Pediatric Fluoroscopy

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

Methods to consider prior to exposure are: Motion Motion accounts for more imaging problems for children than for adults Establish a friendly, non-threatening rapport with the child Practice breath-holding or position-changing Anesthesia or sedation for long procedures Minimal mechanical immobilization Methods to consider prior to exposure are:

Personnel and Parental Protection Leaded gloves and aprons should be worn by whoever is holding the patient and all other personnel standing near the patient 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

Gonadal Shielding Genetic effects of radiation are 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

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

Automatic Brightness Control (ABC) ABC is particularly valuable for fluoroscopy examinations on children Due to more variation in children’s body sizes, ABC will not function properly unless the collimator’s shutters are close to the edges of the part being imaged The exception is when very radiopaque structures are in exposure field (metal structures and barium-filled stomachs) 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

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 Shortest possible patient-to-image intensifier distance should be used

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

Please close this PowerPoint presentation, and continue the lesson. What’s Next? Please close this PowerPoint presentation, and continue the lesson. Presented by Based on: Syllabus on Fluoroscopy Radiation Protection, 6th Rev. By: Radiologic Health Branch – Certification Unit