Image Gently Alliance and The Think A-Head Campaign

Sarah J. Gaskill, MD, FAANS, FACS (left)
Pediatric Neurosurgeon
Past Chair, AANS/CNS Section on Pediatric Neurological Surgery
Tampa, FL

Donald P. Frush, MD (right)
Pediatric Radiologist, Duke University Health System
Durham, NC

Pediatric neurosurgeons have collaborated with many of our colleagues to help develop and implement policy that benefits our patients. There is a growing concern about the harmful effects of lifelong exposure to radiation and the particular vulnerability of our youngest patients to this danger. The Image Gently Alliance is dedicated to reducing radiation doses to children by educating caregivers, empowering parents, and providing outstanding resources to all. This approach involves several things:

1. Do a radiology scan only when necessary. As a parent, you can have influence in this matter. If a doctor has decided a scan needs to be performed which uses radiation (Computed Tomography (CT) scans, plain x-rays), it is appropriate to ask what information is going to be discovered and is there any other way to get the information? Certain conditions require such imaging- for example, when we are dealing with a child with a broken limb, the need is obvious.
2. Reducing the amount of radiation used by “child-sizing.” Not all facilities do this automatically, and the same technique for adults is applied to children. A great resource for this is the Image Gently Website that has protocols for limiting radiation doses in children without compromising the quality of the study.
3. Scan only the body part in question. While this may seem like common sense, often the radiation field is not coned (narrowed) down as far as possible.
4. Scan once. Often CT scans are ordered with and without contrast (a dye given intravenously to help diagnoses certain conditions). In most cases, a CT scan is not needed in children, so ask what they are looking for if a contrast CT is ordered. It can also be common practice to repeat a CT scan the following day for a child who is admitted with a head injury. If the child is doing fine, ask the doctor why another test is needed and what information they are looking to obtain.

The Think A-Head campaign was rolled out about two years ago in conjunction with Image Gently to help parents make informed decisions about imaging for their kids suffering a head injury. Head trauma remains common among children and is very scary for the parents. CT scans are commonly used in head trauma for evaluation and treatment, but may not always be needed. CT scans use ionizing radiation — although at low doses — to generate an image of the brain and to see the potential injury. Results from a CT scan can also be very helpful in treating a minor head injury, even if they are normal. So if your child gets a minor head injury, here are some tips to consider:

1. Find out if the imaging test is (or is not) needed and why.
2. Understand why a head CT scan is (or is not) the right test.
3. Discuss the benefits and risks of the scan.
4. Discuss “child-sizing” the CT radiation dose.

We encourage families to partner with physicians in providing the right care to their children to give them the best chance for an optimal outcome. The Image Gently Alliance is working hard to raise awareness in the medical community about the need to adjust radiation doses when imaging children.

It is important to remember that no level of radiation exposure is without consequence. Be a voice and ask questions. The information on images can save lives and improve outcomes, but we need to work together to Image Gently and only perform necessary testing with the least amount of radiation possible.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #PedsNeurosurgery.