The Alliance for Radiation Safety in Pediatric Imaging

1. The Alliance for Radiation Safety in Pediatric Imaging Update to CT MITA workgroup Marilyn J. Goske, MD Chair, Alliance Silverman Endowed Chair for Radiology Education Professor of Radiology Cincinnati Children’s Hospital

2. Continued growth of the Alliance • 58 organizations, 19 international • Purpose: to promote radiation protection for children through awareness, education and advocacy

3. Founding Organizations The Society for Pediatric Radiology American Society of Radiologic Technologists American Association of Physicists in Medicine American College of Radiology

4. AcknowledgeSteering committee Marilyn J. Goske MD, Chair Kimberly E. Applegate MD, MS Jennifer Boylan, MA Dorothy Bulas, MD Priscilla F. Butler, MS Michael J. Callahan MD Brian D. Coley, MD Steven Don, MD Shawn Farley Donald P. Frush MD Marta Hernanz-Schulman MD Neil D. Johnson MD Sue C. Kaste DO Ceela McElveny Gregory Morrison, CAE, MA RT(R), CNMT Manrita Sidhu, MD Keith J. Strauss MS Ted Treves, MD Coreen Bell, administration

5. Alliance for Radiation Safety in Pediatric Imaging Organizational Chart Alliance Leader Marilyn Goske SPR Executive Director Jennifer Boylan Meeting Manager Karen Schmitt General Administration Coreen Bell STEERING COMMITTEE AAPM Keith Strauss Penny Butler ASRT Greg Morrison Ceela McElveny ACR Penny Butler Donald Frush SPR Marta Hernanz-Schulman Sue Kaste Brian Coley Jennifer Boylan Neil Johnson Parents/Public Dorothy Bulas, Leader Kimberly Applegate Shawn Farley Ceela Mc Elveny International/ Outreach Kimberly Applegate, Leader Donald Frush Dorothy Bulas Website Brian Coley Michael Callahan Jennifer Boylan Public Relations Shawn Farley Ceela Mc Elveny Jennifer Boylan Research Donald Frush, Leader Sue Kaste Kimberly Applegate Corporate Sue Kaste, Leader Jennifer Boylan Shawn Farley CT Initiative Content Donald Frush Sue Kaste Michael Callahan IG Steering committee • Fluoroscopy Initiative • Content • Marta Hernanz-Schulman, Leader • Sue Kaste • Keith Strauss • Valerie Ward • Susan John • Beverley Newman • Daniel Young • Eileen Ahlswede Michael Callahan • Ishtiaq H. Bercha Nuclear Medicine ok Initiative Content Ted Treves, Leader Michael Gelfand Meg Parisi Frederic Fahey Stephanie Spottswood Larry Binkovitz Interventional Initiative Content Manrita Sidhu, Leader John Racadio Brian Coley Bairbre Connolly Keith Strauss Tara Utley Terry Yoshizumi CR/DR Initiative Content Steven Don, MD, Leader Charles Willis Lois Rutz Bruce Whiting Susan John Penny Butler Mythreyi Bhargavan Ellen Charkot Tracy Herrmann Greg Morrison Susan N. Smith Stephen Vastagh

6. WORKGROUPS CT Education Task Force Gregory Morrison, Leader Stephen Vastaugh Myke Kudlas Anita Bowler John Egelhoff Elizabeth Eye Eric Faerber Donald Frush Brenda Garofolo Sue Kaste Barbara Kulhanek Robert Orth Terrie Piontek Thomas Slovis Keith Strauss Thomas Toth CT Physics Task Force Keith Strauss, MS , Co-leader Thomas Toth, GE Healthcare, Co-leader Penny Butler Steven Vastagh Don Frush Jennifer Boylan Paul Biggins, Toshiba Kirsten Boedecker, Toshiba Richard Brandenberg, Siemens Mural Gungor, Siemens David Dobson, GE Healthcare John Jaeckle, GE Healthcare Matthew Jordan, Xoran Rich Mather, Toshiba Christianne Leidecker, Siemens Hugh Morgan, Philips Praveen Nadkarni, Siemens Richard Nelson, Philips Simon Shaw, Siemens Mark Silverman, Hitachi Stefan Ulzheimer, Siemens Bernard Schmidt, Siemens Sholom Ackelsberg, GE Healthcare CR/DR Education Taskforce (OK) Susan John, MD, Strategy Leader Coreen Bell, Administrative Leader Greg Morrison Eileen Maloney  Kevin Powers Susan N. Smith Lois Rutz Tracy Herrmann Ellen Charkot Thalia Mills Steven Don

7. Radiation protection for children Knowledge must be layered Education Public Vendors Agencies Ordering doctors Medical professionals Awareness

