Radiation Protection in Paediatric Radiology

1. Radiation Protection in Paediatric Radiology Organization of a Paediatric Radiology Department L10

2. Educational objectives At the end of the programme, the participants should appreciate: • What are the important issues in planning and organizing pediatric radiology departments • How to communicate with patients and parents Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

3. Children should be given sedation or anaesthesia in no circumstances. Radiology staff should support paediatric patients during radiological examinations. Same shielding devices can be used for male and female patients of all ages. Parent do not need to use personal protective devices when supporting child. Answer True or False Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

4. Contents • Patient preparation and sedation • Environment considerations • Immobilisation • Shielding • Pregnancy issues • Parents, comforters and carers • Radiation protection of staff • Education and training Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

5. Gaining the child’s confidence is an important issue in obtaining good image quality at reasonable low doses Many aspects are important for prevention of protracted investigation times and minimisation of stress to children, parents and staff Introduction Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

6. Dedicated paediatric room or complete sessions dedicated to paediatric radiology should be available i.e. not competing with adults for a room Experienced staff who can obtain the child’s confidence and cooperation in a secure and child-friendly environment are of paramount importance in reducing radiation doses in paediatrics Introduction Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

7. Patient preparation • Preparation of both children and parents is essential • Staff should be fully versed in the investigation to be undertaken • Appointment letters should include brief and clear description and possible preparation for the examination • Posters and pictures of children undergoing radiology examination may be informative for parent and relaxing for children www.mekdesigns.com/UNC-Children_s%20Hospital.htm Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

8. Patient preparation • Waiting time should be minimal, heaving in mind that children need at least 50 % more time than adults for most investigations • Careful and supervised sedation and anaesthesia policies should be in place and their application requires special training Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

9. Environment • Waiting areas and imaging rooms should be child friendly and cheerfully decorated www.mekdesigns.com/UNC-Children_s%20Hospital.htm Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

10. Environment Essential distraction aids: • Toys: rattles, bells, flashing toys, musical toys, CD players • Praise, stickers, balloons… • Bravery certificate Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

11. Chapple, C.L. Radiation protection in paediatric radiology, IRPA 12, RC-14, Buenos Aires, Argentina, 2008 Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

12. Immobilisation Immobilization devices must be easy to use Their usefulness should be explained to the accompanying parent (s) Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department 12

13. Immobilisation • A range of simple, well tried immobilisation devices are recommended (tape for fingers, shaped pads, spongers, swaddling blankets… • Toys: rattles, bells, flashing toys, Positioning for a lateral skull radiograph. The toddler can be wrapped in a blanket for immobilization Cook J, Imaging, 13:229-38, 2001 Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

14. Patient Positioning and Immobilization Immobilisation Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department 14

15. Shielding devices • A range of easily adjusted accessory equipment, varying according size of patient • Appropriately shaped • Special paediatric chest stand Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

16. Shielding devices For all examinations of pediatric patients, use standard equipment of lead-rubber shielding of the body in the immediate proximity of the diagnostic field Special shielding has to be added for certain examinations to protect against external scattered and extra-focal radiation Shielding devices must be correctly positioned: the absorbed dose in the testes can be reduced by up to 95% and in the ovaries about 50% Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department 16

17. Pregnancy issues • Irradiation of potentially pregnant occupationally exposed, workers, comforters and carers or members of the public • Pregnancy in adolescent girls • In female adolescents who are menstruating the 10 day rule should be considered for high exposure procedures: examinations or interventions involving the abdomen, pelvis or uterus and CT Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

18. Pregnancy issues • Private are should be available for tactful questions regarding possible pregnancy of a girl over age of 12 • High dose examinations should only be carried out in the first 10 day after a menstrual cycle commences • If there is a chance of pregnancy, the decision must be made by the radiologist in consultations with the referring physician based oh risk and benefit analysis Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

19. Pregnancy issues: guidelines Guidance for protection of unborn children and infants irradiated due to parental medical exposures Pregnancy and medical radiation Protection of pregnant patients during diagnostic medical exposures to ionising radiation and medical radiation Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department 19

20. An information poster on the wall of the radiological department to capture the attention of a female patient of reproductive age to advise her to announce the possibility of the pregnancy before an X-ray examination. Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

21. http://rpop.iaea.org/RPOP/RPoP/Content/SpecialGroups/1_PregnantWomen/PregnancyAndRadiology.htmhttp://rpop.iaea.org/RPOP/RPoP/Content/SpecialGroups/1_PregnantWomen/PregnancyAndRadiology.htm Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

22. Parents, comforters and carers • As a general principle, parents or family members, should support the child during any radiological examination • They should be provided with appropriate shielding and instructions • Radiological staff members should only hold a patient under exceptional circumstances • Even in quite young children the time allocation for an examination must include the time to explain the procedure not only to the parents but also to the child Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

23. www.imagegently.org Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

24. Staff • Closely involved in the examination • All patient dose reduction tools apply • Shall understand the role and how to perform it • Wear personal protective devices (lead apron, collars..) • Never enter any part of the body in primary beam • Inform management when pregnant Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

25. Staff • Staff should not be in the room when exposures are ongoing unless this is absolutely necessary • This is only the case during interventions and when conducting fluoroscopy • Special training is required in this case (please se L07) Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

26. Education and training • Medical practitioners providing radiological services and professions including medical physicists and technologists shall undertake additional special education and training: • in radiological techniques involved • in radiation protection • Radiologists, medical physicists and technologists should have specific training in the special issues that arise in paediatric radiology • Continuing professional development, to allow to cope with new development in techniques and technologies Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

27. Summary Children are uncooperative and radiosensitive Radiation protection is of great importance Equipment should be selected and adapted to children with various immobilization tools Environment should be child-friendly Parents that knowing and willingly offer their service, should be properly instructed and given personal protective devices Education and training of the staff is an important factor in radiation protection of patient in paediatric radiology Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department 27

28. Children should be given sedation or anaesthesia in no circumstances. Radiology staff should support paediatric patients during radiological examinations. Same shielding devices can be used for male and female patients of all ages. Parent do not need to use personal protective devices when supporting child. Answer True or False Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

29. Answer True or False • False - Whenever necessary and to avoid repeat examination, sedation may be preferred. • False - Parents and family members should comfort the child and they should be given clear instructions and personal protective devices. • False - There are different types of shielding devices for males and females gonads and they should be available in various sizes. • False - They should be provided protection. Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department

30. References • European Guidelines on Quality Criteria for Diagnostic Radiographic Images in Paediatrics, July 1996. EUR 16261. Available at: http://www.cordis.lu/fp5-euratom/src/lib_docs.htm • Cook, V., Radiation protection and quality assurance in paediatric radiology, Imaging, 13 (2001) 229–238 • Chapple, C.L. Radiation protection in paediatric radiology, IRAP 12, RC-14, Buenos Aires, Argentina, 2008 Radiation Protection in Paediatric Radiology L10. Organisation of paediatric radiology department