Paediatric Medical Imaging (Research Paper Sample)

Paediatric Medical Imaging
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Challenges facing paediatric x-raying and solutions for positioning
The process of getting a proper x-ray of a child can be very challenging even for radiology professionals with a lot of experience. Although x-rays are painless, children fear them resulting in nervousness and fidgeting which makes the process of getting an image increasingly difficult (University of Michigan C.S. Motts Children’s Hospital, 2013). This fidgeting creates problems for imaging staff because of the limited time that they have to produce images that can aid diagnosis. According to Cook et al. (2001), there is substantial evidence which suggests that children are more affected by the effects of ionizing radiation than adults. The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) has further emphasized that the risks of exposure for the ionizing radiation is dependent on age. In the case of children, exposure results in significant increases in the lifetime risks for harmful effects that include solid cancers (United Nations Scientific Committee on the Effects of Atomic Radiation, 2001). Imaging staff should therefore ensure that they get the required x-ray images within the shortest time.
A strategy that can be used to reduce the fidgeting and thus ensure that the x-ray is finished in time is to make the child comfortable. The presence of the equipment found in X-ray rooms as well as the new faces create an intimidating environment for many children. This intimidating environment should be made to look less threatening at the earliest time possible in order to improve the chances of the child being cooperative. This is especially critical in large hospitals where the patient traffic is high, thus limiting the time that can be spent on examining each patient.
According to the American Chiropractic Registry of Radiologic Technologists (ACCRT) (2013), there are several ways to establish trust with the children. The child should be made to understand the procedure that will be followed and that x-raying does not hurt. After the child has understood this, the radiologists should perform a demonstration using a doll to show exactly what will happen. This should be followed by a rehearsal so that when the actual imaging is done, the chances of trauma will be minimized (American Chiropractic Registry of Radiologic Technologists, 2013). Other strategies that can be used include distracting the child, wearing funny gear to make the environment less threatening, and creating themed x-ray rooms.
The other challenge that faces the staff tasked with getting an X-ray image of a child is getting them into the correct position. Adults can comfortably take up uncomfortable poses and maintain them for long durations. However, a child might find it difficult to maintain the same position so that an x-ray can be completed. This applies to parts of the body such as the head, chests, and arms and legs. Several types of positioning aids can be used to obtain workable images of these body parts.
As stated, one of the problematic regions when it comes to taking x-rays is the chest. One of the options that radiologists have is to find a way to immobilize a child. This can be done by using a device known as a Pigg-O-Stat. According to Oludipe (2013), the device straps a child into a position that is optimal for taking a chest x-ray of good quality. The challenge with using this device is to ensure that the child is calm to make strapping easy. This device has been used by doctors and technicians across the world for over 40 years, meaning that it is a good option for positioning children during x-rays (Pigg-O-Stat, 2013).
The limitation of the Pigg-O-Stat is that it is designed for infants who cannot be directed to take up certain positions. When it comes to slightly older children, other solutions need to be found. The Browning Ball is an example of an aid that has been developed to make chest exams easier for the children as well as radiation technologists. The device works in two ways; the child is at first allowed to play with the ball so that they become less fearful and more cooperative. At the time of imaging, the child is expected to be in upright position while hugging the ball to his/her chest (Imaging Technology News, 2011). For the lateral images, the child is instructed to raise and hold the ball above the head while standing (Supertech, 2013). The ball has been designed in a way that makes it light enough for most children to lift it with ease. An added benefit is that it is made out of foam which makes it have the same density as air, thereby having no impacts on the exposures.
When it comes to dental x-rays, several positions that can be taken. The child can sit and place their chins on supports while the x-ray is being done. X-rays of the arms can be taken in standing positions while those for legs can be taken in a lying position where restraints are used to limit movement. However, the child needs to be calm before any of these procedures are done.
Considerations of Radiation and Protection in Paediatrics
As stated, research has shown that children are more susceptible to the harmful effects of ionizing radiation. The lifetime risks of detrimental results increase two to three times when children are exposed to radiation (United Nations Scientific Committee on the Effects of Atomic Radiation, 2000). Technologists should take these facts into consideration when taking paediatric x-rays. A recommended step to minimize this danger is to ensure that proper guidelines are put in place in the x-ray referral processes of hospital (European Commission, 1996). This will help to ensure that children are exposed to radiation only when it is the only option available for a diagnosis to be made. Another consideration that needs to be made is ensuring that unnecessary organs should not be included.
The dosage of radiation used while imaging should be carefully considered. A study by Cook et al. (2001) showed that some referral medical centers had the tendency to produce images that were of very high quality so as to impress the institutions that made the referrals. This would result in the entry surface dose of radiation being up to three to four times higher than normal (Cook et al., 2001). Technicians need to carefully consider the dosage for children due to the added dangers involved.
According to the European Commission (1996), the first step in radiation protection is justifying the need for exposing a patient to the radioactive procedure. When it comes to children, a perfect imaging procedure is meaningless if the patient does not get benefits like a correct diagnosis and a positive final outcome. The second step is optimizing the procedure itself in order to minimize the dose that the patient will be exposed to (European Commission, 1996). The protection needed while carrying out the x-ray can be achieved by using several methods. Layers of lead rubber can be placed in sensitive areas such as the eyes and the gonads to protect them (Science Daily, 2011). Radiation technologists can also to use modern storage plate systems so as to capture high resolution images at very low radiation doses (Alzen & Benz-Bohm, 2011).
The voltage selected determines how penetrating the radiation will be. Given that children are smaller than adults, paediatric radiology should employ lower voltages that should not exceed 65kV to get the desired images (Alzen & Benz-Bohm, 2011). Another protection strategy that is needed is positioning the child as close to the imaging equipment as possible. This will guarantee that no radiation is wasted. The use of scattered radiation should also be avoided in children while additional tube filters should be used for children (Alzen & Benz-Bohm, 2011).
Common paediatric pathologies encountered and their specific Imaging
Imaging fetuses, infants and children requires specialization because the pathology of children is different from that of adults (Chateil, 2005). For instance, there are several medical conditions that affect children only. In addition to this, the dynamics of the child’s growing body needs to be taken into account. Three commonly occurring paediatric pathologies that will be discussed are Wilm’s tumor, greenstick fractures, and meningitis.
Wilm’s tumor is a solid renal mass and abdominal malignancy that is common in childhood with a prevalence of 1 case for every 10,000 children (Medscape, 2013). It is curable in most children with the treatment depending on the degree to which the cancer has spread to other parts of the body. Diagnosis can be done using blood and urine tests as well as biopsies (Mount Sinai Hospital, 2013). The imaging required for Wilm’s tumor should be CT scans or MRI scans. Chest radiographies should not be used because lung metastases might be missed (Medscape, 2013). However, the CT scans should be performed on children only when the information is reliable and they correlate with the patient’s prognosis.
Greenstick fractures are partial bone fractures that occur in children. They occur when a child’s bone bends and cracks without breaking into separate pieces. The cause of these fractures is the combination of children’s soft bones and their flexibility (Mayo Clinic, 2013). These fractures are difficult to diagnose as the child can retain full motion and suffer...