to improve the accuracy and reproducibility of exposures Automatic exposure control (AEC) devices should be used with caution in pediatrics AEC should have specific technical requirements for pediatrics 21: Optimization of Protection in Pediatric Radiology

Careful manual selection of exposure factors usually results in lower doses X Ray rooms for pediatrics should be designed for improving the child’s cooperation (control panel with easy patient visibility and contact, etc.) Fast film-screen combinations have advantages (reduction of dose) and limitations (higher repetition rate) Low-absorbing materials in cassettes, tables, etc. Are specially important in pediatrics radiology 21: Optimization of Protection in Pediatric Radiology

The antiscatter grid in pediatrics gives limited improvement in image quality and increases patient dose given the smaller irradiated volume (and mass) the scattered radiation is less Antiscatter grids for pediatrics should have specific technical requirements Antiscatter grid should be removable in pediatric equipment, particularly fluoroscopic systems Image intensifiers should have high conversion factors for reducing patient dose in fluoroscopic systems 21: Optimization of Protection in Pediatric Radiology

Specific kV-mA dose rate curves for automatic brightness control (ABC) should be used in fluoroscopic systems for pediatrics. It is preferable not to use the ABC unless there is an automatic cut-off device. For CT examinations, the use of specific technical radiographic parameters for CT examinations should be promoted (lower mAs than for adults, and lower kV in some cases). The use of mobile X Ray units in pediatrics could raise special problems (low power, etc). 21: Optimization of Protection in Pediatric Radiology

In pediatrics, there are advantages and disadvantages of under-couch and over-couch fluoroscopy units Pulsed fluoroscopy allows patient dose reduction Digital equipment and the role/use of frame-grab technique may allow dose reductions The cine playback (digital) and video playback (digital/conventional fluoroscopy) in screening examinations may allow patient dose reductions Additional tube filtration may allow dose reductions 21: Optimization of Protection in Pediatric Radiology

Reduction of exposure The causes of repeating films in pediatrics should be analyzed periodically (reject analysis) as part of the audit program. Feedback should be foreseen Immobilization can reduce the repeating film rate The different immobilization devices available for pediatric radiology to make application atraumatic should be considered. The role of simple aids such as sticky tape, sponge wedges and sand bags should also be considered. 21: Optimization of Protection in Pediatric Radiology

Short exposure times can improve image quality and reduce the number of films repeated The use of mobile X Ray units for pediatrics should be restricted due to the difficulty in getting short exposure times Radiographers should have specific training in pediatric radiology Gonadal protection is specially important in pediatric radiology. Several sizes and types of protectors should be available 21: Optimization of Protection in Pediatric Radiology

Collimation is important (in addition to the basic collimation corresponding to the film size) in pediatric patients, particularly window protection for hips and lateral collimation devices for follow-up scoliosis The correct patient positioning and collimation is important in pediatrics, particularly for excluding the gonads from the direct beam It is important to establish whether adolescent girls (over 12 years) might be pregnant when abdominal examinations are contemplated 21: Optimization of Protection in Pediatric Radiology

Motion is a greater problem in children and could require specific adjustment of radiographic techniques Proper consultative relationship between the referring physician and the radiologist is specially important in pediatrics Agreed protocols and diagnostic pathways should be promoted 21: Optimization of Protection in Pediatric Radiology

Some radiological examinations are of questionable value in children (like some follow-up chest radiographs in simple pneumonia, abdominal radiographs in suspected constipation, etc.) The repetition of a radiological examination in pediatrics should always be decided by the radiologist. 21: Optimization of Protection in Pediatric Radiology

Appropriate projections for minimizing dose in high risk tissues should be used (PA projections should replace AP where possible for spinal examinations) Additional filters should be available to enable them to be easily changed (1 mm Al; 0.1 and 0.2 mm Cu should be available). 21: Optimization of Protection in Pediatric Radiology

