Paeds Vivas · investigations-procedures-and-technology
Radiation protection and imaging stewardship — branching viva
Branching viva on the three pillars of radiological protection, the linear-no-threshold paediatric risk model, the CT and fluoroscopy dose quantities and the diagnostic reference level, the optimisation levers, the modern gonadal-shielding guidance, and the counselling of a parent about radiation risk and consent for imaging.
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Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A 6-year-old oncology patient is being followed with serial surveillance CT. The examiner asks you to state the principles of radiation protection that govern his imaging, to quantify and defend the radiation risk to his anxious parent, to advise on whether a multiphase surveillance CT is justified, and to explain why the department is phasing out routine gonadal shielding.
Opening question
This child has had several surveillance CT scans and is due for another. Give me the three pillars of radiological protection, and tell me which of them applies to a patient investigation and which does not — and why. [8]
References6ShowHide
- [1]Pearce MS, Salotti JA, Little MP, et al Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study Lancet, 2012.PMID 22681860
- [2]Meulepas JM, Ronckers CM, Smets AMJB, et al Radiation Exposure From Pediatric CT Scans and Subsequent Cancer Risk in the Netherlands J Natl Cancer Inst, 2019.PMID 30020493
- [3]Brenner DJ, Hall EJ Computed tomography--an increasing source of radiation exposure N Engl J Med, 2007.PMID 18046031
- [8]Frush DP, Frush KS The ALARA concept in pediatric imaging: building bridges between radiology and emergency medicine Pediatr Radiol, 2008.PMID 18810422
- [10]Kanal KM, Butler PF, Chatfield MB, et al U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations Radiology, 2022.PMID 34928733
- [12]Thakur Y, Schofield SC, Bjarnason TA, et al Discontinuing Gonadal and Fetal Shielding in X-Ray Can Assoc Radiol J, 2021.PMID 33573394