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RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY

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Title: RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY


1
RADIATION PROTECTION INDIAGNOSTIC
ANDINTERVENTIONAL RADIOLOGY
IAEA Training Material on Radiation Protection in
Diagnostic and Interventional Radiology
  • L 21 Optimization of Protection in Pediatric
    Radiology

2
Introduction
  • Good radiation protection policy in Pediatric
    radiology is essential.
  • There exist International recommendations and
    code of good practice in this field which
    constitute a framework for an effective
    implementation of the optimization principle to
    diagnostic examinations.

3
Topics
  • General recommendations
  • Quality criteria for radiographic images
    (EUR-16261 document)
  • Recommendations for X Ray equipment and rooms for
    pediatric radiology
  • References

4
Overview
  • To become familiar with the principles of
    radiation protection in pediatric radiology, the
    X Ray systems to be used and the principles of
    optimization and quality assurance.

5
Part 21 Optimization of Protection in Pediatric
Radiology
IAEA Training Material on Radiation Protection in
Diagnostic and Interventional Radiology
  • Topic 1 General recommendations for pediatric
    radiology

6
General recommendations for pediatric radiology
  • General, equipment and installation
    considerations
  • The generator should have enough power to allow
    short exposure times (3 milliseconds) and the
    timer should allow short exposure times
  • The generator should be of high frequency to
    improve the accuracy and reproducibility of
    exposures
  • Automatic exposure control (AEC) devices should
    be used with caution in pediatrics
  • AEC should have specific technical requirements
    for pediatrics

7
General recommendations for pediatric radiology
  • Careful manual selection of exposure factors
    usually results in lower doses
  • X Ray rooms for pediatrics should be designed for
    improving the childs cooperation (control panel
    with easy patient visibility and contact, etc.)
  • Fast film-screen combinations have advantages
    (reduction of dose) and limitations (higher
    repetition rate)
  • Low-absorbing materials in cassettes, tables,
    etc. Are specially important in pediatrics
    radiology

8
General recommendations for pediatric radiology
  • The antiscatter grid in pediatrics gives limited
    improvement in image quality and increases
    patient dose given the smaller irradiated volume
    (and mass) the scattered radiation is less
  • Antiscatter grids for pediatrics should have
    specific technical requirements
  • Antiscatter grid should be removable in pediatric
    equipment, particularly fluoroscopic systems
  • Image intensifiers should have high conversion
    factors for reducing patient dose in fluoroscopic
    systems

9
General recommendations for pediatric radiology
  • Specific kV-mA dose rate curves for automatic
    brightness control (ABC) should be used in
    fluoroscopic systems for pediatrics.
  • It is preferable not to use the ABC unless there
    is an automatic cut-off device.
  • For CT examinations, the use of specific
    technical radiographic parameters for CT
    examinations should be promoted (lower mAs than
    for adults, and lower kV in some cases).
  • The use of mobile X Ray units in pediatrics could
    raise special problems (low power, etc).

10
General recommendations for pediatric radiology
  • In pediatrics, there are advantages and
    disadvantages of under-couch and over-couch
    fluoroscopy units
  • Pulsed fluoroscopy allows patient dose reduction
  • Digital equipment and the role/use of frame-grab
    technique may allow dose reductions
  • The cine playback (digital) and video playback
    (digital/conventional fluoroscopy) in screening
    examinations may allow patient dose reductions
  • Additional tube filtration may allow dose
    reductions

11
General recommendations for pediatric radiology
  • Reduction of exposure
  • The causes of repeating films in pediatrics
    should be analyzed periodically (reject analysis)
    as part of the audit program. Feedback should be
    foreseen
  • Immobilization can reduce the repeating film rate
  • The different immobilization devices available
    for pediatric radiology to make application
    atraumatic should be considered. The role of
    simple aids such as sticky tape, sponge wedges
    and sand bags should also be considered.

