Image Gently organizers look ahead on 1-year anniversary: Part 1

One year ago, a group of radiology and pediatric organizations launched the Image Gently campaign to raise awareness about pediatric radiation dose during CT scans. Twelve months later, the Alliance for Radiation Safety in Pediatric Imaging has succeeded in taking its message to North American radiologists and is now looking to expand its focus, both internationally and to parents and pediatricians.

In Part 1 of this two-part series of articles, AuntMinnie.com takes a retrospective look at the Image Gently campaign's accomplishments and discusses the project's future. In our next article, we'll detail what major CT manufacturers are doing to implement the campaign's vision of lower, more personalized radiation dose levels for children.

Getting started

Image Gently was the brainchild of a group of pediatric radiologists who had been organizers and presenters at a series of ALARA (as low as reasonably achievable) pediatric imaging seminars sponsored by the Society for Pediatric Radiology (SPR) of Reston, VA. These radiologists were concerned about the escalating use of CT scans for children, with approximately 4 million exams performed in 2006, predominantly by radiology departments that didn't specialize in pediatric imaging.

A major concern was that many pediatric patients were undergoing procedures that utilized adult radiation dose protocols, exposing children to unnecessary radiation. The radiologists saw a need for an education awareness campaign that highlighted concerns about radiation dose, but that didn't discourage the use of CT when medically necessary. They also saw a need for free dissemination of child-specific CT protocols.

To accomplish these goals, the SPR formed the Alliance for Radiation Safety in Pediatric Imaging in 2007. In addition to SPR, other founding members included the American College of Radiology (ACR), the American Society of Radiologic Technologists (ASRT), and the American Association of Physicists in Medicine (AAPM). Imaging vendor GE Healthcare of Chalfont St. Giles, U.K., helped the group get off the ground with an unrestricted educational grant of $30,000.

When the Image Gently campaign was launched in January 2008, nine other organizations had joined the alliance coalition, for a total representation of more than 500,000 medical professionals. More than 2,600 radiology professionals downloaded the pediatric CT protocols during the first week that they were posted.

Image Gently accomplishments

Since it was launched in January 2008, the Image Gently campaign has logged a number of accomplishments in its quest to raise awareness of pediatric radiation dose:

  • Image Gently broadened its focus from the U.S. to North America and is now preparing to go global with an international campaign.
  • The alliance has grown from a coalition of four founding and nine affiliated professional organizations to a total of 34 organizations spanning the globe and including all of the world's professional pediatric imaging societies, collectively representing more than 600,000 medical professionals.
  • The Image Gently pledge has been taken by 2,058 medical professionals. The alliance's free pediatric CT exam protocol has been viewed 10,546 times and downloaded 9,439 times.
  • Image Gently's CT worksheet has been downloaded 2,544 times, and the CT practice standards have been downloaded 1,303 times.
  • The www.imagegently.org Web site has been visited 99,234 times.
  • The U.S. Food and Drug Administration's Center for Devices and Radiological Health (CDRH) issued an advisory to radiology professionals about CT dose for pediatric imaging.
  • The U.S. House of Representatives issued a resolution supporting the Image Gently initiative.
  • CareCore National, a radiology benefits management firm, modified its requirements for pediatric CT imaging to mandate utilization of the protocols recommended by the Image Gently campaign.

Evaluating the accomplishments

The primary objective of the alliance is to change current practice by raising awareness about the need to adjust radiation dose when imaging children, and to provide the tools necessary to achieve this goal, according to Dr. Marilyn Goske, chairman of the alliance and a staff radiologist at the Cincinnati Children's Hospital Medical Center in Ohio.

"Medical professionals all want to do the best for their patients, but they can be overwhelmed by the quantity of information about pediatric imaging published in peer review publications and presented at professional meetings," Goske said. "The Image Gently Web site enables pediatric imaging specialists to offer proven lower-dose CT protocols and practice information to radiologists who don't image a lot of children and want to know what to do. All they have to do is download the information."

Goske attributes continuing interest in the campaign to its practical approach, and the fact that it targets all professionals who have an interest in medical imaging.

"We are thrilled that the professionals supporting this campaign include representatives of the vendor companies that design and manufacture CT equipment; the teams of radiologists, technologists, and medical physicists who acquire the images safely and interpret them accurately; and the pediatricians, nurses, and other healthcare professionals who work with families," Goske said. "This combined approach has been so critical to the success of this project to date."

