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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In January 2009, AHRA: The Association for Medical Imaging Management, in conjunction with Toshiba, awarded three $7,500 grants to help fund innovative patient-safety and quality initiatives. St. Mary’s was a recipient, along with Washington Hospital Center, Washington, DC, and Jennie Edmundson Hospital, Council Bluffs, Iowa. “We have changed the way we engage patients. We now are more focused on being patient-centered and family-centered,” Knightly says. “It’s little things that make a big difference, like having a blanket warmer in the room. We just converted a warmer box that was used for contrast media, and we located this right in the scanner room so it’s easy to access for the technologist and they can keep the patient warm during the scan.”

Gayle Thompson-Smiley, director of Radiology at Washington Hospital Center, used her facility’s grant to initiate a patient-handoff program designed to refine the processes involved in transferring 300-350 patients a day from the hospital floor to the radiology department. “Washington Hospital Center is a very large institution and quite complex. In this type of environment, we’re also focused on how we can better improve the patient experience and the patient outcome,” she says. “This was a very unique opportunity for us.”

Meanwhile, Jim Lipcamon, director of Imaging Services at Jennie Edmundson Hospital, sought to leverage his hospital’s information systems to alert radiologic technologists to potential complications associated with contrast media for imaging. “People who take metformin [for type II diabetes] are contraindicated to receive iodinated contrast,” he explains. “We wanted to hardwire that process. Prior to the grant, that process was strictly on paper, relying on the patients to remember to tell their physician or tell the nurse on the floor. With the increase in obesity nationwide, we felt that this was a critical issue that needed to be addressed in our institution.”

Tom Kaiser, informatics pharmacist at Jennie Edmundson, is grateful for the interdepartmental collaboration fostered by the grant. “We’ve been able to use a multidisciplinary approach to our patient-safety enhancements,” he says. “It allowed me an opportunity to work with IT professionals, radiology professionals, and the pharmacy itself to come up with a program that generated rules based on patients’ medications.”

Washington Hospital Center is developing a CME course to train staff on successful handoff communications programs. “The CME event will help prepare physicians in our staff to really think about how best to keep patients safe in day-to-day care and in whatever handoff communication processes that they are involved with,” says Kathleen Srsic-Stroehr, senior nursing director for Evidence-based Practice and Quality. “It’s really important to think about those particular processes and those sender and receiver communication messages that are so important in a handoff communication situation.”

Knightly concurs: “This is a great opportunity for other departments in CT to tap into this knowledge and apply it to what they do every day out in the field. These best practices are very simple, very usable and make a difference in patient care and patient safety. It’s very exciting to be able to share what we’ve found and also to encourage people to use what’s out there.”

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