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Table of Contents   
EDITORIAL COMMENTARY  
Year : 2017  |  Volume : 10  |  Issue : 2  |  Page : 313-314
Radiation exposure in pediatric imaging: Justification, optimization, and risk communication


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India

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Date of Web Publication22-Jun-2017
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Radiation exposure in pediatric imaging: Justification, optimization, and risk communication. Ann Trop Med Public Health 2017;10:313-4

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Radiation exposure in pediatric imaging: Justification, optimization, and risk communication. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Aug 23];10:313-4. Available from: http://www.atmph.org/text.asp?2017/10/2/313/196803
Globally, close to 3.6 billion diagnostic radiological investigations have been conducted, of which almost 350 million are being performed on the pediatric population.[1] In-fact, these estimates are expected to rise continuously as gradually the number of people who access medical care services are also on the rise.[1] However, because of the advances in ionizing radiation technologies, the application of various imaging techniques has increased enormously both for diagnostic and therapeutic purposes, even among children.[1],[2]

Moreover, because of the small size and a much longer lifespan than the adults, children are at more risk for the development of the radiation-induced side effects.[1] It is very important to understand that despite the limited individual risk, the area of radiation safety in pediatric group has acquired a public health importance, due to the tremendous rise of radiation exposure in pediatric population and increased public awareness.[2],[3] Further, no confirmatory evidence is available to suggest that exposure to more number of imaging procedures will result in additional benefit to the pediatric patients.[1],[3]

Although there is no doubt regarding the advantages these methods offer, and the utility of them in saving the lives of pediatric population, nevertheless inappropriate use might result in unnecessary and excessive radiation exposure to the patients.[2],[3] Thus, it is very much crucial to compare the benefits offered against the potential risks of the radiation exposure among children.[1],[2] This can be done either through justifying the need for the procedure by adhering to the imaging referral recommendations, or by enhancing the level of protection through keeping the radiation dose to the minimum.[4] In-fact, there is a definite scope for reducing the radiation dose without compromising much on the loss of diagnostic information.[1],[4]

A wide range of factors have been associated with inappropriate ionizing-radiation procedures in children, such as low awareness pertaining to radiation doses or associated risks or existence of methods, which do not use ionizing radiations, either absence or ignorance about imaging referral guidelines, lack of clinical information provided for justification, over-reliance on imaging or poor clinical expertise, demand from patients or family members, fear about malpractice litigations, market pressure to promote the use of imaging technologies or pressure from referring doctor, poor interaction between the referrers and the radiologists, too frequent or unnecessary repeat examinations, giving more importance to the personal or previous experience not supported by evidence-based medicine, and no availability of other radiological procedures or specialist to perform the procedure.[1],[2],[3],[4],[5]

Further, there is an indispensable need to improve the communication of radiation risk in pediatric imaging to ensure that a benefit–risk balance is maintained between health care providers, families, and patients.[5] In-fact, it is the combined responsibility of the health care provider requesting and the person performing radiological procedures to ensure that the precise information is conveyed to the patient and their family members to enable them to make an informed choice.[5] It is quite obvious that if patients and families are not adequately informed about the risks and benefits of an imaging procedure, they might opt for those methods that are more harmful than being beneficial to the patient.[1]

Acknowledging the importance of risk communication in pediatric imaging, the World Health Organization has released a specific instruction manual to assist the health care providers to effectively communicate to the beneficiaries.[5] This is quite an effective tool in low resource settings wherein ensuring protection of patients from radiation risks is a big challenge due to the inadequate radiation guidelines, poor compliance with existing recommendations, absence or limited training of medical professionals, and nonadherence to the advocated standards for maintenance, or disposal of radiology equipments.[1],[5] Further, these guidelines will aid in improving the radiation safety standards and creating awareness among the policy makers (for the formulation of specific radiation policies) and the general population.[4],[5] In-fact, these recommendations have been used in African nations, and the results have been quite encouraging.[1]

To conclude, amidst the rising use of imaging techniques in pediatric population, it is the responsibility of each of the stakeholders to assist the patient in making an informed decision. Thus, there is a great need to justify the utility of the procedure, keep the dose of radiation to a minimum, and improve the communication skills of the healthcare providers

Acknowledgement

S.R.S. contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work.

P.S.S. contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

J.R. contributed in revising the draft, approval of the final version of the manuscript, and agreed for all aspects of the work.

 
   References Top

1.
World Health Organization. To X-ray or not to X-ray?; 2016. Available from: http://who.int/features/2016/to-xray-or-not-to-xray/en/. [Last accessed on 2016 April 17].  Back to cited text no. 1
    
2.
Strauss KJ, Goske MJ. Estimated pediatric radiation dose during CT. Pediatr Radiol 2011;41:472-82.  Back to cited text no. 2
[PUBMED]    
3.
Morton RP, Reynolds RM, Ramakrishna R, Levitt MR, Hopper RA, Lee A. Low-dose head computed tomography in children: a single institutional experience in pediatric radiation risk reduction: clinical article. J Neurosurg Pediatr 2013;12:406-10.  Back to cited text no. 3
    
4.
Bunt CW, Burke HB, Towbin AJ, Hoang A, Stephens MB, Fontelo P. Point-of-care estimated radiation exposure and imaging guidelines can reduce pediatric radiation burden. J Am Board Fam Med 2015;28:343-50.  Back to cited text no. 4
    
5.
World Health Organization. Communicating radiation risks in paediatric imaging: information to support healthcare discussions about benefit risk. 2016 Geneva WHO press 1-24.  Back to cited text no. 5
    

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Correspondence Address:
Saurabh R Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd floor, Ammapettai village, Thiruporur: Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196803

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