Dedicated pediatric room or complete sessions dedicated to pediatric radiology should be available Experienced staff who can obtain the child’s confidence and cooperation in a secure and child-friendly environment are of paramount importance in reducing radiation doses in pediatrics Specific referral criteria for pediatric radiology should be available, e.g. for head injury where the incidence of injury is low 21: Optimization of Protection in Pediatric Radiology

Referral criteria for all X Ray examination of children should be established, especially those which may be age-related, e.g. scaphoid not ossified, below age of 6 years, nasal bones cartilaginous below age of 3 years High kV techniques should be used when possible Long focus patient distances could be used to minimize patient entrance dose (with the compromise of appropriate exposure times) 21: Optimization of Protection in Pediatric Radiology

Light beam diaphragm to move the patient into position should be used rather than screening during overcouch fluoroscopy procedures Audit and quality assurance should be promoted in maintaining or improving image quality with reasonable dose 21: Optimization of Protection in Pediatric Radiology

Risk factors As children are at greater risk of incurring stochastic effects, pediatric examinations should require special consideration in the justification process Thus the benefit of some high dose examinations (e.g. computed tomography, IVU, etc.) should be carefully weighed against the increased risk 21: Optimization of Protection in Pediatric Radiology

Risk factors Longer life expectancy in children means a greater potential for manifestation of possible harmful effects of radiation Radiation doses used to examine young children should generally be smaller than those employed in adults Risk factors for cancer induction in children is between 2 and 3 times higher than for adults 21: Optimization of Protection in Pediatric Radiology

Patient dosimetry - Guidance levels Measuring patient doses in pediatrics presents special difficulties (small values) Dosimetric techniques used for patient dosimetry in pediatrics should be specifically adapted Patient dose values are related to patient size 21: Optimization of Protection in Pediatric Radiology

Guidance levels in pediatrics should be related with patient size Guidance levels available at present for pediatrics are limited of a small set of values The use of guidance levels in pediatric radiology should be used with caution due to the difficulty of measuring patient dose and the limited set of available values to be used as reference 21: Optimization of Protection in Pediatric Radiology

Protection of personnel and parents Parents can cooperate in the radiological examination of their children if they are duly informed and duly protected Parents’ exposure in this situation can be considered as a medical exposure but optimization criteria must be applied 21: Optimization of Protection in Pediatric Radiology

Parents or helpers should be duly informed and should know exactly what is required of them Pregnant women should not be allowed to help during pediatric examinations Lead aprons and lead gloves (if the hands are near the direct radiation field) should be used in these situations 21: Optimization of Protection in Pediatric Radiology

ICRP-ISR “smart” message for pediatrics
21: Optimization of Protection in Pediatric Radiology

Part 21: Optimization of protection in Pediatric Radiology
Part No...., Module No....Lesson No Module title IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology Part 21: Optimization of protection in Pediatric Radiology Topic 2: Quality criteria for radiographic images (EUR document) Part …: (Add part number and title) Module…: (Add module number and title) Lesson …: (Add session number and title) Learning objectives: Upon completion of this lesson, the students will be able to: … . (Add a list of what the students are expected to learn or be able to do upon completion of the session) Activity: (Add the method used for presenting or conducting the lesson – lecture, demonstration, exercise, laboratory exercise, case study, simulation, etc.) Duration: (Add presentation time or duration of the session – hrs) Materials and equipment needed: (List materials and equipment needed to conduct the session, if appropriate) References: (List the references for the session) IAEA Post Graduate Educational Course in Radiation Protection and Safe Use of Radiation Sources

Free PDF version available at:
European Guidelines on Quality Criteria for Diagnostic Radiographic Images in Paediatrics, July 1996. EUR EN Free PDF version available at: 21: Optimization of Protection in Pediatric Radiology

21: Optimization of Protection in Pediatric Radiology

Criteria related to images
The Image Criteria for pediatric patients presented for a particular type of radiograph are those deemed necessary to produce an image of standard quality No attempt has been made to define acceptability for particular clinical indications The image criteria allow an immediate evaluation of the image quality of the respective radiograph. They are appropriate for the most frequent requirements of radiographic imaging of pediatric patients 21: Optimization of Protection in Pediatric Radiology