8. Alliance activities 2006 - The Society for Pediatric Radiology 2007 - ASRT, ACR, AAP founding partners Summer 2007 - Organizational workshop Fall 2007 - Alliance partnership January 2008 – CT Rollout August 2008 – CT vendor summit January 2009 – CT parent rollout March 2009 – National Quality Forum Safe Practice #34 April 2009 – IEC advocacy June, 2009 – ACR CT pediatric accreditation = Image Gently designation August 2009 – Step Lightly interventional radiology campaign February 2010 – CR/DR vendor summit March, 2010 – FDA public hearing April 2010 –Nuclear Medicine consensus conference October, 2010 – FDA contract – CR/DR February, 2011 – Flouroscopy rollout 16 scientific papers

9. ACR CT accreditation- pediatric accreditation Marta Hernanz- Schulman, Strategy Leader

10. New Collaborations IAEA – research, surveys, RPOP web links, technical experts WHO – coordination of global referral guideline development and radiation protection educational materials Brazilian College of Radiology – increased links with S. America and Brazil IRPA – International Radiation Protection Association: Helsinki mtg participation, news release IRQN – (with WHO) initial work to develop consensus on referral guidelines to decrease radiation dose Kimberly Applegate International outreach leader

11. Editors IAEA physics modules • L01 Goske Strauss Talking Rad Prot in Ped Rad • L02 Goske Bercha Understanding Radiation Un DONE • L03 Don Willis, Whiting Rad Prot Screen Film Radiography • L04 Don Willis, Whiting Rad Prot Digital Radiography • L05 Hernanz-Schulman Bercha Rad Prot Fluoroscopy • L06 Frush Bercha Rad Prot CT • L07 Sidhu Yoshizumi Rad Prot Intervent& Cardio DONE • L08 Hernanz-Schulman Butler Standards and Guidelines • L09 Applegate Butler Quality Assurance • L10 Callahan Strauss Organization of Ped Rad Deot

12. Medical literacy for parents

13. Practice Quality Improvement Project for radiologists: Review 25 patients in their practice MOC credit FREE at www.imagegently.org

14. Image Gently Digital Radiography Summit February 4, 2010 Mallinckrodt Institute of Radiology

15. Outcome • Supplement to Pediatric Radiology • ACR National Radiology Data Registry (NRDR) approved- Steve Don, leader (Thanks ACR, L Coombs) • AAPM adopts IEC standards for uniform nomenclature • Education subcommittee FDA contract for educational materials with vendors Susan John, Greg Morrison et al

16. Nuclear medicine initiativeStandardize pediatric radiopharmaceutical doseNew North American GuidelinesSNM, SPR, Image Gently

17. Speakers: Greg Morrison Don Frush Keith Strauss Marta Hernanz Schulman Marilyn Goske Present: Steve Don Penny Butler

18. New AAPM Taskforce • Subject: TG on pediatric CT dose John Boone and Keith Strauss Thank you for your leadership !!

19. Feb 14, 2011New Fluoroscopy campaign Marta Hernanz - Schulman, Strategy leader

21. New pediatric CT quality registry • Thank you ACR NRDR • Thank you RSNA education scholar grant • Thank you SPR Research & Education Foundation • Not an Image Gently activity • Not limited to radiation dose • Quality improvement methodology

22. Quality Improvement Registry in CT Scans in Children (QuIRCC)

23. Purpose of Registry • Coalition of 6 children’s hospitals • Baseline scan technique/ dose index in children • Establish DRLs • Data collection - ACR National Radiology Data Registry • Compare mathematical algorithm “CTPD” with standard dose indices • Use quality improvement methods to standardize practice, for continuous cycles of improvement • Investigate agreement by investigators as to “image quality” to serve as a standard by which future dose optimization could be based

24. Prototype registry6 institutions • Marilyn J. Goske, MD- Principal Investigator Cincinnati Children’s Hospital Medical Center, Ohio • Keith Mandel, MD – Co-Investigator Cincinnati Children’s Hospital Medical Center, Ohio • Laura Coombs, PhD – Co-investigator Director of Data Registries, American College of Radiology, Virginia • David Larson, MD – Quality Metrics Lead Cincinnati Children’s Hospital Medical Center, Ohio • Keith White, MD – Informatics Lead Primary Children’s Hospital, Utah • Keith Strauss, MS - Medical Physicist Boston Children’s Hospital, Massachusetts • Alexander Towbin, MD –IT Cincinnati Children’s Hospital Medical Center

25. Participating Hospitals and Site Primary Investigators • Michael Callahan, MD Boston Children’s Hospital • Kassa Darge, MD, PhD Children’s Hospital of Philadelphia • Daniel Podberesky, MD Cincinnati Children’s Hospital Medical Center • Donald P. Frush, MD Duke University Medical Center • Sjirk Westra, MD Massachusetts General Hospital, • Jeffrey Prince, MD Primary Children’s Hospital, Utah

26. To date • IRB approved at all sites • All six sites entering data • n= 550, anticipate 1100 • Phase 1 data collection complete 12.31.2010 • Analyze data, transparency of practice, optimize/standardize across 6 sites • Repeat measurements