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Lower Radiation Exposure In Pediatric Radiology – Nathan Holmes, MD


According to the Radiological Society of North
America, children are more sensitive to radiation exposure than adults. So it’s very important
to protect young patients who need imaging tests done. We spoke to Dr. Nathan Holmes,
a Pediatric Radiologist at Children’s Hospital of Orange County who talks about what he sees
everyday. Imaging plays an important role in dealing
with children that are coming into the hospital with different conditions. We do MRI’s for
a lot of kids with seizures and we also do some procedures in the radiology department
specific for illnesses and diseases related to children. Kids when they come to our department
for different imaging procedures, we do treat them differently. We can’t just roll them
up underneath the fluoroscopic or put them right in the gantry of the CT because it is
scary to them and one thing we do is we work closely with Child Life Program here at CHOC
and our technologist are specially trained to deal with kids so we do have to put them
in an environment that they’re a little more comfortable in and that’s a big difference
between pediatric imaging and imaging that goes on in an adult hospital. How do you calm
a child down when they don’t want to have an imaging test done? We’ll try to talk to
the kid in terms that they understand at their level of maturity or their age and try to
explain to them what’s going to happen; make sure there’s no surprises to them and oftentimes,
we also have to do the same with the child’s parents because we see a lot of times anxiety
of the parents it sort of gets transferred to the child in different situations. We see
that in our department with imaging, so we have to often explain to the parents so they
understand and can help us along when we do or perform an X-ray or a CT or a fluoroscopic
exam. Reading images in pediatric radiology is a little bit different for sure than in
the adult world. A good example is someone who comes in with a right lower quadrant pain,
that’s you know, pain down in the right lower corner of their abdomen. In the adult, the
differential diagnosis is pretty long, but in the child it’s usually a little bit smaller.
So even though we may not have a really good history that an adult may be able to give
the ER physician or the radiologist, you have to tailor what you’re looking at in the pediatric
world. Dr. Holmes shares a patients story. We had an eight year old child present at
an outside hospital who had abdominal pain and underwent a CT scan a Cat scan of the
abdomen, the way the Cat scan was performed at the outside hospital, they didn’t use intravenous
contrast. When the child presented to our hospital we did the examination again, protocol
it in a more specific way and gave contrast and were able to diagnose a condition where
the child’s spleen had twisted on itself which is very unusual but by understanding what
we needed to look at and making sure the Cat scan was protocol correctly we were able to
make a diagnosis which was very unusual but really helped out the surgeon in knowing exactly
what to do and what was causing the child’s pain. When you have a child that needs an
imaging study, let’s use CT scan for example. You want to be in an institution that tailors
that CT examination specifically for a child because of radiation dose. We want to minimize
exposure to the child but at the same time making a correct diagnosis. We try to choose
an imaging procedure that doesn’t use radiation to begin with like ultrasound and if that
does’t answer the question then we need to do something else, we’ll do it at that time.
Our new CT scanner that we have, we’re seeing radiation doses that are between 40 and 80%
lower than some other hospitals or hospitals that we’re getting patients referred from.
So part of it is our staff our radiologist, really scrutinizing the radiation dose and
minimizing it. The other part is the technology, we have the latest generation CT scanner which
allows more adjustability more ways to reduce radiation doses. Whereas in the past that
was not always a possibility. I’ve seen changes in radiation doses that are being emitted
from our CT scanners, that’s going down which is a good thing. Additionally MRI is also
advancing, MRI’s prone to movement and artifacts from motion but it’s improving, the protocols
are improving and the sequences are improving in MRI. So I think we are going to see the
use of MRI more in the future not only because it doesn’t use ionizing radation but because
it’s providing great detail, anatomic detail and functional detail. Want to lose weight?
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