The anatomical features and body proportions vary due to the developmental process in infancy, childhood and adolescence They are different in the respective age groups and are distinct from those of a mature patient The Guidelines presuppose knowledge of the changing radiographic anatomy of the developing child. The term “consistent with age” indicates that the respective image criteria essentially depend on the age of the patient 21: Optimization of Protection in Pediatric Radiology

The smaller body size The age dependent body composition The lack of co-operation and many functional differences (e.g. higher heart rate, faster respiration, inability to stop breathing on command, increased intestinal gas etc.) Prevent the production of radiographic images in pediatric patients to which standard adult image criteria can be applied 21: Optimization of Protection in Pediatric Radiology

Correct positioning of pediatric patients may be much more difficult than in co-operative adult patients Effective immobilization often necessitates the use of auxiliary devices Sufficient skill and experience of the imaging staff and ample time for the particular investigation are the imperative prerequisites to fulfil this quality criterion in infants and younger children 21: Optimization of Protection in Pediatric Radiology

Incorrect positioning is the most frequent cause of inadequate image quality in pediatric radiographs Image criteria for the assessment of adequate positioning (symmetry and absence of tilting etc) are much more important in pediatric imaging than in adults A lower level of image quality than in adults may be acceptable for certain clinical indications 21: Optimization of Protection in Pediatric Radiology

An inferior image quality, however, cannot be justified unless this has been intentionally designed and must then be associated with a lower radiation dose The fact that the X Ray was taken from a non-cooperative pediatric patient (anxious, crying, heavily resisting) is not an excuse for producing an inferior quality film which is often associated with an excessive dose 21: Optimization of Protection in Pediatric Radiology

Criteria for Radiation Dose to the Patient
Expressed in terms of a reference value for the entrance surface dose for a “standard sized” pediatric patient Reference dose values are available only for the most frequently performed types of radiographs for which sufficient data were acquired in a series of European Trials on infants, 5 year old and 10 year old patients 21: Optimization of Protection in Pediatric Radiology

Criteria for Radiation Dose to the Patient
The assessment of compliance with the criteria for radiation dose to the patient for a specific radiograph unavoidably involves some form of dose measurement This requires representative sampling of the patient population A number of dose measurements methods are described in the European Guideline 21: Optimization of Protection in Pediatric Radiology

General principles associated with good imaging performance
Image Annotation The patient identification, the date of examination, positional markers and the name of the facility must be present and legible on the film These annotations should not obscure the diagnostically relevant regions of the radiograph An identification of the radiographers on the film would also be desirable 21: Optimization of Protection in Pediatric Radiology

Quality Control of X Ray Imaging Equipment Quality control programs should be instigated in every medical X Ray facility and should cover a selection of the most important physical and technical parameters associated with the types of X Ray examination being carried out Limiting values for these technical parameters and tolerances on the accuracy of their measurement should be required 21: Optimization of Protection in Pediatric Radiology

Low Attenuation Materials Recent developments in materials for cassettes, grids, tabletops and front plates of film-changers using carbon fiber and some new plastics enable significant reduction in patient doses This reduction is most significant in the radiographic-voltage range recommended in pediatric patients and may reach 40%. Use of these materials should be encouraged 21: Optimization of Protection in Pediatric Radiology

Patient Positioning and Immobilization Patient positioning must be exact whether or not the patient co-operates. In infants, toddlers and younger children immobilization devices, properly applied, must ensure that: the patient does not move the beam can be centered correctly the film is obtained in the proper projection accurate collimation limits the field size exclusively to the required area shielding of the remainder of the body is possible. 21: Optimization of Protection in Pediatric Radiology

Patient Positioning and Immobilization 21: Optimization of Protection in Pediatric Radiology

Patient Positioning and Immobilization Immobilization devices must be easy to use, and their application atraumatic to the patient. Their usefulness should be explained to the accompanying parent(s). Radiological staff members should only hold a patient under exceptional circumstances Even in quite young children the time allocation for an examination must include the time to explain the procedure not only to the parents but also to the child 21: Optimization of Protection in Pediatric Radiology

