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 Fluoroscopy should only be performed on children if radiography cannot provide the necessary information Significant issues to keep in mind when performing fluoroscopy on children: 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: Establish a friendly, non-threatening rapport with the child to obtain trust and cooperation Practice breath-holding or position changing Anesthesia or sedation for long procedures Minimal mechanical immobilization

Personnel and Parental Protection In situations when hospital personnel or parents must physically restrain a child: Remember that scatter radiation from the fluoroscopic examination can be significant for those standing near the patient Leaded gloves and aprons should be worn by whoever is holding the patient and all other personnel standing near the patient

Gonadal Shielding Genetic effects of radiation thought to be cumulative Children may experience deleterious effects in their offspring years later Gonadal shielding of at least 0.5 mm lead equivalent must be used whenever possible

Artifacts Exposure settings for young children generally lower Artifacts from clothing can easily degrade image quality Remove all clothing, bandages, and diapers from area of interest prior to conducting fluoroscopic examination

Automatic Brightness Control (ABC) Particularly valuable for fluoroscopy examinations on children Due to more variation in children’s body sizes Will not function properly unless child covers entire exposure detection device Exception when very radiopaque structures are in exposure field (metal structures and barium-filled stomach) ABC controls will sense dim image and increase exposure factors to maximum Avoid having contrast-filled structures in center or large portion of screen When this happens adjust technical factors manually Higher kVp =better tissue penetration and less absorbed dose

Distance Shortest possible patient-to-image intensifier distance should be used Longer distances = increased scattered radiation dose to patient and operator Increasing distance increases motion and penumbral blur

Other Technical Considerations Utilize smallest possible beam size Keep cineradiography frame rates to minimum necessary for examination to reduce cumulative absorbed dose Grids (which increase patient dose) may not be necessary when exposing small infants Use photospot film and digital photospot cameras whenever possible for children to significantly reduce radiation dose Spot film cameras allow for much shorter exposure times which decreases potential motion blurring

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