Transcript 10. Organization of a Paediatric Radiology Department - RPOP

Radiation Protection in Paediatric Radiology
Organization of a Paediatric
Radiology Department
L10
IAEA
International Atomic Energy Agency
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
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Answer True or False
1. Children should be given sedation or
anaesthesia in no circumstances.
2. Radiology staff should support paediatric
patients during radiological examinations.
3. Same shielding devices can be used for male
and female patients of all ages.
4. Parent do not need to use personal protective
devices when supporting child.
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Contents
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Patient preparation and sedation
Environment considerations
Immobilisation
Shielding
Pregnancy issues
Parents, comforters and carers
Radiation protection of staff
Education and training
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Introduction
• 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
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Introduction
• 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 childfriendly environment are of paramount
importance in reducing radiation doses in
paediatrics
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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
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Radiation Protection in Paediatric Radiology
www.mekdesigns.com/UNCChildren_s%20Hospital.htm
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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
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Environment
• Waiting areas and imaging
rooms should be child
friendly and cheerfully
decorated
www.mekdesigns.com/UNCChildren_s%20Hospital.htm
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Environment
Essential distraction aids:
• Toys: rattles, bells,
flashing toys, musical
toys, CD players
• Praise, stickers,
balloons…
• Bravery certificate
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Chapple, C.L. Radiation protection in paediatric radiology,
IRPA 12, RC-14, Buenos Aires, Argentina, 2008
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Immobilisation
• Immobilization devices must be easy to use
• Their usefulness should be explained to the
accompanying parent (s)
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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
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Immobilisation
Patient Positioning and
Immobilization
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Shielding devices
• A range of easily adjusted accessory equipment,
varying according size of patient
• Appropriately shaped
• Special paediatric chest stand
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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%
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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
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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
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Pregnancy issues: guidelines
Guidance for protection of
unborn children and infants
irradiated due to parental
medical exposures
Pregnancy and
medical radiation
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Protection of pregnant patients
during diagnostic medical exposures
to ionising radiation and medical
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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.
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http://rpop.iaea.org/RPOP/RPoP/Content/SpecialGroups/1_PregnantWomen/Preg
nancyAndRadiology.htm
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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
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www.imagegently.org
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Staff
• Closely involved in the
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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
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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)
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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
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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
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Answer True or False
1. Children should be given sedation or anaesthesia
in no circumstances.
2. Radiology staff should support paediatric patients
during radiological examinations.
3. Same shielding devices can be used for male and
female patients of all ages.
4. Parent do not need to use personal protective
devices when supporting child.
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Answer True or False
1. False - Whenever necessary and to avoid repeat
examination, sedation may be preferred.
2. False - Parents and family members should
comfort the child and they should be given clear
instructions and personal protective devices.
3. False - There are different types of shielding
devices for males and females gonads and they
should be available in various sizes.
4. False - They should be provided protection.
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References
• European Guidelines on Quality Criteria for Diagnostic
Radiographic Images in Paediatrics, July 1996. EUR
16261. Available at: http://www.cordis.lu/fp5euratom/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
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