Field Size and X Ray Beam Limitation Inappropriate field size is the most important fault in pediatric radiographic technique A field which is too small will immediately degrade the respective image criteria A field which is too large will not only impair image contrast and resolution by increasing the amount of scattered radiation but also, most importantly, result in unnecessary irradiation of the body outside the area of interest 21: Optimization of Protection in Pediatric Radiology

Field Size and X Ray Beam Limitation Correct beam limitation requires proper knowledge of the external anatomical landmarks by the technician These differ with the age of the patient according to the varying proportions of the developing body. In addition, the size of the field of interest depends much more on the nature of the underlying disease in infants and younger children than in adults 21: Optimization of Protection in Pediatric Radiology

Field Size and X Ray Beam Limitation A basic knowledge of pediatric pathology is required for radiographers and other technical assistants to ensure proper beam limitation in these age groups The acceptable minimal field size is set by the listed recognizable anatomical landmarks for specific examinations 21: Optimization of Protection in Pediatric Radiology

Field Size and X Ray Beam Limitation Beyond the neonatal period, the tolerance for maximal field size should be less than 2 cm greater than the minimal In the neonatal period, the tolerance level should be reduced to 1.0 cm at each edge 21: Optimization of Protection in Pediatric Radiology

Field Size and X Ray Beam Limitation In pediatric patients, evidence of the field limits should be apparent by clear rims of unexposed film Beam-limiting devices automatically adjusting the field to the full size of the cassette are inappropriate for pediatric patients Discrepancies between the radiation beam and the light beam must be avoided by regular assessment 21: Optimization of Protection in Pediatric Radiology

Additional filtration The soft part of the radiation spectrum which is absorbed in the patient is useless for the production of the radiographic image and contributes unnecessarily to the patient dose Part of it is eliminated by the filtration of the tube, tube housing, collimator etc., but this is insufficient Most tubes have a minimum filtration of 2.5 mm Al Additional filtration can further reduce unproductive radiation and thus patient dose 21: Optimization of Protection in Pediatric Radiology

Additional filtration For pediatric patients, total radiation dose must be kept low, particularly when high speed screen film systems or image intensifying techniques are used Not all generators allow the short exposure times that are required for higher kV technique Low radiographic voltage is frequently used for pediatric patients. This results in comparatively higher patient doses. 21: Optimization of Protection in Pediatric Radiology

Additional filtration Adequate additional filtration allows the use of higher radiographic voltage with the shortest available exposure times, thus overcoming the limited capability of such equipment for short exposures This makes the use of high speed screen film systems and image intensifier photography possible 21: Optimization of Protection in Pediatric Radiology

Protective Shielding For all examinations of pediatric patients, the examples for “Good Radiographic Technique” include standard equipment of lead-rubber shielding of the body in the immediate proximity of the diagnostic field Special shielding has to be added for certain examinations to protect against external scattered and extra-focal radiation 21: Optimization of Protection in Pediatric Radiology

Protective Shielding For exposures of kV, maximum gonadal dose reduction of about 30 to 40% can be obtained by shielding with 0.25 mm lead equivalent rubber immediately at the field edge However, this is only true when the protection is placed correctly at the field edge 21: Optimization of Protection in Pediatric Radiology

Protective Shielding The gonads in "hot examinations", i.e. when they lie within or close (nearer than 5 cm) to the primary beam, should be protected whenever this is possible without impairing necessary diagnostic information It is best to make one's own lead contact shields for girls and lead capsules for boys They must be available in varied sizes 21: Optimization of Protection in Pediatric Radiology

Protective Shielding By properly adjusted capsules, the absorbed dose in the testes can be reduced by up to 95% In girls, shadow masks within the diaphragm of the collimator are as efficient as direct shields. They can be more exactly positioned and do not slip as easily as contact shields When shielding of the female gonads is effective, the reduction of the absorbed dose in the ovaries can be about 50% 21: Optimization of Protection in Pediatric Radiology