Dr. Donald Frush, chair of the ACR Pediatric Commission, and chief of pediatric radiology at Duke University Medical Center in Durham, NC, also believes the campaign has made progress so far.

"I think that awareness of the need to use child-friendly pediatric CT protocols has increased significantly in the past year," Frush said. "If only 10% of the hospitals whose radiologists or technologists downloaded the protocols from the Web site have changed their practices, this still represents a substantial change in the pattern of pediatric imaging," Frush said.

He noted that an encouraging number of radiologists have personally contacted Duke's pediatric team to request its protocols or answers to questions about reducing CT radiation dose.

In part because of the Image Gently campaign, residents are learning proper techniques from the outset, according to Dr. Marla Hernanz-Schulman, chair of the SPR and a professor of diagnostic imaging at Vanderbilt Children's Hospital in Nashville, TN. She pointed out that there are not as many pediatric subspecialists as there should be, but that the Image Gently campaign offered immediately accessible protocols to any radiologist or technologist in the world.

Global expansion

Although Image Gently began as a U.S. campaign, the steering committee of the alliance felt that expanding the project globally would keep the campaign focused.

While on a sabbatical in Australia, Dr. Kimberly Applegate, professor of radiology and pediatrics at the Indiana University School of Medicine in Indianapolis, discussed the campaign with Australian pediatric radiologists, who convinced the Royal Australian and New Zealand College of Radiologists to join.

"Once efforts were under way, the steering committee thought it would be appropriate to expand our approach to include all the pediatric radiology organizations worldwide," Applegate said. "At our one-year anniversary, all the major pediatric imaging societies in the world, or the organizations in which they are a subgroup, have joined the alliance. Having the global consensus of pediatric imaging organizations is helping to move the Image Gently campaign forward."

Applegate heads the internationalization efforts of the alliance. One of the projects that she hopes will be accomplished in 2009 is the translation into other languages of the Image Gently Web site, particularly the pediatric CT protocols and the medical radiation safety information for parents. International radiologist volunteers meeting at the 2008 RSNA conference offered to provide translations in Arabic, Chinese, French, German, Korean, Portuguese, Spanish, and Turkish. Applegate is seeking translator volunteers for other languages.

Technologists on board

The ASRT has been very involved in promoting the Image Gently campaign to its members, according to ASRT board chairman Connie Mitchell of the University of Nebraska Medical Center's School of Allied Health Professions in Omaha.

"Whole departments report that they are taking the Image Gently pledge, and technologists are very aware that more is not better, meaning that adult-size KV and mAs are not necessary for small bodies," Mitchell said. "Technologists are the front line in the imaging process. We are very aware that we are the patient's advocate and play a major role in educating parents."

At its 2008 annual governance meeting, the ASRT delegates passed a position statement (C-08.01) recommending that CT examinations should employ ALARA principles. The association is working with its members to assist them in implementing the position statement in their individual radiology departments.

Looking ahead

In addition to continuing the pediatric CT dose reduction campaign, the alliance has formed groups to create materials to expand the concept to include computed and digital radiography, fluoroscopy, interventional radiology, and nuclear medicine. These initiatives will be rolled out over the next two years, according to Goske, with the interventional radiology campaign scheduled for late summer or early fall. A computed radiography/digital radiography vendor summit meeting to be held in January 2010 is being planned.

In addition, a major campaign targeted at educating parents and pediatricians was launched this week.

Meanwhile, the ASRT is working on the production of short educational products on pediatric CT dose reduction tips and techniques that will be available free of charge to all technologists. For its part, the alliance is working with vendors on a series of seven teaching modules for CT technologists, representing concise recommendations that can be absorbed in 20 minutes, according to Goske.

The alliance is an all-volunteer group operating on a financial shoestring. It welcomes new volunteers and unrestricted financial contributions. Interested individuals should communicate via the www.imagegently.org Web site.

By Cynthia E. Keen
AuntMinnie.com staff writer
February 6, 2009

Related Reading

AAPM approves Image Gently work group agenda, December 23, 2008

CareCore endorses Image Gently campaign, November 12, 2008

Cincinnati meeting starts long road to harmonize CT dose displays, September 17, 2008

FDA posts pediatric imaging advisory, June 25, 2008

House resolution advocates lower pediatric x-ray dose, May 27, 2008

Copyright © 2009 AuntMinnie.com

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