IR - Frequently Asked Questions - Pediatricians
Parents - Press
The amount of radiation that people are receiving from medical sources is increasing, and this includes children. It is difficult to show directly that radiation doses from pediatric interventional radiology (IR) lead directly to cancer. However, good data from other sources of exposure show that there are increased cancers in people who have been exposed to radiation at levels now encountered by some patients undergoing many radiology procedures. This is particularly important in children, whose tissues are more radiosensitive, who receive a larger effective dose for a given level of radiation, and who have a longer time to develop cancers resulting from radiation exposure. For any one person, the risk of death from cancer is about 1 in 5. While estimates vary, additional risk from an interventional procedure is a small fraction of the total risk. The risk is cumulative, however, and each subsequent procedure may increase the risk accordingly. While for any one individual the increased risk is very small, given many procedures performed, the risk to the population as a whole is much larger.
Do children really undergo many IR procedures?
With advances in minimally invasive technology and education, IR procedures are increasingly performed in children to help diagnose and treat medical illness. Especially in children with chronic diseases, the number of IR procedures may be significant over their lifetime. Interventional radiation is the third largest contributor to medical radiation dose in the USA, following CT and nuclear medicine.
Can the risk from IR be lessened while still obtaining quality procedures?
Absolutely. There are many techniques that can be used to dramatically lessen the amount of radiation children are exposed to during IR procedures. These include:
- Taking time out to child size the technique
- Step lightly on the fluoroscopy pedal
- Consider ultrasound or, where possible, MRI guidance
Should I not order IR procedures for my pediatric patients?
IR procedures can improve health and save lives, and thus can provide more benefit than harm. Like any medical treatment, there should be clear reasons to perform IR procedures. For some indications, ultrasound or, rarely, MRI guidance may be used without exposing a child to radiation. Discussing the clinical situation and the medical need with the pediatric interventional radiologist can help determine if an alternative diagnostic or therapeutic treatment might be better. If an IR procedure is needed, make sure that your imaging facility uses appropriate pediatric radiation reduction protocols and techniques, and that those performing these pediatric studies are qualified.
How can I determine if my IR providers are using appropriate pediatric techniques?
Without asking, you won’t know. Some facilities may not alter dose technique for procedures on children. This website has published specific steps that can be implemented at your site.
- if your IR facility uses pediatric appropriate dose reduction techniques
- if the technologists are credentialed in radiology
- if a board certified radiologist will be performing the study
Should I talk to parents about the radiation risks involved in the imaging guidance for an IR procedure?
The long-term risks of exposure to medical radiation are small but real. However, the medical value that an IR procedure can provide in the short-term usually far outweighs the long-term risks. Most patients are not informed about IR or of any potential risks from medical radiation prior to the exam (1-3) While it seems like this would deter patients from getting potentially important procedures performed, a research study found that parents who were told about the risks and benefits of other radiology procedures such as CT still agreed to go ahead and have the study performed (3). In short, you should not hesitate to discuss the potential risks of radiation from IR procedures with patients and families (4).
For your convenience, there is an informational patient brochure on this website which you can review and give to your patients (link here). In addition, encourage your patients to track their imaging and interventional procedures using the downloadable patient imaging record (link here), which is similar to an immunization record. Keeping track of procedures and exams will help future imaging and interventional planning, and avoid unnecessary duplication of exams which may help minimize the patient’s cumulative risk.
More information about different types of IR procedures
Interventional procedures use a variety of imaging modalities. Frequently a combination of more than one imaging modality is used during a single interventional procedure. Not all interventional procedures require the use of ionizing radiation. For example, ultrasound and MRI use no ionizing radiation so do not contribute to radiation dose. However, MRI imaging guidance is only feasible in a few instances and locations at present. Ionizing radiation is present during any procedure that includes fluoroscopy, spot film exposures, digital subtraction angiography (DSA), CT and CT fluoroscopy. Radiation dose varies greatly among interventional procedures, making risk estimates per procedure difficult.
The amount of radiation during a procedure depends on several factors:
- Imaging modality employed (in order of increasing dose)
- Pulsed fluoroscopy (X-rays emitted in ultra short pulses of varying frequency, rather than continuously)
- Continuous fluoroscopy
- Spot films / single exposures
- Digital Subtraction Angiography (DSA )
- CT and CT fluoroscopy
- Age and size of the patient
- Larger bodies require more x-rays to generate a useful image so overall dose increases by patient size
- Complexity of the procedure
- Duration of procedure
- Technical difficulty of procedure
- Complexity of patient’s underlying anatomy
- The interventionalist’s practice
- Operators awareness of radiation and judicious use of radiation
Examples of the amount of radiation typically delivered by general category of procedure, although individual dose per procedure can vary significantly based on the above factors:
- No Dose: ultrasound guided liver, renal or tumor biopsies, aspirations, paracentesis, pleurocentesis
- Low Dose: PICC, simple CVL and PORT insertions, G tube insertion, abscess and pleural drains, nephrostomy, some sclerotherapy procedures
- Moderate Dose: biliary procedures, difficult ureteric drainages, sclerotherapy, simple angiography and venography, IVC filters, CT myelography
- Larger Dose: interventional cerebral and abdominal angiography, CT guided procedures.
Where can I find guidelines/protocols for pediatric IR procedures?
Return to the home page of this website for specific suggestions and guidelines for every member of the team including protocol recommendations.
1. Ricketts ML, Asch MR, Myers A, Baerlocher MO. Perception of Radiation Exposure and Risk Among Patients, Medical Students and Referring Physicians at a Tertiary Care Community Hospital. Presented at the 32nd Annual SIR meeting, Washington, DC. 2007
2. Baerlocher MO, et al. Awareness of interventional radiology among patients referred to the interventional radiology department: a survey of patients in a large Canadian community hospital. JVIR 2007 May;18(5): 633-7
3. Lee CI, et al. Diagnostic CT scans: assessment of patient, physician and radiologist awareness of radiation dose and possible risk. Radiology 2004;231:393-398
4. Larson DB, et al. Informing parents about CT radiation exposure in children: it’s OK to tell them. AJR 2007;189:271-275
5. Bulas D, Goske M, Applegate K, et al. (2009) Image Gently: why we should talk to parents about CT in children. AJR Am J Roentgenol 192:1176-1178