Challenges and Solutions in Imaging Children
In 2008, an alliance of radiology organizations was formed to launch the Image Gently campaign, emphasizing the importance of child sizing radiation dose to image pediatric patients more safely. The renewed focus on improving the safety of imaging for children has prompted hospital radiology departments and imaging centers to reexamine every aspect of their pediatric care. By reducing exam times, eliminating the need for follow-up exams and providing automated dose protocols for a range of weights and sizes, the right imaging technology can help facilitate safer imaging for the youngest patients.
Robb Young, senior manager of the CT business unit at Toshiba America Medical Systems, Inc., asks, “What are the greatest challenges in imaging small children? Children, especially young children, have a hard time taking instructions, and they tend to be a little squirmy. That’s the main challenge in pediatric imaging versus adult imaging: How do you get the diagnostic image you need so you don’t have to re-image?”
Young says that Toshiba’s Aquilion® ONE 320-detector row, dynamic volume CT scanner is optimal for pediatric imaging in terms of both speed and dose. “With this technology, we can image children so quickly that we need less – sometimes even no – sedation, and often without them having to hold their breath.” he says. “You can image 16 cm in 0.35 seconds, whereas on a conventional CT it could take four or five seconds.”
The Aquilion ONE’s automated dose protocols take the guesswork out of imaging children by automatically child sizing dose, so the technologist can focus on the patient, not the control board. “This is a real issue,” Young says. “Should the technologists be focused on the scanner or the patient? Our design philosophy has always been to automate everything so they can focus on the child.”
Sometimes pediatric imaging goes beyond the diagnosis, and physicians are faced with performing interventional procedures where imaging plays a key role in the care delivered. Allan Berthe, product manager for Toshiba’s X-ray vascular business unit, notes that in some pediatric hospitals, cardiac imaging is performed alongside surgery to repair congenital heart defects. While this can help minimize disturbance to patients, it also creates unique challenges in the cardiac-catheterization suite. Toshiba’s Infinix-i™ C-arm addresses this issue with a unique five-axis positioner, enabling multiple clinicians to work around the patient while gathering high-quality images.
“There’s always a challenge with maneuverability around the room because the patient doesn’t give you any cooperation,” Berthe says. “It was paramount that the entire system design philosophy was changed to accommodate greater patient access and coverage. The five-axis positioner enables us to park the C-arm in a position that, when combined with the ceiling C-arm, gives 180° open head-end access while maintaining the C-arm coverage you want, the motion in various directions, the speed and the right angles.”
The Gentler Approaches
Ultrasound is often used as the frontline modality in imaging children because it is noninvasive and emits no radiation. Erin Owen, senior manager for Toshiba’s ultrasound business unit, says, “If they can diagnose it with ultrasound, they’re going to do that first.” Toshiba’s ultrasound technology facilitates rapid, high-quality pediatric imaging through a multitude of proprietary features. One such feature is differential tissue harmonic imaging (D-THI), which offers superior penetration at the high frequency needed to maintain image quality. “The higher the frequency, the better the image quality,” she says. “D-THI gives us image quality throughout without losing the penetration and while maintaining the resolution.”
Toshiba also offers two transducers that are ideal for pediatric imaging. One condition often experienced by infants in the neonatal ICU is bleeding in the brain; Toshiba’s neonatal head transducer offers high-frequency imaging in a nickel-sized package designed to fit the smallest patients. Another transducer, the 745 BTV, is “a very small convex transducer that is good for neonatal heads and also for looking at the livers or kidneys of very tiny babies,” Owen says. “For some of these babies, a regular transducer would be too powerful, and that would negatively affect image quality.” Precision Imaging, a feature available on most TAMS transducers, also enhances image quality by providing superior definition of lesions. “It helps us get a clearer understanding of what’s going on, and might help eliminate a more costly or frightening exam,” Owen says.
Pediatric MRI represents a multitude of challenges. Most MRI exams are lengthy and children might require sedation to keep still. Additionally, anyone who has experienced an MRI exam can testify to the loud noise, which can frighten young patients. Joel Urick, product manager in Toshiba’s MRI business unit, explains how the company’s MRI technology addresses these issues by shortening exam length and improving image quality. “Our coils are integrated into the table. Therefore, instead of having to go into the MRI room to reposition the child, you can continue the scan without stopping. This not only makes the exam faster when performing multiple exams, but also makes the exam more comfortable for the patient,” he says. “You landmark the patient ahead of time and the table moves from location to location.”
Toshiba’s non-contrast MRI techniques can eliminate the need for an IV for a child prior to a scan, enabling users to perform contrast-free imaging for full runoffs down the legs, renal exams, pulmonary embolism and more. The manufacturer’s proprietary JET™ sequence offers motion correction, a valuable benefit with imaging patients who have a hard time holding still. “Even if a patient turns his or her head to the side, JET can extrapolate the data where the patient wasn’t moving and produce a detailed image,” Urick says. “Even if a child moves during a scan, it might not be necessary to repeat it.”
Improving the safety of pediatric imaging yields benefits across the board, Young notes. “If you are able to image children at the lowest possible dose, you can image everyone that way,” he says. “If it’s safe for kids, it’s safe for everyone.”
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Tags: Awareness, patient safety, radiology
Category: Medical Imaging —