Reduction Of Radiology Dose Pediatric Fluoroscopy (Article Critique Sample)

Article review: Pediatric fluoroscopy
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Article: Hernanz-Schulman, M., Goske, M. J., Bercha, I. H., & Strauss, K. J. (2011). Pause and pulse: ten steps that help manage radiation dose during pediatric fluoroscopy. American journal of roentgenology, 197(2), 475-481.
Abstract
This paper is about a number of steps which are addressing dose optimization in radiology for pediatric fluoroscopic procedures with an aim of reducing the amount of radiation in the young patients’ population. Fluoroscopy is an imaging technique that has over the years been used for pediatric radiologic examination. Among the many existing modalities, fluoroscopy has shown a rising pediatric radiation dose from its interventional guided procedures. A report from a 2009 study on the dose of radiation led to the need for promoting precautions on radiation safety among the pediatric population CITATION Wil16 \l 1033 (Wildgruber, 2016).
Keywords: fluoroscopy, radiation dose, Image gently, x-ray
Article summary.
Through a campaign by the Image Gently Campaign of the Alliance for Radiation Safety in Pediatric Imaging, ten steps have been put forward in the campaign’s most recent phase- Pause and Pulse addressing dose optimization methods in the pediatric fluoroscopy as explained by the authors of the article.
Step one- knowing the equipment and gaining knowledge on usage of the features that save the dose. A fluoroscopic equipment yield, measured as Roentgens i.e. Coulombs/Kg/minute has an operating legal limit exposure rate of 258 × 10^-5 C/kg/Min. Other gadgets are set to run at an elevated dose rate that couples the initial legal limit. Fluoroscopic procedures’ radiation dose is always variable and the total dose for a patient depends on how many images are obtained, both fluoroscopic and radiographic.
Step two- Pause and determine if the clinical indication is well-matched by the requested examination and if alternate imaging techniques are applicable too. A knowledge of the clinical scenario that needs answering is relevant in the planning of the most appropriate examination.
Step three- Pause to plan properly, study preparation. An example is pausing to ask oneself whether there is a possibility to come across an unusual anatomy in a medical or surgical case. The preparation is valuable and will save fluoroscopy time and also exclude a potential necessity to repeat the examination.
Step four- X-ray stream is pulsed at the lowermost frame rate that is needed for every bit of the exam. It is in this pulsed manner where the x-ray stream gets swapped on and off after every fluoroscopic image. That results in a reduction in time of exposure as compared to the usual thirty-three milliseconds of exposure in the continuous fluoroscopy.
Step five- Removal of the anti-scatter grid during the imaging of small patients. Anti-scatter grid is placed in position when imaging a 40-50 pounds’ patients, i.e. approximately 18-23 kilograms. It attenuates the scattered radiation thus improving the contrast of the image. Removal of the grid is necessary for small patients in that their small bodies don’t produce a sufficient distribution to largely mortify the images especially during the visualization of a high-contrast object, for example, an iodinated or barium media.
Step six- the largest fields of view are used or the smallest electronic magnification that is possible. A reduction in the field of view results in an increase in the sharpness of the structures, enlarging the small structures on the display. However, this increases the patient’s radiation dose.
Step seven- Collimation in order to focus on the part of interest. The x-ray stream area is reduced so that patient’s anatomical area that needs visualization is focused. This, however, doesn’t decrease the radiation dose. It’s tricky to collimate in pediatrics because the patient’s movements might put the region of concern external to the x-ray beam.
Step eight- positioning of the patient appropriately relative to the pivotal spot and the image receptor. Finding are that the dose of radiation is significantly affected by the patient’s distance from the pivotal spot and entry level. By the inverse square law, skin dose to the patient decreases with a rise in the space from the patient to the pivotal spot.
Step nine- using the “last image hold and the fluoroscopy store” CITATION Her11 \l 1033 (Hernanz-Schulman, 2011). The last fluoroscopic image displays that result after the release of the of fluoroscopy pedal or hand switch on the display monitor is known as the last image or fluoro save. Use of this technique allows the radiologist to spend a significant amount of time studying anatomy without worries of an additional dose of radiation.
Step ten- the physicist participation in the fluoroscope optimization and conservation. Consultation with physicists should be done by the radiologists within their working institutions. Review of features that save dosages of the fluoroscopic imagers should also be done in their department. The operator also needs to understand the configuration of the pulsed fluoroscopy, pulse width, spatial beam filtering, the number of frames per second and dose monitoring.
However, these ten steps are not as effective as put. This is because step four is not entirely practical in that pulsing the beam of the x-ray doesn’t necessarily reduce the dosage of the radiation. Also, the use of electronic magnification for a better visualization has a cost of an increased dose of radiation. Older equipment quadruples the dose, hence the need for newer equipment which is not a viable idea. Some of these steps need a highly experienced technician who can handle the high-technology equipment. If the radiologic technologists are unavailable, the operation of the machines will be hindered. Even though the radiologists are able to use some simple maneuvers that save the dose to reduce fluoroscopic doses as seen above, the equipment manufacturers have come up with an inbuilt system that helps decrease exposure dose which is released by the x-ray tube. This radiographic equipment now uses filters of low energy thus removing any undesirable low energy x-rays that the anode ...