1. Pediatric Fluoroscopy

2. 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

3. 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:

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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What’s Next?
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Presented by
Based on:
Syllabus on Fluoroscopy Radiation Protection, 6th Rev.
By: Radiologic Health Branch – Certification Unit