12
General recommendations for pediatric radiology
  • Short exposure times can improve image quality
    and reduce the number of films repeated
  • The use of mobile X Ray units for pediatrics
    should be restricted due to the difficulty in
    getting short exposure times
  • Radiographers should have specific training in
    pediatric radiology
  • Gonadal protection is specially important in
    pediatric radiology. Several sizes and types of
    protectors should be available

13
General recommendations for pediatric radiology
  • Collimation is important (in addition to the
    basic collimation corresponding to the film size)
    in pediatric patients, particularly window
    protection for hips and lateral collimation
    devices for follow-up scoliosis
  • The correct patient positioning and collimation
    is important in pediatrics, particularly for
    excluding the gonads from the direct beam
  • It is important to establish whether adolescent
    girls (over 12 years) might be pregnant when
    abdominal examinations are contemplated

14
General recommendations for pediatric radiology
  • Motion is a greater problem in children and could
    require specific adjustment of radiographic
    techniques
  • Proper consultative relationship between the
    referring physician and the radiologist is
    specially important in pediatrics
  • Agreed protocols and diagnostic pathways should
    be promoted

15
General recommendations for pediatric radiology
  • Some radiological examinations are of
    questionable value in children (like some
    follow-up chest radiographs in simple pneumonia,
    abdominal radiographs in suspected constipation,
    etc.)
  • The repetition of a radiological examination in
    pediatrics should always be decided by the
    radiologist.

16
General recommendations for pediatric radiology
  • Appropriate projections for minimizing dose in
    high risk tissues should be used (PA projections
    should replace AP where possible for spinal
    examinations)
  • Additional filters should be available to enable
    them to be easily changed (1 mm Al 0.1 and 0.2
    mm Cu should be available).

17
General recommendations for pediatric radiology
  • Dedicated pediatric room or complete sessions
    dedicated to pediatric radiology should be
    available
  • Experienced staff who can obtain the childs
    confidence and cooperation in a secure and
    child-friendly environment are of paramount
    importance in reducing radiation doses in
    pediatrics
  • Specific referral criteria for pediatric
    radiology should be available, e.g. for head
    injury where the incidence of injury is low

18
General recommendations for pediatric radiology
  • Referral criteria for all X Ray examination of
    children should be established, especially those
    which may be age-related, e.g. scaphoid not
    ossified, below age of 6 years, nasal bones
    cartilaginous below age of 3 years
  • High kV techniques should be used when possible
  • Long focus patient distances could be used to
    minimize patient entrance dose (with the
    compromise of appropriate exposure times)

19
General recommendations for pediatric radiology
  • Light beam diaphragm to move the patient into
    position should be used rather than screening
    during overcouch fluoroscopy procedures
  • Audit and quality assurance should be promoted in
    maintaining or improving image quality with
    reasonable dose

20
General recommendations for pediatric radiology
  • Risk factors
  • As children are at greater risk of incurring
    stochastic effects, pediatric examinations should
    require special consideration in the
    justification process
  • Thus the benefit of some high dose examinations
    (e.g. computed tomography, IVU, etc.) should be
    carefully weighed against the increased risk

21
General recommendations for pediatric radiology
  • Risk factors
  • Longer life expectancy in children means a
    greater potential for manifestation of possible
    harmful effects of radiation
  • Radiation doses used to examine young children
    should generally be smaller than those employed
    in adults
  • Risk factors for cancer induction in children is
    between 2 and 3 times higher than for adults

22
General recommendations for pediatric radiology
  • Patient dosimetry - Guidance levels
  • Measuring patient doses in pediatrics presents
    special difficulties (small values)
  • Dosimetric techniques used for patient dosimetry
    in pediatrics should be specifically adapted
  • Patient dose values are related to patient size

23
General recommendations for pediatric radiology
  • Guidance levels in pediatrics should be related
    with patient size
  • Guidance levels available at present for
    pediatrics are limited of a small set of values
  • The use of guidance levels in pediatric radiology
    should be used with caution due to the difficulty
    of measuring patient dose and the limited set of
    available values to be used as reference

24
General recommendations for pediatric radiology
  • Protection of personnel and parents
  • Parents can cooperate in the radiological
    examination of their children if they are duly
    informed and duly protected
  • Parents exposure in this situation can be
    considered as a medical exposure but optimization
    criteria must be applied

25
General recommendations for pediatric radiology
  • Parents or helpers should be duly informed and
    should know exactly what is required of them
  • Pregnant women should not be allowed to help
    during pediatric examinations
  • Lead aprons and lead gloves (if the hands are
    near the direct radiation field) should be used
    in these situations

26
ICRP-ISR smart message for pediatrics
27
Part 21 Optimization of protection in Pediatric
Radiology
IAEA Training Material on Radiation Protection in
Diagnostic and Interventional Radiology
  • Topic 2 Quality criteria for radiographic images
    (EUR document)