Protective Shielding There is no reason to include the male gonads in the scrotum within the primary radiation field for radiographs of the abdomen The same applies, usually, for films of the pelvis and micturating cystourethrographies. The tests should be protected with a lead capsule, but kept outside the field In abdominal examinations gonad protection for girls is not possible 21: Optimization of Protection in Pediatric Radiology

Protective Shielding In practice, the great majority of pelvic films show that female gonad protection is completely ineffective The position of all sorts of lead material is often ludicrous There are justifiable reasons for omitting gonad protection for pelvic films in girls, e.g. trauma, incontinence, abdominal pain, etc 21: Optimization of Protection in Pediatric Radiology

Protective Shielding The eyes should be shielded for X Ray examinations involving high absorbed doses in the eyes, e.g. for conventional tomography of the petrous bone, when patient cooperation permits The absorbed dose in the eyes can be reduced by 50% - 70% In any radiography of the skull the use of PA-projection rather than the AP-projection can reduce the absorbed dose in the eyes by 95% 21: Optimization of Protection in Pediatric Radiology

Protective Shielding PA-projection, therefore, should be preferred as soon as patient age and co-operation permit prone or erect positioning As developing breast tissue is particularly sensitive to radiation, exposure must be limited The most effective method is by using the PA-projection, rather than the AP 21: Optimization of Protection in Pediatric Radiology

Protective Shielding While this is well accepted for chest examinations, the greatest risk is during spinal examinations, and here PA examinations must replace AP It should also be remembered that thyroid tissue should be protected, whenever possible, e.g. during dental and facial examinations 21: Optimization of Protection in Pediatric Radiology

Radiographic Exposure Conditions Knowledge and correct use of appropriate radiographic exposure factors, e.g. Radiographic voltage, nominal focal spot value, filtration, film-focus distance is necessary because they have a considerable impact on patient doses and image quality Permanent parameters of the apparatus such as total tube filtration and grid characteristics should also be taken into consideration 21: Optimization of Protection in Pediatric Radiology

Automatic Exposure Control Adult patients vary in size, but their variation is minimal compared to the range in pediatric patients from premature infants, weighing considerably less than a thousand grams, to adolescents approaching 70 kg Those investigating pediatric patients must be able to adapt to this range. One would expect that a device for automatic exposure control (AEC) would be helpful 21: Optimization of Protection in Pediatric Radiology

Automatic Exposure Control Many of the AEC systems commonly available are not satisfactory They have relatively large and fixed ionization chambers. Neither their size nor their shape nor their position is able to compensate for the many variations of body size and body proportion in pediatric patients In addition, the usual ionization chambers of AECs are built in behind a grid 21: Optimization of Protection in Pediatric Radiology

Automatic Exposure Control AEC-use may be associated with the use of the grid (where the grid is not removable) which is frequently unnecessary The optimal adaptation of the radiographic technique to the clinical needs requires the use of screen film systems of different speeds and different switch-off doses at the image receptor 21: Optimization of Protection in Pediatric Radiology

Automatic Exposure Control Screens and AEC chambers are wavelength dependant, particularly in the lower range of radiographic voltage, but these dependencies do not correspond with each other AECs lengthen the minimal exposure times All these factors must be considered when AECs are used in pediatric patients 21: Optimization of Protection in Pediatric Radiology

Automatic Exposure Control Specially designed pediatric AECs have a small mobile detector for use behind a lead-free cassette Its position can be selected with respect to the most important region of interest This must be done extremely carefully, as even minor patient movement may be disastrous 21: Optimization of Protection in Pediatric Radiology

Automatic brightness control Automatic brightness control (ABC) has to be switched off during fluoroscopic examinations where there are relatively large areas of positive contrast material to avoid excessive dose rates, e.g. full bladders 21: Optimization of Protection in Pediatric Radiology

Guidance on implementation of quality criteria
Quality Criteria are presented for a number of selected radiographic projections used in the course of routine types of X Ray examination They apply to pediatric patients with the usual presenting symptoms for the type of examination being considered They are to be used by radiologists, radiographers, and medical physicists as a check on the routine performance of the entire imaging process 21: Optimization of Protection in Pediatric Radiology

