Imaging challenges: a US perspective on controlling exposure to ionizing radiation in children with cancer

Abstract

Issues pertaining to control of radiation dose exposures in pediatric imaging are on the forefront of patient care worldwide. Certain factors contribute to appropriate – or inappropriate – use of ionizing radiation in pediatric medical imaging. Such issues include naiveté regarding cancer risk and the role of medical imaging in its development, misinformation about exposure to ionizing radiation, resource availability, staffing, scheduling “snags,” costs, limited evidence-based imaging practice information and shrinking funding. These issues will be introduced in this paper.

Imaging in childhood cancer: A society for pediatric radiology and children's oncology group joint task force report

“…As such, there is limited standardization for imaging modality choice and subsequent technical considerations (e.g., MRI sequences, phase of contrast when imaged, method of administering contrast, slice thicknesses, technique parameters). There are also deficiencies and ambiguities in protocols that drive cancer treatment plans . A primary problem for most childhood cancers is that, except for a few select examples , there are no evidence‐based guidelines to guide frequency of imaging and choice of modality.…”

The ALARA concept in pediatric oncology

“…Perhaps the most important technical factor to consider is whether alternative imaging modalities (e.g., US, MRI) can provide comparable diagnostic information while obviating exposure to ionizing radiation [14]. As an example of how alternative imaging strategies can be implemented in pediatric oncologic imaging consider the routine staging of patients with suspected lymphoma in the U.S. as compared to Europe.…”

“…Strategies for improving and optimizing the use of imaging in the diagnosis, treatment and long-term monitoring of pediatric oncology patients will necessarily create additional challenges for the pediatric radiology workforce [14]. Most of these children are being treated on multi-center collaborative clinical trials.…”

With great power comes great responsibility – What pediatricians referring babies and small children to radiological interventions should know

“… Many children requiring radiological interventions are also exposed to a higher risk of cancer the long term owing to either their primary pathological condition (cancer, leukemia, metabolic disorders, immunodeficiency…) or their necessary treatments (chemotherapy, immunosuppression…). There is limited quantitative information in the literature to assess this interaction and cumulative effect, but it has been shown that the “radiogenic excess absolute risk” is higher in some chemotherapy‐treated groups compared to that in non‐treated groups (12–15). Other unique considerations are related to the smaller size of children, especially infants, and relate to technical aspects and limits of the currently available systems that are primarily designed for adult use: Overall and in fact, a dose of radiation in a child can result in a threefold (up to 10‐fold according some authors) increase in neoplastic potential compared to the equivalent dose in an adult (2, 9) (Fig.…”

“…Many children requiring radiological interventions are also exposed to a higher risk of cancer the long term owing to either their primary pathological condition (cancer, leukemia, metabolic disorders, immunodeficiency…) or their necessary treatments (chemotherapy, immunosuppression…). There is limited quantitative information in the literature to assess this interaction and cumulative effect, but it has been shown that the “radiogenic excess absolute risk” is higher in some chemotherapy‐treated groups compared to that in non‐treated groups (12–15).…”