28
European Guidelines on Quality Criteria for
Diagnostic Radiographic Images in Paediatrics,
July 1996. EUR 16261 EN Free PDF version
available at http//www.cordis.lu/fp5-euratom/sr
c/lib_docs.htm
29
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31
Criteria related to images
  • The Image Criteria for pediatric patients
    presented for a particular type of radiograph are
    those deemed necessary to produce an image of
    standard quality
  • No attempt has been made to define acceptability
    for particular clinical indications
  • The image criteria allow an immediate evaluation
    of the image quality of the respective
    radiograph. They are appropriate for the most
    frequent requirements of radiographic imaging of
    pediatric patients

32
Criteria related to images
  • The anatomical features and body proportions vary
    due to the developmental process in infancy,
    childhood and adolescence
  • They are different in the respective age groups
    and are distinct from those of a mature patient
  • The Guidelines presuppose knowledge of the
    changing radiographic anatomy of the developing
    child.
  • The term consistent with age indicates that the
    respective image criteria essentially depend on
    the age of the patient

33
Criteria related to images
  • The smaller body size
  • The age dependent body composition
  • The lack of co-operation and many functional
    differences (e.g. higher heart rate, faster
    respiration, inability to stop breathing on
    command, increased intestinal gas etc.)
  • Prevent the production of radiographic images in
    pediatric patients to which standard adult image
    criteria can be applied

34
Criteria related to images
  • Correct positioning of pediatric patients may be
    much more difficult than in co-operative adult
    patients
  • Effective immobilization often necessitates the
    use of auxiliary devices
  • Sufficient skill and experience of the imaging
    staff and ample time for the particular
    investigation are the imperative prerequisites to
    fulfil this quality criterion in infants and
    younger children

35
Criteria related to images
  • Incorrect positioning is the most frequent cause
    of inadequate image quality in pediatric
    radiographs
  • Image criteria for the assessment of adequate
    positioning (symmetry and absence of tilting etc)
    are much more important in pediatric imaging than
    in adults
  • A lower level of image quality than in adults may
    be acceptable for certain clinical indications

36
Criteria related to images
  • An inferior image quality, however, cannot be
    justified unless this has been intentionally
    designed and must then be associated with a lower
    radiation dose
  • The fact that the X Ray was taken from a
    non-cooperative pediatric patient (anxious,
    crying, heavily resisting) is not an excuse for
    producing an inferior quality film which is often
    associated with an excessive dose

37
Criteria for Radiation Dose to the Patient
  • Expressed in terms of a reference value for the
    entrance surface dose for a standard sized
    pediatric patient
  • Reference dose values are available only for the
    most frequently performed types of radiographs
    for which sufficient data were acquired in a
    series of European Trials on infants, 5 year old
    and 10 year old patients

38
Criteria for Radiation Dose to the Patient
  • The assessment of compliance with the criteria
    for radiation dose to the patient for a specific
    radiograph unavoidably involves some form of dose
    measurement
  • This requires representative sampling of the
    patient population
  • A number of dose measurements methods are
    described in the European Guideline

39
General principles associated with good imaging
performance
  • Image Annotation
  • The patient identification, the date of
    examination, positional markers and the name of
    the facility must be present and legible on the
    film
  • These annotations should not obscure the
    diagnostically relevant regions of the radiograph
  • An identification of the radiographers on the
    film would also be desirable

40
General principles associated with good imaging
performance
  • Quality Control of X Ray Imaging Equipment
  • Quality control programs should be instigated in
    every medical X Ray facility and should cover a
    selection of the most important physical and
    technical parameters associated with the types of
    X Ray examination being carried out
  • Limiting values for these technical parameters
    and tolerances on the accuracy of their
    measurement should be required

41
General principles associated with good imaging
performance
  • Low Attenuation Materials
  • Recent developments in materials for cassettes,
    grids, tabletops and front plates of
    film-changers using carbon fiber and some new
    plastics enable significant reduction in patient
    doses
  • This reduction is most significant in the
    radiographic-voltage range recommended in
    pediatric patients and may reach 40. Use of
    these materials should be encouraged

42
General principles associated with good imaging
performance
  • Patient Positioning and Immobilization
  • Patient positioning must be exact whether or not
    the patient co-operates.
  • In infants, toddlers and younger children
    immobilization devices, properly applied, must
    ensure that
  • the patient does not move
  • the beam can be centered correctly
  • the film is obtained in the proper projection
  • accurate collimation limits the field size
    exclusively to the required area
  • shielding of the remainder of the body is
    possible.