However, the Quality Criteria cannot be applied to all cases For certain clinical indications lower level of image quality may be acceptable, but this should ideally always be associated with a lower radiation dose to the patient 21: Optimization of Protection in Pediatric Radiology

Under no circumstances should an image which fulfils all clinical requirements but does not meet all image criteria ever be rejected 21: Optimization of Protection in Pediatric Radiology

21: Optimization of Protection in Pediatric Radiology

Diagnostic Reference Doses in Pediatrics
Examples of Diagnostic Reference Doses in Pediatrics, for standard five-year-old patients, expressed in entrance surface dose per image, for single views (from EUR-16261) 21: Optimization of Protection in Pediatric Radiology

Part 14.1: Optimization of Protection in Pediatric Radiology
Part No...., Module No....Lesson No Module title IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology Part 14.1: Optimization of Protection in Pediatric Radiology Topic 3: Recommendations for X Ray room and equipment Part …: (Add part number and title) Module…: (Add module number and title) Lesson …: (Add session number and title) Learning objectives: Upon completion of this lesson, the students will be able to: … . (Add a list of what the students are expected to learn or be able to do upon completion of the session) Activity: (Add the method used for presenting or conducting the lesson – lecture, demonstration, exercise, laboratory exercise, case study, simulation, etc.) Duration: (Add presentation time or duration of the session – hrs) Materials and equipment needed: (List materials and equipment needed to conduct the session, if appropriate) References: (List the references for the session) IAEA Post Graduate Educational Course in Radiation Protection and Safe Use of Radiation Sources

Recommendations for X Ray room and equipment to be used in pediatrics
Visibility of the patient and easy audio communication from the control panel High frequency generators of mA with linearity from 50 until kV Exposures of 3 ms should be possible. AEC devices should be specifically adapted Different control for the anode rotation and exposure (specially important for chest examinations to avoid respiratory movement) 21: Optimization of Protection in Pediatric Radiology

Low absorption materials and plastic cassettes should be used Antiscatter grid should be removable When using the grid, this should be Fixed (specific for pediatric) or with very fast movement due to the short exposure times Image intensifier (I.I.) of 15 cm can be the appropriate size for small patients. Higher sizes or multimode I.I. can produce worse images 21: Optimization of Protection in Pediatric Radiology

The use of additional filtration should be considered in pediatric X Ray equipment Mobile X Ray system for pediatrics should have the highest possible output Immobilization devices should be available in pediatric rooms 21: Optimization of Protection in Pediatric Radiology

References European Guidelines on Quality Criteria for Diagnostic Radiographic Images in Paediatrics, July EUR Available at: ICRP Publication 34, Protection of the Patient in Diagnostic Radiology. Annals of the ICRP (2/3) 1982. NCRP 68. Radiation protection in pediatric radiology, 1981. 21: Optimization of Protection in Pediatric Radiology

References Cook JV, Shah K, Pablot S, Kyriou J, Pettet A, Fitzgerald M. Guidelines of best practice in the X-ray imaging of children. Edited by the Queen Mary’s Hospital of Children. London 1998. Guidelines on education and training in radiation protection for medical exposures. Radiation Protection 116. European Commission Available at: 21: Optimization of Protection in Pediatric Radiology

References Guidance on diagnostic reference levels (DRLs) for medical exposures. Radiation Protection 109. European Commission Available at: Rational use of diagnostic imaging in pediatrics. WHO, 1987. 21: Optimization of Protection in Pediatric Radiology

Module title Summary Particular attention should be given to technical specifications of X Ray equipments and protocols used in X Ray pediatric radiology. Radiologists and radiographers should be specifically trained and the higher radiosensitivity of the patients should be taken into account. General rules of protection and guidelines are presented. Let’s summarize the main subjects we did cover in this session. (List the main subjects covered and stress again the important features of the session) 21: Optimization of Protection in Pediatric Radiology IAEA Post Graduate Educational Course in Radiation Protection and Safe Use of Radiation Sources

RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY

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