Safety measures protect young patients

Step into the radiology department at CHKD, and the “kid-centric” nature of the place pops up immediately.

The X-ray shields that protect children come with purple sparkles, for instance, and a new low-dose digital X-ray machine features a cheerful turtle cavorting with smiling sea creatures.

That’s what meets the eye, but it’s what you can’t see – an “image gently” philosophy – that raises the standard of care at CHKD and its outpatient locations.

That philosophy is built with years of education, training, and expertise from a team that is uniquely poised to treat children – from the doctors who order the scans to the technologists who operate the imaging equipment to the pediatric radiologists who read the images.

“It’s not a cookie-cutter approach at all,” said Dr. Neil Vachhani, medical director of radiology at CHKD. “We tailor each scan specifically to the child. One of our principles is to determine how we can avoid or minimize the exposure to radiation and still address the concern of the patient and clinician.”

That takes into consideration an array of factors. What is the age and size of the child? What part of the body is being examined? Does the child have an acute injury or a chronic condition that’s likely to need a lifetime of monitoring?

Dr. Christopher Foley, chief of medicine at CHKD, says the extra years of training required of a pediatric radiologist helps them distinguish subtle changes that are normal in a developing body from abnormalities that signal disease.

“If pediatric scans are all you look at every day, you get very good at it,” Foley says. “And ensuring everything is done right the first time means there’s no need to repeat it. This limits radiation and unnecessary tests and ensures accurate results that are correctly interpreted.”

Vachhani said choosing the proper “modality” – ultrasound, MRI, X-ray – is key when imaging children. There are situations where a non-radiation option, such as ultrasound, is best. An MRI also doesn’t use radiation, but requires a patient to lie still over time, so children may need to be sedated. At CHKD, a pediatric sedation team oversees that process, including child life specialists who can calm anxious children. Providing safe sedation for children is an essential part of getting the best images.

The equipment itself also makes a difference. CHKD recently purchased six new mobile imaging machines that use up to 50 percent less radiation and also provide a higher quality scan.

Over the years, exposure to radiation has become a prime concern to pediatric specialists, who follow strict guidelines in ordering a scan in the first place, according to Foley: “For small children, you need a different threshold. You want to be sure to order only the tests that are necessary, and you need to consider lifetime exposure.”

That premise guides CHKD specialists every step of the way, Vachhani says: “It’s not about getting the quickest answer, but the safest.”