43
General principles associated with good imaging
performance
  • Patient Positioning and Immobilization

44
General principles associated with good imaging
performance
  • Patient Positioning and Immobilization

45
General principles associated with good imaging
performance
  • Patient Positioning and Immobilization

46
General principles associated with good imaging
performance
  • Patient Positioning and Immobilization

47
General principles associated with good imaging
performance
  • Patient Positioning and Immobilization
  • Immobilization devices must be easy to use, and
    their application atraumatic to the patient.
  • Their usefulness should be explained to the
    accompanying parent(s).
  • Radiological staff members should only hold a
    patient under exceptional circumstances
  • Even in quite young children the time allocation
    for an examination must include the time to
    explain the procedure not only to the parents but
    also to the child

48
General principles associated with good imaging
performance
  • Field Size and X Ray Beam Limitation
  • Inappropriate field size is the most important
    fault in pediatric radiographic technique
  • A field which is too small will immediately
    degrade the respective image criteria
  • A field which is too large will not only impair
    image contrast and resolution by increasing the
    amount of scattered radiation but also, most
    importantly, result in unnecessary irradiation of
    the body outside the area of interest

49
General principles associated with good imaging
performance
  • Field Size and X Ray Beam Limitation
  • Correct beam limitation requires proper knowledge
    of the external anatomical landmarks by the
    technician
  • These differ with the age of the patient
    according to the varying proportions of the
    developing body.
  • In addition, the size of the field of interest
    depends much more on the nature of the underlying
    disease in infants and younger children than in
    adults

50
General principles associated with good imaging
performance
  • Field Size and X Ray Beam Limitation
  • A basic knowledge of pediatric pathology is
    required for radiographers and other technical
    assistants to ensure proper beam limitation in
    these age groups
  • The acceptable minimal field size is set by the
    listed recognizable anatomical landmarks for
    specific examinations

51
General principles associated with good imaging
performance
  • Field Size and X Ray Beam Limitation
  • Beyond the neonatal period, the tolerance for
    maximal field size should be less than 2 cm
    greater than the minimal
  • In the neonatal period, the tolerance level
    should be reduced to 1.0 cm at each edge

52
General principles associated with good imaging
performance
  • Field Size and X Ray Beam Limitation
  • In pediatric patients, evidence of the field
    limits should be apparent by clear rims of
    unexposed film
  • Beam-limiting devices automatically adjusting the
    field to the full size of the cassette are
    inappropriate for pediatric patients
  • Discrepancies between the radiation beam and the
    light beam must be avoided by regular assessment

53
General principles associated with good imaging
performance
  • Additional filtration
  • The soft part of the radiation spectrum which is
    absorbed in the patient is useless for the
    production of the radiographic image and
    contributes unnecessarily to the patient dose
  • Part of it is eliminated by the filtration of the
    tube, tube housing, collimator etc., but this is
    insufficient
  • Most tubes have a minimum filtration of 2.5 mm
    Al
  • Additional filtration can further reduce
    unproductive radiation and thus patient dose

54
General principles associated with good imaging
performance
  • Additional filtration
  • For pediatric patients, total radiation dose must
    be kept low, particularly when high speed screen
    film systems or image intensifying techniques are
    used
  • Not all generators allow the short exposure
    times that are required for higher kV technique
  • Low radiographic voltage is frequently used for
    pediatric patients. This results in comparatively
    higher patient doses.

55
General principles associated with good imaging
performance
  • Additional filtration
  • Adequate additional filtration allows the use of
    higher radiographic voltage with the shortest
    available exposure times, thus overcoming the
    limited capability of such equipment for short
    exposures
  • This makes the use of high speed screen film
    systems and image intensifier photography possible

56
General principles associated with good imaging
performance
  • Protective Shielding
  • For all examinations of pediatric patients, the
    examples for Good Radiographic Technique
    include standard equipment of lead-rubber
    shielding of the body in the immediate proximity
    of the diagnostic field
  • Special shielding has to be added for certain
    examinations to protect against external
    scattered and extra-focal radiation

57
General principles associated with good imaging
performance
  • Protective Shielding
  • For exposures of 60 - 80 kV, maximum gonadal dose
    reduction of about 30 to 40 can be obtained by
    shielding with 0.25 mm lead equivalent rubber
    immediately at the field edge
  • However, this is only true when the protection is
    placed correctly at the field edge

