Radiation protection
in pediatrics

Apply the ALARA principle

‘As low as reason­ably achiev­able,’ or ALARA, is a global radi­a­tion pro­tec­tion prin­ci­ple for the opti­mized use of radi­a­tion. Basi­cally, it means that radi­a­tion should be used as judi­ciously as pos­sible on humans, ani­mals, and mate­rials. ‘Judi­ciously’ means that every dose should be as low as possible, consid­er­ing all advan­tages and dis­advan­tages. Espe­cially in pedi­at­rics, the ALARA principle is of highest priority.

Avoiding unnecessary radiation

With every X-ray, but espe­cially when imaging children, it is important to use radiation with special care. This means that radia­tion should be condu­cive for the suc­cess of the therapy goals: Is fluo­ro­scopy abso­lutely nec­es­sary? Are there alter­natives, such as the pos­si­bil­ity of radia­tion-free mag­netic resonance imaging or ultra­sound? The answers to these ques­tions must be weighed carefully.

Protect all sensitive areas

The region of interest (ROI) is the area of rele­vance to be exam­ined. It should always be as small as pos­sible, because this keeps radia­tion expo­sure as low as pos­sible. Every­thing out­side the ROI is shielded by special lead blankets. In children, skin, brain, eyes, thyroid and gonad glands, as well as breast and bone marrow should be espe­cially protected.

Keep fluoroscopy exposure times brief

If radiation has to be used, exposure should be as brief as possible. With current tech­nol­ogy, some pre­set­tings of the system can be changed with­out X-ray expo­sure. This allows tar­geted radia­tion, and the fluo­ro­scopy expo­sure time is limited.

Working close to the detector

Positioning the detec­tor as close to the patient as pos­sible has several advan­tages: image quality is better, the dose is reduced, and the field of view (FOV) is extended. Scattered radia­tion is also signif­i­cantly reduced, which is ben­e­ficial for the staff, in particular.

Pulsed fluoroscopy

In some countries, pulsed fluo­ro­scopy is standard for pediatric fluo­ro­scopy due to legal require­ments. How­ever, the correct appli­ca­tion with indi­vid­ual reduc­tion of the pulse rates is impor­tant. Thanks to new Ziehm tech­nol­ogies, image quality com­pa­ra­ble to that achieved with high pulse rates can be acquired at low pulse rates.

Using innovative technologies

Pediatric proce­dures should be carried out with the latest tech­nol­ogy – in recent years, aspects such as dose manage­ment, and appli­ca­tions sup­porting ease of use and image-quality opti­mi­za­tion have been con­tin­u­ously improved. Ziehm C-arms not only deliver very good image quality, but also improved copper and carbon pre-filtering. This is respon­sible for increased hard­ening of the X-ray beam, which in turn leads to a reduced skin entrance dose. In addi­tion, all Ziehm Imaging CMOSline devices come with a ‘Low Dose Mode’ presetting.

Radiation-free patient positioning

The laser can help deter­mine the region of interest (ROI) with­out using any radi­a­tion. The C-arm is thus posi­tioned quickly and opti­mally with­out addi­tional dose. The virtual colli­ma­tors can be set asym­met­rically to the ROI on the touch screen with just one hand. The smallest possible radi­a­tion field is then dis­played for cap­turing the image.

Using special anatomical programs

Ziehm C-arms offer var­i­ous so-called ‘ana­tom­i­cal pro­grams’ (APR) for each impor­tant body region. These pro­grams are opti­mized for the respec­tive area in terms of image qual­ity and dose. In addi­tion to the APRs, patient-spe­cific options can be selected with modi­fiers. The mod­i­fiers can also be used to acti­vate fur­ther dose-reducing options for children. In addi­tion, there is a low-dose button that is always acti­vated during a pedi­at­ric examination.

Applying magnification modes

In the so-called ‘MagModes,’ an enlarged view of the rele­vant anat­omy can be achieved at the same dose. Another advan­tage of the magni­fi­cation modes is the irradi­a­tion of a small area. The higher reso­lu­tion and the lower noise of the CMOS detec­tor also allow a more precise image with­out increasing the dose.

Dilute contrast medium

If a con­trast medium has to be used, high image quality can also be achieved with diluted con­trast medium. This reduces the strain on the body.

Removing the anti-scatter grid

Due to their smaller anat­o­mies, the scattered radia­tion created during fluo­ro­scopy of children or other small patients is signif­i­cantly lower. There­fore, the anti-scatter grid can be removed for pedi­at­ric or other dose-sensi­tive appli­ca­tions. Never­the­less, excel­lent image quality can be achieved with a signif­i­cantly lower dose.