Steven Don

Radiosensitivity of children: potential for overexposure in CR and DR and magnitude of doses in ordinary radiographic examinations.

The linear, no-threshold model is currently the best estimate of risk from radiation exposure with no level below which radiation is safe. Plain-film radiography has a much lower patient dose than CT or fluoroscopy. With the advent of computed radiography (CR) the dose to patients is higher than screen-film radiography and overexposure is quite common. Task-oriented adjustment of technique, commonly used in CT, is rarely used in CR. Exposure reduction is important in CR as research indicates an increased risk of childhood acute lymphocytic leukemia from plain-film studies and an increased risk of fatal breast cancer from scoliosis series. Future needs include better documentation of the dose the patient receives, dose-based research on the radiation risk, and accreditation in CR and digital radiography for public assurance.

Sensitivity and Cost Minimization Analysis of Radiology Versus Olive Palpation for the Diagnosis of Hypertrophic Pyloric Stenosis

BACKGROUND/PURPOSE Two strategies are commonly used for the initial diagnosis of hypertrophic pyloric stenosis (HPS): (1) physical examination and (2) radiologic evaluation using upper gastrointestinal series (UGI) or sonography. The authors wished to determine the sensitivity and relative cost of each strategy. METHODS The charts of 234 patients presenting over 3 years with a history suggestive of HPS were reviewed retrospectively. Cost, expressed as mean diagnostic charges (MDC) and mean total charges (MTC), was calculated according to two theoretical models. In model A, all patients first are examined by a surgeon. If an olive is palpable, they proceed to surgery. If not, they are sent to radiology. In model B, all patients have radiologic investigation first, and then surgical evaluation if the study result is positive. RESULTS Of the 234 patients, 150 had HPS (64%). Olives were appreciated in 111 of these (palpation sensitivity of 74%). There was one false-positive olive (0.7%) and no false-negatives. Sonography and UGI were equally accurate (sensitivity of 100%, 0.5% false-positive). Equations were generated to estimate MDC and MTC for our patient population under each model. In model A, MDC =

Image gently campaign back to basics initiative: Ten steps to help manage radiation dose in pediatric digital radiography

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Image gently 5 years later: What goals remain to be accomplished in radiation protection for children?

221 x palpation sensitivity) and MTC =

New Exposure Indicators for Digital Radiography Simplified for Radiologists and Technologists

2,543 (

Image Gently pediatric digital radiography summit: executive summary

240 x palpation sensitivity). In model B, MDC =

The Image Gently Pediatric Digital Radiography Safety Checklist: Tools for Improving Pediatric Radiography

449 and MTC =

Pediatric digital radiography summit overview: state of confusion

2,454, and costs were independent of ability to feel an olive. When cost was plotted against palpation sensitivity, model A yielded a lower MDC than model B if palpation sensitivity was at least 26%, and a lower MTC if palpation sensitivity was at least 37%. Because our palpation sensitivity was 74%, approximately

Approaches to promotion and implementation of action on radiation protection for children

100 per patient would be saved by sending all infants suspected of having HPS to a surgeon for examination as an initial step. CONCLUSIONS Although highly sensitive, imaging is superfluous if an olive is palpable. Children suspected of having HPS should have a surgical consultation before a radiology study as long as the surgeons palpation sensitivity for an olive is at least 37%. Improved palpation skills will result in maximum financial savings.

VERITAS: COMBINING EXPERT OPINIONS WITHOUT LABELED DATA

OBJECTIVE The purpose of this review is to summarize 10 steps a practice can take to manage radiation exposure in pediatric digital radiography. CONCLUSION The Image Gently campaign raises awareness of opportunities for lowering radiation dose while maintaining diagnostic quality of images of children. The newest initiative in the campaign, Back to Basics, addresses methods for standardizing the approach to pediatric digital radiography, highlighting challenges related to the technology in imaging of patients of widely varying body sizes.