58
General principles associated with good imaging
performance
  • Protective Shielding
  • The gonads in "hot examinations", i.e. when they
    lie within or close (nearer than 5 cm) to the
    primary beam, should be protected whenever this
    is possible without impairing necessary
    diagnostic information
  • It is best to make one's own lead contact
    shields for girls and lead capsules for boys
  • They must be available in varied sizes

59
General principles associated with good imaging
performance
  • Protective Shielding
  • By properly adjusted capsules, the absorbed dose
    in the testes can be reduced by up to 95
  • In girls, shadow masks within the diaphragm of
    the collimator are as efficient as direct
    shields. They can be more exactly positioned and
    do not slip as easily as contact shields
  • When shielding of the female gonads is
    effective, the reduction of the absorbed dose in
    the ovaries can be about 50

60
General principles associated with good imaging
performance
  • Protective Shielding
  • There is no reason to include the male gonads in
    the scrotum within the primary radiation field
    for radiographs of the abdomen
  • The same applies, usually, for films of the
    pelvis and micturating cystourethrographies. The
    tests should be protected with a lead capsule,
    but kept outside the field
  • In abdominal examinations gonad protection for
    girls is not possible

61
General principles associated with good imaging
performance
  • Protective Shielding
  • In practice, the great majority of pelvic films
    show that female gonad protection is completely
    ineffective
  • The position of all sorts of lead material is
    often ludicrous
  • There are justifiable reasons for omitting gonad
    protection for pelvic films in girls, e.g.
    trauma, incontinence, abdominal pain, etc

62
General principles associated with good imaging
performance
  • Protective Shielding
  • The eyes should be shielded for X Ray
    examinations involving high absorbed doses in the
    eyes, e.g. for conventional tomography of the
    petrous bone, when patient cooperation permits
  • The absorbed dose in the eyes can be reduced by
    50 - 70
  • In any radiography of the skull the use of
    PA-projection rather than the AP-projection can
    reduce the absorbed dose in the eyes by 95

63
General principles associated with good imaging
performance
  • Protective Shielding
  • PA-projection, therefore, should be preferred as
    soon as patient age and co-operation permit prone
    or erect positioning
  • As developing breast tissue is particularly
    sensitive to radiation, exposure must be limited
  • The most effective method is by using the
    PA-projection, rather than the AP

64
General principles associated with good imaging
performance
  • Protective Shielding
  • While this is well accepted for chest
    examinations, the greatest risk is during spinal
    examinations, and here PA examinations must
    replace AP
  • It should also be remembered that thyroid tissue
    should be protected, whenever possible, e.g.
    during dental and facial examinations

65
General principles associated with good imaging
performance
  • Radiographic Exposure Conditions
  • Knowledge and correct use of appropriate
    radiographic exposure factors, e.g. Radiographic
    voltage, nominal focal spot value, filtration,
    film-focus distance is necessary because they
    have a considerable impact on patient doses and
    image quality
  • Permanent parameters of the apparatus such as
    total tube filtration and grid characteristics
    should also be taken into consideration

66
General principles associated with good imaging
performance
  • Automatic Exposure Control
  • Adult patients vary in size, but their variation
    is minimal compared to the range in pediatric
    patients from premature infants, weighing
    considerably less than a thousand grams, to
    adolescents approaching 70 kg
  • Those investigating pediatric patients must be
    able to adapt to this range. One would expect
    that a device for automatic exposure control
    (AEC) would be helpful

67
General principles associated with good imaging
performance
  • Automatic Exposure Control
  • Many of the AEC systems commonly available are
    not satisfactory
  • They have relatively large and fixed ionization
    chambers. Neither their size nor their shape nor
    their position is able to compensate for the many
    variations of body size and body proportion in
    pediatric patients
  • In addition, the usual ionization chambers of
    AECs are built in behind a grid

68
General principles associated with good imaging
performance
  • Automatic Exposure Control
  • AEC-use may be associated with the use of the
    grid (where the grid is not removable) which is
    frequently unnecessary
  • The optimal adaptation of the radiographic
    technique to the clinical needs requires the use
    of screen film systems of different speeds and
    different switch-off doses at the image receptor

69
General principles associated with good imaging
performance
  • Automatic Exposure Control
  • Screens and AEC chambers are wavelength
    dependant, particularly in the lower range of
    radiographic voltage, but these dependencies do
    not correspond with each other
  • AECs lengthen the minimal exposure times
  • All these factors must be considered when AECs
    are used in pediatric patients

