Radiation dose to the fetus from body MDCT during early gestation

OBJECTIVE: The purpose of our study was to determine radiation dose to the fetus at early gestation when contemporary MDCT scanners are used for common clinical indications. MATERIALS AND METHODS: Anthropomorphic phantoms were constructed to reflect a pregnant woman. Thermoluminescence dosimeters (TLDs) and metal oxide semiconductor field effect transistor (MOSFET) detectors were placed in appropriate locations to determine real-time radiation exposure to the fetus at 0 and 3 months' gestation. Imaging was performed on a 16-MDCT scanner using current institutional CT protocols: renal stone (140 kVp, 160 mA, rotation time of 0.5 sec, 16 x 0.625 mm), appendix (140 kVp, 340 mA, rotation time of 0.5 sec, 16 x 0.625 mm), and pulmonary embolus (140 kVp, 380 mA, rotation time of 0.8 sec, 16 x 1.25 mm). RESULTS: The radiation dose to the fetus at 0 and 3 months, respectively, was as follows: renal stone protocol, 0.8-1.2 and 0.4-0.7 cGy; appendix protocol, 1.52-1.68 and 2-4 cGy; and pulmonary embolus protocol, 0.024-0.047 and 0.061-0.066 cGy. CONCLUSION: Radiation doses to the fetus from institutional MDCT protocols that may be used during pregnancy (for pulmonary embolus, appendicitis, and renal colic) are below the level thought to induce neurologic detriment to the fetus. Imaging the mother for appendicitis theoretically may double the fetal risk for developing a childhood cancer. Radiation doses to the fetus from pulmonary embolus chest CT angiography are of the same magnitude as ventilation-perfusion (V/Q) scanning.     

Comparison of the different imaging modalities used to image pediatric oncology patients: A COG diagnostic imaging committee/SPR oncology committee white paper

Diagnostic imaging is essential in the diagnosis and management, including surveillance, of known or suspected cancer in children. The independent and combined roles of the various modalities, consisting of radiography, fluoroscopy, ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine (NM), are both prescribed through protocols but also function in caring for complications that may occur during or subsequent to treatment such as infection, bleeding, or organ compromise. Use of a specific imaging modality may be based on situational circumstances such as a brain CT or MR for a new onset seizure, chest CT for respiratory signs or symptoms, or US for gross hematuria. However, in many situations, there are competing choices that do not easily lend themselves to a formulaic approach as options; these situations depend on the contributions of a variety of factors based on a combination of the clinical scenario and the strengths and limitations of the imaging modalities. Therefore, an improved understanding of the potential influence of the imaging decision pathways in pediatric cancer care can come from comparison among the individual diagnostic imaging modalities. The purpose of the following material to is to provide such a comparison. To do this, pediatric imaging content experts for the individual modalities of radiography and fluoroscopy, US, CT, MRI, and NM will discuss the individual modality strengths and limitations.     

Pediatric multidetector body CT

The MDCT has advantages that are uniquely suited to imaging of infants and children. This is one reason why the use of CT has continued to increase. There is also, however, an increased complexity with this technology. Because diagnosis is dependent on adequate quality, and inappropriately high radiation doses can result from poor technique, it is necessary for the radiologist to be familiar with the techniques of MDCT in children. With attention to these techniques, and appropriate application of MDCT, it is possible to maximize the yield while minimizing the risk to children.     

Review of radiation issues for computed tomography.

Over the past three decades, computed tomography (CT) has proven to be central in imaging evaluation. Multidetector technology continues to drive practice patterns by combining fast scanning with high quality data sets. This has resulted in new applications as well as improved use in traditional applications. With this recognition has also come the realization that there are potential costs of CT. One major cost is the radiation dose. Therefore, in order to begin to assess benefits (which are relatively familiar to radiologists) versus costs (which are less familiar), the issues related to CT radiation need to be addressed. Familiarity with measures of CT radiation and the actual doses delivered by CT are important issues as they provide a basis for understanding the potential cancer risks from CT radiation. Moreover, these justify development of strategies to minimize radiation dose. Strategies include obtaining only necessary CT examinations and adjusting the examinations based on scan indication, region examined, and patient size. These strategies must also be combined with efforts by manufacturers in development and implementation of technology aimed at radiation dose management, as well as efforts in research, education, and CT standards and regulation. This article reviews the subject of radiation dose with multidetector CT technology, including measures of CT radiation, the dose that can result from CT examinations, the risks of this amount of radiation, and strategies for minimizing CT radiation dose.     

Abnormalities of the chest wall in pediatric patients

A variety of focal processes and diffuse abnormalities are found predominantly in children. In addition, thoracic manifestations of trauma differ in children because of increased chest wall compliance. Familiarity with both these abnormalities as well as the common normal variations provides optimal imaging evaluation.