Pediatric Fluoroscopy Based on: Syllabus on Fluoroscopy Radiation Protection, 6th Rev. By: Radiologic Health Branch – Certification Unit PPT created by: Jed Miles, BSRS, RT(R), CRT-CA

Introduction Radiation doses received by children for fluoroscopic examinations are generally significantly less than those received by adults for an equivalent study However, the longer life span of a child allows more time for manifestation of long term detrimental effects of radiation It is also suggested that children are more sensitive to the effects of radiation since their tissues undergo higher rates of mitotic activity than those of adults

Introduction For these reasons, it is especially important to keep radiation doses to children to a minimum particularly during fluoroscopy since these procedures given much larger doses of radiation to the patient than radiography Fluoroscopy should only be performed if radiography cannot provide the necessary information Significant issues to keep in mind when performing fluoroscopy on children are Motion Personnel and parental protection Gonad shielding Artifacts Automatic Brightness Control (ABC) Distance Other special Technical Considerations

Motion Motion accounts for more imaging problems than for adults Methods to consider prior to exposure are If possible, establish a friendly, non-threatening rapport with the child to obtain trust and cooperation Practice breath-holding or position changing If examination is long – consider the use of anesthesia or sedation Use of mechanical immobilization may be useful and needed but kept to a minimum

Personnel and Parental Protection Often is may be impossible or impractical to use mechanical methods of immobilization and not medically practical to use sedation or anesthesia In these situations, hospital personnel or parents must physically restrain the infant or toddler during radiation exposure It is important to remember that scatter radiation from the fluoroscopic examination can be significant for those standing near the patient Therefore, leaded gloves and aprons should be worn by whoever is holding the patient and all other personnel who are standing near the patient

Gonadal Shielding Gonadal shielding of at least 0.5 mm lead equivalent must be used whenever possible The importance of gonadal shield cannot be expressed enough as genetic effects of radiation are thought to be cumulative The cumulative effects to the gonads may produce deleterious effects in their offspring years later…

Artifacts As exposure setting for young children are generally set to lower values artifacts from clothing can easily degrade image quality It is import to remove all clothing, bandages, and diapers form the area of interest prior to conducting a fluoroscopic examination

Automatic Brightness Control (ABC) Automatic Brightness Control (ABS) also known as Automatic Brightness Stabilization (ABS) is particularly valuable for fluoroscopy examinations on children This is due to so much more variation in children’s body sizes It is also import to understand the ABC will not function properly unless the child covers the entire exposure detection device Otherwise the beam will directly expose the input phosphor and produce a light image on both the TV monitor and any recorded photospot images

Automatic Brightness Control (ABC) There is one important exception to using the ABC to reduce radiation dose This occurs when a very radiopaque structures are in the exposure field This includes metal structures and a barium filled stomach When this happens the ABC controls will sense a dim image and increase exposure factors to the maximum Therefore, it is important to avoid having contrast filled structures fill up the center or a large portion of the screen When this happens it is best to adjust the technical factors on a manual basis Higher kVp is best for better tissue penetration and less absorbed dose

Distance The shortest possible patient-to-image intensifier distance should be used When longer distances are used the scattered radiation dose to the patient and operator will increase Increasing distance also increases motion and penumbral blur

Other Technical Considerations Utilizing the smallest possible beam size Small increases in field sizes can dramatically increase the child’s total radiation dose Collimation should be limited to the area of interest and not the entire image intensifier field Manual override of automatic collimator may be necessary to achieve this goal Keeping cineradiography frame rates to the minimum necessary for the examination to reduce the cumulative absorbed dose Grid use which increase patient dose may not be necessary when exposing small infants due to the small volume being irradiated Omission of grids can significantly decrease dose rates

Other Technical Considerations Use of photospot film cameras and digital photospot cameras whenever possible in lieu of conventional cassette spot filming for children will significantly reduce radiation dose In addition, use of spot film cameras allows the use of much shorter exposure times which decreases potential motion blurring

Next up…Mobile Fluoroscopy