70
General principles associated with good imaging
performance
  • Automatic Exposure Control
  • Specially designed pediatric AECs have a small
    mobile detector for use behind a lead-free
    cassette
  • Its position can be selected with respect to the
    most important region of interest
  • This must be done extremely carefully, as even
    minor patient movement may be disastrous

71
General principles associated with good imaging
performance
  • Automatic brightness control
  • Automatic brightness control (ABC) has to be
    switched off during fluoroscopic examinations
    where there are relatively large areas of
    positive contrast material to avoid excessive
    dose rates, e.g. full bladders

72
Guidance on implementation of quality criteria
  • Quality Criteria are presented for a number of
    selected radiographic projections used in the
    course of routine types of X Ray examination
  • They apply to pediatric patients with the usual
    presenting symptoms for the type of examination
    being considered
  • They are to be used by radiologists,
    radiographers, and medical physicists as a check
    on the routine performance of the entire imaging
    process

73
Guidance on implementation of quality criteria
  • However, the Quality Criteria cannot be applied
    to all cases
  • For certain clinical indications lower level of
    image quality may be acceptable, but this should
    ideally always be associated with a lower
    radiation dose to the patient

74
Guidance on implementation of quality criteria
Under no circumstances should an image which
fulfils all clinical requirements but does not
meet all image criteria ever be rejected
75
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Diagnostic Reference Doses in Pediatrics
Examples of Diagnostic Reference Doses in
Pediatrics, for standard five-year-old patients,
expressed in entrance surface dose per image, for
single views (from EUR-16261)
78
Diagnostic Reference Doses in Pediatrics
Examples of Diagnostic Reference Doses in
Pediatrics, for standardfive-year-old patients,
expressed in entrance surface dose per image,for
single views (from EUR-16261)
79
Part 14.1 Optimization of Protection in
Pediatric Radiology
IAEA Training Material on Radiation Protection in
Diagnostic and Interventional Radiology
  • Topic 3 Recommendations for X Ray room and
    equipment

80
Recommendations for X Ray room and equipment to
be used in pediatrics
  • Visibility of the patient and easy audio
    communication from the control panel
  • High frequency generators of 600-800 mA with
    linearity from 50 until 120-150 kV
  • Exposures of 3 ms should be possible. AEC devices
    should be specifically adapted
  • Different control for the anode rotation and
    exposure (specially important for chest
    examinations to avoid respiratory movement)

81
Recommendations for X Ray room and equipment to
be used in pediatrics
  • Low absorption materials and plastic cassettes
    should be used
  • Antiscatter grid should be removable
  • When using the grid, this should be Fixed
    (specific for pediatric) or with very fast
    movement due to the short exposure times
  • Image intensifier (I.I.) of 15 cm can be the
    appropriate size for small patients. Higher sizes
    or multimode I.I. can produce worse images

82
Recommendations for X Ray room and equipment to
be used in pediatrics
  • The use of additional filtration should be
    considered in pediatric X Ray equipment
  • Mobile X Ray system for pediatrics should have
    the highest possible output
  • Immobilization devices should be available in
    pediatric rooms

83
References
  • European Guidelines on Quality Criteria for
    Diagnostic Radiographic Images in Paediatrics,
    July 1996. EUR 16261. Available at
    http//www.cordis.lu/fp5-euratom/src/lib_docs.htm
  • ICRP Publication 34, Protection of the Patient in
    Diagnostic Radiology. Annals of the ICRP (2/3)
    1982.
  • NCRP 68. Radiation protection in pediatric
    radiology, 1981.

84
References
  • Cook JV, Shah K, Pablot S, Kyriou J, Pettet A,
    Fitzgerald M. Guidelines of best practice in the
    X-ray imaging of children. Edited by the Queen
    Marys Hospital of Children. London 1998.
  • Guidelines on education and training in radiation
    protection for medical exposures. Radiation
    Protection 116. European Commission 2000.
    Available at http//europa.eu.int/comm/environmen
    t/radprot

85
References
  • Guidance on diagnostic reference levels (DRLs)
    for medical exposures. Radiation Protection 109.
    European Commission 1999. Available at
    http//europa.eu.int/comm/environment/radprot
  • Rational use of diagnostic imaging in pediatrics.
    WHO, 1987.

86
Summary
  • Particular attention should be given to technical
    specifications of X Ray equipments and protocols
    used in X Ray pediatric radiology.
  • Radiologists and radiographers should be
    specifically trained and the higher
    radiosensitivity of the patients should be taken
    into account.
  • General rules of protection and guidelines are
    presented.
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