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Image Gently: A Pediatric Neurosurgical Perspective

gasGuest post from Sarah J. Gaskill, MD
Professor, College of Medicine Neurosurgery and Department of Neurosurgery and Brain Repair at University of South Florida
Chairman, AANS/CNS Section on Pediatric Neurological Surgery
Tampa, FL

The Think-A-Head Image Gently Campaign rolled out last year, as a multispecialty campaign under the umbrella of the Image Gently Alliance, an organization for education and awareness. It has grown exponentially, with more than 100 health care organizations and agencies participating, including more than 35 internationally, amounting to more than one million professionals worldwide.

Image Gently is a communication campaign which benefits the market and not the “marketers,” with a goal to use only the necessary radiation dose in children. This is a critical issue for several reasons:

  • Children are more radiosensitive than adults, due to their growing tissues and developing central nervous system.
  • The Lancet article in June 2012, “Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study” represented the first association with prior CT scans and cancer, and has fueled the public and specialty debate about imaging particularly with CT in the pediatric population.
  • As pediatric neurosurgeons, we care for many patients with lifelong, chronic illnesses including shunted hydrocephalus.
  • Any child with a shunt is subject to the frequent policy of a CT and shunt series every time they have an office visit, or every time they show up in an emergency department.
  • Replacing a CT for the evaluation of a shunt with a rapid sequence MRI gives us the advantage of a quick, non-sedated, no radiation look at the ventricles for the evaluation of a shunt.

gentlyAll physicians need to be aware of the radiation exposure associated with diagnostic tests and make a decision: Is this truly necessary? Will the results of this test change the management of this patient in a meaningful way? Could I get this information without using a diagnostic test that requires radiation?

It is for these reasons that the AANS/CNS Section on Pediatric Neurological Surgery became a sponsor of the Think-A-Head Image Gently Campaign. This campaign is for physicians and parents. The goal of the campaign is to “help providers appropriately obtain and perform computed tomography (CT) scans in children with minor head injuries.” Here are some tips to consider.


  • Order CT scans in minor head injuries based on the latest evidence-based medical guidelines;
  • Explain to parents why an image is (or is not) necessary;
  • Discuss possible alternative exams;
  • Discuss the risks and benefits of the CT scan; and
  • Use child-size radiation dose where appropriate.


  • Ask if the exam will help improve your child’s care;
  • Ask the risks and benefits of the test;
  • Inquire if there alternate tests that do not use radiation, such as MRI; and
  • Ask what your child will experience during and after the examination.

For all neurosurgeons, it is important to remember that no level of radiation exposure is without consequence. If a study is necessary for the care of the patient, it is justified. If the information gathered from a radiographic study will not change the management, then it likely should not be obtained. I’m sure we can all do better with less imaging. So, remember to Image Gently.

Editor’s note: The content of this post originally appeared in the Congress Quarterly which is a publication of the Congress of Neurological Surgeons (CNS).

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